不同剂量骨水泥经皮椎体后凸成形术治疗胸腰椎骨折的效果及预后比较

Comparison of the effects and prognosis of percutaneous kyphoplasty with different doses of bone cement in the treatment of thoracolumbar fractures

目的分析不同剂量骨水泥经皮椎体后凸成形术治疗胸腰椎骨折的效果及对预后的影响。方法回顾性分析2018年10月~2023年1月在中国人民解放军联勤保障部队第904医院接受经皮椎体后凸成形术治疗的86例患者的病历资料,所有患者均行经皮椎体后凸成形术,根据术中骨水泥注入量分为小剂量组44例和大剂量组42例。术后随访12个月,记录患者的手术时间、X线照射次数、术后住院时间、椎体前缘高度、中部高度、后凸Cobb角度、腰背部疼痛程度、功能障碍指数及并发症。结果小剂量组患者的手术时间短于大剂量组患者,X线照射次数少于大剂量组患者(P<0.05);两组患者的术后住院时间比较差异无统计学意义(P>0.05)。术后6个月,两组患者的椎体前缘高度、中部高度较术前均升高,后凸Cobb角较术前均降低(P<0.05);术前及术后6个月,两组患者的前缘高度、中部高度及后凸Cobb角组间比较差异均无统计学意义(P>0.05)。术前、术后3个月、术后6个月,两组患者的疼痛程度评分组内比较依次降低(P<0.05);术后3个月及术后6个月,小剂量组患者的疼痛程度评分均低于大剂量组(P<0.05)。术前、术后3个月及术后6个月,两组患者的功能障碍指数评分组间比较,差异均无统计学意义(P>0.05);术后3个月,两组患者的功能障碍指数评分较术前均降低(P<0.05);术后6个月,两组患者的功能障碍指数评分均低于术前及术后3个月时的功能障碍指数评分(P<0.05)。小剂量组患者术后骨水泥渗漏发生率低于大剂量组(P<0.05);两组患者发生血肿、临近节段再发骨折的占比无统计学差异(P>0.05)。结论小剂量骨水泥经皮椎体后凸成形术治疗胸腰椎骨折,同样可达到大剂量骨水泥治疗的效果,且更有助于缩短手术时间,降低术后疼痛反应,降低术后骨水泥渗漏的发生风险。

Objective To analyze the effectiveness of percutaneous kyphoplasty with different doses of bone cement in the treatment of thoracolumbar fractures and its impact on prognosis.Methods The clinical data of 86 patients who underwent percutaneous kyphoplasty in the 904th Hospital of the Joint Logistics Support Force of People’s Liberation Army from October 2018 to January 2023 were retrospectively analyzed.All patients underwent percutaneous ky⁃phoplasty,and were divided into low⁃dose group(44 cases)and high⁃dose group(42 cases)according to the amount of bone cement injected during the operation.Followed up for 12 months after surgery,the operation time,number of X⁃ray irradiation,postoperative hospitali⁃zation time,anterior vertebral height,central height,kyphotic Cobb angle,degree of back pain,oswestry disability index,and complications were recorded.Results The operation time of the low⁃dose group was shorter than that of the high⁃dose group,and the number of X⁃ray ir⁃radiation was less than that of the high⁃dose group(P<0.05);There was no statistically sig⁃nificant difference in postoperative hospitalization time between the two groups of patients(P>0.05).Six months after surgery,the anterior and middle heights of the vertebral bodies in both groups of patients increased compared with those before surgery,while the Cobb angle of ky⁃phosis decreased compared with that before surgery(P<0.05);Before and 6 months after sur⁃gery,there was no statistically significant difference in the anterior edge height,middle height,and posterior convex Cobb angle between the two groups of patients(P>0.05).Before surger⁃y,3 months after surgery,and 6 months after surgery,the pain level scores of the two groups of patients decreased sequentially within the group(P<0.05);At 3 months and 6 months after surgery,the pain scores of patients in the low⁃dose group were lower than those in the high⁃dose group(P<0.05).There was no statistically significant difference in the dysfunction in⁃dex scores between the two groups of patients before surgery,3 months after surgery,and 6 months after surgery(P>0.05);At 3 months after surgery,the dysfunction index scores of both groups of patients decreased compared with those before surgery(P<0.05);At 6 months after surgery,the dysfunction index scores of both groups of patients were lower than those be⁃fore and 3 months after surgery(P<0.05).The incidence of postoperative bone cement leak⁃age in the low⁃dose group was lower than that in the high⁃dose group(P<0.05);There was no statistically significant difference in the proportion of hematoma,and adjacent segment re⁃current fractures between the two groups of patients(P>0.05).Conclusion Low⁃dose bone cement percutaneous kyphoplasty for thoracolumbar fractures can also achieve the effect of high⁃dose bone cement treatment,and is more helpful in shortening surgical time,reducing postop⁃erative pain response,and reducing the risk of bone cement leakage after surgery.