新型骨水泥桥接螺钉系统联合PVP治疗伴IVC的SCOVF患者的效果

Effect of New Type of Bone Cement Bridging Screw System Combined with PVP on SCOVF Patients with IVC

目的:探讨新型骨水泥桥接螺钉系统联合经皮椎体成形术(PVP)治疗伴椎体内真空裂隙(IVC)的症状性陈旧性胸椎骨质疏松性骨折(SCOVF)患者的效果。方法:回顾性分析广西壮族自治区人民医院2018年1月—2020年1月收治的120例伴IVC的SCOVF患者,纳入患者全部为绝经期女性患者,均行新型骨水泥桥接螺钉系统联合PVP治疗,且在手术过程中取骨质测量其骨微结构、骨硬度及弹性模量,以了解人体骨质疏松症发生发展过程中其骨微观结构及其力学特性的变化情况。并观察患者椎体指数(VBI)、椎体角(VBA)、双节段Cobb角(BCA)、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、健康状况及骨水泥移位发生情况。结果:120例患者骨微结构指标骨小梁厚度(Tb.Th)为(0.20±0.05)%,骨体积分数(BV/TV)为(0.19±0.04)%,结构模型指数(SMI)为(1.47±0.09)mm,骨小梁间隔(Tb.Sp)为(0.72±0.03)mm,骨硬度为(0.16±0.03),弹性模量为(1.96±0.05)。术前、术后1 d及术后3年,120例患者的VBI、VBA及BCA比较,差异有统计学意义(P<0.05)。随着时间的延长,患者VAS评分及ODI评分均逐渐降低,且术后3年患者的VAS评分及ODI评分低于术后1 d及术前,术后1 d患者的VAS评分及ODI评分低于术前,差异有统计学意义(P<0.05)。术后3年,120例患者健康调查简表(SF-36)评分均高于术前,差异有统计学意义(P<0.05)。随访3年,120例患者中无人发生骨水泥移位并发症。结论:新型骨水泥桥接螺钉系统联合PVP治疗伴IVC的SCOVF患者固定复位效果满意,疼痛缓解明显,功能恢复良好,术后并无骨水泥异位发生。

Objective:To investigate the efficacy of new type of bone cement bridging screw system combined with percutaneous vertebroplasty(PVP)in the treatment of symptomatic old thoracic osteoporotic fracture(SCOVF)with internal vacuum fissure(IVC).Method:A retrospective analysis was performed on 120 patients with SCOVF accompanied by IVC admitted to Guangxi Zhuang Autonomous Region People's Hospital from January 2018 to January 2020.All the patients were menopausal female patients who received new type of bone cement bridging screw system combined with PVP treatment,and bone microstructure,bone hardness and elastic modulus were measured during the operation,to understand the changes of bone microstructure and mechanical properties during the occurrence and development of human osteoporosis.The vertebral body index(VBI),vertebral angle(VBA),two-level Cobb angle(BCA),visual analogue score(VAS),Oswestry disability index(ODI),health condition and the incidence of bone cement displacement were observed.Result:The bone microstructure index trabecular thickness(Tb.Th)was(0.20±0.05)%,bone volume fraction(BV/TV)was(0.19±0.04)%,structural model index(SMI)was(1.47±0.09)mm,and trabecular interval(Tb.Sp)was(0.72±0.03)mm,bone hardness was(0.16±0.03)and elastic modulus was(1.96±0.05)of 120 patients.VBI,VBA and BCA of 120 patients were compared before surgery,1 d after surgery and 3 years after surgery,and the differences were statistically significant(P<0.05).With the extension of time,the VAS score and ODI score of patients were gradually decreased,and the VAS score and ODI score of patients at 3 years after surgery were lower than those of patients at 1 d after surgery and before surgery,and the VAS score and ODI score of patients at 1 d after surgery were lower than those before surgery,the differences were statistically significant(P<0.05).Three years after surgery,the the MOS item short from health survey(SF-36)scores of 120 patients were higher than those before surgery,the differences were statistically significant(P<0.05).After 3 years of follow-up,none of the 120 patients developed complications of bone cement displacement.Conclusion:The new type of bone cement bridging screw system combined with PVP treatment in SCOVF patients with IVC had satisfactory fixation and reduction results,obvious pain relief,good functional recovery,and no bone cement ectopia occurred after surgery.