| 王梦然,傅智轶,王惠东,姚方超,吴玉杰*.不同骨水泥剂量经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折[J].脊柱外科杂志,2020,18(4):217-221,236. |
不同骨水泥剂量经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折  点此下载全文 (Fulltext) |
| 王梦然 傅智轶 王惠东 姚方超 吴玉杰* |
| 上海交通大学医学院附属第九人民医院骨科, 上海 200011 |
| 基金项目：上海市重中之重临床医学中心和重点学科建设项目（2017ZZ01023）；上海市临床重点专科2018年评审项目（shslczdzk00402） |
| DOI：10.3969/j.issn.1672-2957.2020.04.001 |
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| 摘要： |
| 目的 分析比较不同骨水泥剂量在经皮椎体成形术（PVP）治疗骨质疏松性椎体压缩性骨折（OVCF）中的临床疗效。方法 回顾性分析2017年3月—2018年12月收治的95例老年胸腰椎单椎体OVCF患者临床资料，按骨水泥实际注入量分为3组：A组（< 3.5 mL）45例，B组（≥3.5 mL且≤6.0 mL）23例，C组（> 6.0 mL且≤8.5 mL）27例。记录并比较各组骨水泥渗漏情况、伤椎Cobb角、椎体前缘高度比。采用疼痛视觉模拟量表（VAS）评分评估腰背部疼痛情况。结果 3组患者术后2 d和末次随访时VAS评分与术前相比均显著降低，差异有统计学意义（P<0.05）；术后2 d和末次随访时VAS评分A组 > B组 > C组，术后1 h VAS评分A组 < B组 < C组，组间两两比较差异均有统计学意义（P<0.05）。3组患者术后2 d较术前伤椎Cobb角均减小，椎体前缘高度比均增大，但组间两两比较差异无统计学意义（P>0.05）；3组末次随访时较术后2 d伤椎Cobb角均增大，椎体前缘高度比均减小，且组间两两比较差异有统计学意义（P<0.05）。3组患者共38例发生骨水泥渗漏，骨水泥渗漏率为44.7%，其中A组35.6%、B组39.1%、C组48.1%，组间两两比较差异无统计学意义（P>0.05）。3组均未发生继发性骨水泥渗漏或其他严重并发症。结论 一定范围内，注入更大剂量骨水泥可使胸腰椎OVCF患者获得更好的中短期疼痛缓解和影像学指标改善，但术后极短期内腰背痛也更加明显。 |
| 关键词：胸椎 腰椎 骨折，压缩性 骨质疏松 椎体成形术 骨代用品 手术中并发症 |
| Percutaneous vertebroplasty with different doses of bone cement for osteoporotic thoracolumbar vertebralcompression fractures Fulltext |
| WANG Meng-ran FU Zhi-yi WANG Hui-dong YAO Fang-chao WU Yu-jie* |
| Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medecine, Shanghai 200011, China |
| Fund Project: |
| Abstract: |
| Objective To analyze and compare the clinical efficacy of percutaneous vertebroplasty(PVP) for osteoporotic vertebral compression fracture(OVCF) with different doses of bone cement. Methods The clinical data of 95 elderly patients with single-segment thoracolumbar OVCF admitted from March 2017 to December 2018 were retrospectively analyzed. According to the actual injection amount of bone cement,they were divided into 3 groups:group A(< 3.5 mL) 45 cases,group B(≥ 3.5 mL and ≤ 6.0 mL) 23 cases and group C(> 6.0 mL and ≤ 8.5 mL) 27 cases. The leakage of bone cement,Cobb's angle of the injured vertebra and the ratio of vertebra anterior edge height were recorded and compared between the groups. Visual analogue scale(VAS) score was used to assess the relief of low back pain. Results VAS scores were significantly lower at postoperative 2 d and the final follow-up than pre-operation in the 3 groups(P<0.05). VAS scores in groups A,B and C were decreased successively at postoperative 2 d and the final follow-up(group A > group B > group C),and increased successively at postoperative 1 h(group A < group B < group C),and the pairwise comparison between groups showed statistically significant differences(P<0.05). The Cobb's angle of the injured vertebra decreased and the ratio of vertebra anterior edge height increased at postoperative 2 d compared with pre-operation in the 3 groups,but there was no significant difference in pairwise comparison between groups(P>0.05). At the final follow-up,the Cobb's angle of the injured vertebra increased and the ratio of vertebra anterior edge height decreased in the 3 groups,and the pairwise difference between groups was statistically significant(P<0.05). A total of 38 patients in the 3 groups had bone cement leakage,and the bone cement leakage rate was 44.7%,among which the incidence was 35.6% in group A,39.1% in group B,and 48.1% in group C. There was no significant difference in pairwise comparison between groups(P>0.05). No secondary bone cement leakage or other complications occurred in the 3 groups. Conclusion Within a certain range,patients with OVCF in the thoracolumbar segment could get better pain relief in the short and medium term and better imaging indicators by injecting more bone cement,but the low back pain should be also more obvious in the very short term after operation. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Fractures,compression Osteoporosis Vertebroplasty Bone substitutes Intraoperative complications |
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