不同骨水泥弥散程度下骨水泥分布类型对经皮椎体成形术治疗骨质疏松性椎体压缩性骨折疗效的影响

Effect of distribution type of bone cement under different diffusion degrees on therapeutic effect of percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的 分析不同骨水泥弥散程度下骨水泥分布类型对经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)疗效的影响。方法 回顾性分析南方医科大学第七附属医院2021年6月-2022年10月采用PVP治疗的142例OVCF患者资料,参照既往研究中骨水泥弥散程度等级和分布分区方法,将患者分为弥散充分组(n=56)和弥散不良组(n=86)。在手术前后影像学资料上测量并记录术前、术后2 d伤椎前缘高度、伤椎中部高度、伤椎局部后凸Cobb角,并计算手术前后变化值。术前、术后2 d、末次随访时采用疼痛视觉模拟量表(VAS)评分评估疼痛程度,采用Oswestry功能障碍指数(ODI)评估腰椎功能。结果 2组术后VAS评分与ODI较术前明显改善,末次随访时较术后2 d进一步改善,且Ⅰ、Ⅱ、Ⅲ型患者改善情况优于Ⅳ型患者,差异均有统计学意义(P <0.05)。弥散充分组Ⅰ、Ⅲ型患者VAS评分和ODI较弥散不良组改善更明显,差异均有统计学意义(P <0.05)。2组Ⅰ、Ⅱ、Ⅲ型患者术后椎体前缘高度、椎体中部高度改善值优于Ⅳ型患者,差异均有统计学意义(P <0.05)。弥散充分组Ⅳ型患者椎体前缘高度变化值明显高于弥散不足组,差异有统计学意义(P <0.05)。结论 PVP可有效改善OVCF患者疼痛与腰椎功能,且骨水泥灌注越充分、弥散范围越广,治疗效果越好,要尽量避免骨水泥偏心分布且灌注不良的情况。

Objective To analyze the effects of different bone cement distribution types under different diffusion degrees on the therapeutic effect of percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fracture(OVCF).Methods The data of 142 patients with OVCF treated with PVP from June 2021 to October 2022 in the Seventh Affiliated Hospital of Southern Medical University were retrospectively analyzed.Referring to the level and distribution zoning method of bone cement dispersion in previous studies,patients were divided into fully dispersed group(n=56)and poor dispersed group(n=86).The anterior vertebral height,central vertebral height and local kyphotic Cobb angle of the injured vertebra were measured and recorded on the imaging data at pre-operation and postoperative 2 d,and the changing value of the above indexes before and after surgery were calculated.At pre-operation,postoperative 2 d and the final follow-up,pain intensity was assessed by visual analogue scale(VAS)score,and lumbar function was assessed by Oswestry disability index(ODI).ResultsThe VAS scores and ODI in the 2 groups were significantly improved at postoperative 2 d and the final follow-up,and further improved at the final follow-up compared with postoperative 2 d,and the improvement of types I,II,and II patients was better than that of type IV patients,and the differences were statistically significant(P<0.05).The VAS score and ODI of types I and II patients in the fully dispersed group improved more significantly than those in the poor dispersed group,and the differences were statistically significant(P<0.05).The improvement values of anterior vertebral body height and central vertebral body height in 2 groups of types I,II,and II patients were better than those in type IV patients,all with a statistically significant difference(P<0.05).The change of the anterior vertebral body height in type IV patients in the fully dispersed group was significantly higher than that in the poor dispersed group,and the difference was statistically significant(P<0.05).Conclusions PVP can effectively improve pain and lumbar function in OVCF patients,and the more sufficient and extensive the diffusion range of bone cement infusion,the better the treatment effect.It is necessary to avoid eccentric distribution and poor perfusion of bone cement as much as possible.