PKP术中不同骨水泥填充剂量治疗骨质疏松性椎体压缩骨折的疗效分析

Efficacy analysis of different bone cement filling doses for treating osteoporotic vertebral compression fractures in PKP surgery

目的探讨经皮椎体后凸成型术(PKP)中不同骨水泥填充剂量治疗骨质疏松性椎体压缩骨折(OVCF)的疗效分析。方法选择2021年1月—2022年12月本院收治的OVCF患者63例作为研究对象,根据PKP术中骨水泥填充剂量分为低剂量组(2~3 ml)、常规剂量组(3~5 ml)和高剂量组(6~8 ml)三组,每组各21例。比较三组手术前后疼痛评分、腰椎功能、伤椎高度改善情况及并发症发生率。结果术后7 d、3个月,三组VAS评分、Oswestry功能障碍指数评分均低于术前,差异均具有统计学意义(P<0.05);但术后3个月三组间VAS评分、Oswestry功能障碍指数评分比较,差异均无统计学意义(P>0.05)。术后7 d、3个月,三组椎体前缘高度、椎体中间高度及椎体后缘高度均高于术前,Cobb角低于术前,差异具有统计学意义(P>0.05),但术后各时间点三组伤椎高度、Cobb角比较差异无统计学意义(P>0.05)。低剂量组骨水泥渗漏发生率为4.76%(1/21),常规剂量组为19.05%(4/21),高剂量组为38.10%(8/21),三组骨水泥渗漏发生率比较,差异均具有统计学意义(P<0.05)。结论PKP术中填充不同剂量骨水泥治疗OVCF均可获得满意的临床疗效,能有效缓解患者疼痛,促进椎体功能恢复;但低剂量骨水泥注入在降低骨水泥渗漏发生方面更具优势。

Objective To investigate the efficacy of different cement filling doses in percutaneous kyphoplasty(PKP)for the treatment of osteoporotic vertebral compression fracture(OVCF).Methods 63 patients suffering from OVCF who were admitted to our hospital from January 2021 to December 2022 were selected as study subjects and they were divided into the low-dose group(2~3 ml,21 cases),the regular-dose group(3~5 ml,21 cases)and the high-dose group(6~8 ml,21 cases)according to the filler dosage during PKP.The pain score,lumbar spine function,improvement of the height of injured vertebrae,and the complication rate were compared among the three groups before and after surgery.Results At 7th day and 3 months postoperative,the VAS score and Oswestry dysfunction index score of the 3 groups were significantly lower than those of the preoperative period,and the differences were statistically significant(P<0.05);however,the differences in VAS score and Oswestry dysfunction index score among the three groups were not statistically significant when compared at 3 months postoperative(P>0.05).At 7th day and 3 months postoperative,the height of the anterior vertebral margin,the height of the middle vertebral body and the height of the posterior vertebral body of the 3 groups were significantly higher than those of the preoperative period,and the Cobb angle was significantly lower than that of the preoperative period,and the difference was statistically significant(P>0.05);however,there was no statistically significant difference in comparing the height of the injured vertebrae and the Cobb angle among the 3 groups at all postoperative time points(P>0.05).The incidence of bone cement leakage was 4.76%(1/21)in the low-dose group,19.05%(4/21)in the regular-dose group,and 38.10%(8/21)in the high-dose group,and the difference in the incidence of cement leakage among the three groups was statistically significant when comparing the incidence of cement leakage(P<0.05).Conclusions Intraoperative filling with different doses of bone cement during PKP for the treatment of OVCF can achieve satisfactory clinical efficacy,effectively relieve patients'pain,and promote the recovery of vertebral function;however,low-dose cement injection has more advantageous in reducing the incidence of bone cement leakage.