摘要
目的观察不同充填材料对经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)疗效的影响。方法 OVCF共69例(69椎),均为女性。分成3组:A组23例(23椎),充填材料为聚甲基丙烯酸甲酯骨水泥(PMMA)。B组23例(23椎),充填材料为丙烯酸树脂骨水泥。C组23例(23椎),充填材料为注射型自固化磷酸钙骨水泥(CPC)。手术均在局部麻醉下由同一组医生负责完成。术前骨密度测量(DXA)值为0.62～0.88g/cm2,平均0.72±0.16g/cm2,提示3组均存在重度骨质疏松。比较3组术前、术后1w、术后8w椎体前、中份高度,脊柱后凸角度,主观满意度(VAS评分、止痛药使用评分),骨水泥渗漏率等指标。观察3种充填材料对PKP疗效的影响。结果 3组年龄,术前椎体前、中份高度,脊柱后凸角度,VAS评分,止痛药使用评分均无统计学差异(P>0.05)。术后1w,3组椎体前、中份高度,脊柱后凸角度均较术前有显著改善(P<0.01)。术后8w,C组椎体前、中份高度较术后1w有轻度丢失(P<0.05)。术后1w,3组VAS评分、止痛药使用评分均较术前有不同程度改善(P<0.05),其中A、B组对疼痛改善程度无统计学差异(P>0.05),但均优于C组(P<0.05)。术后8w,3组对疼痛改善程度无统计学差异(P>0.05)。3组术中骨水泥充填量及骨水泥渗漏率无统计学差异(P>0.05)。结论充填材料对PKP治疗OVCF的疗效可能存在一定的影响。PMMA与丙烯酸树脂骨水泥近期止痛效果确切,CPC充填后患者卧床时间相对较长,但远期疗效可能优于前者。
Objective To evaluate the effect of different filling materials on the efficacy of percutaneous kyphoplasty（PKP） for the treatment of patients with osteoporotic vertebral compression fractures（OVCF）.Methods Sixty-nine OVCF female patients were divided into 3 groups.Patients in group A（n=23） were filled with polymethacrylate（PMMA）.Patients in group B（n=23） were filled with acrylic bone cement.And patients in group C（n=23） were filled with calcium phosphate cement（CPC）.The operations were completed by the same team of doctors with local anesthesia.The preoperative bone mineral density values were 0.62-0.88g/cm2 with an average of 0.72±0.16g/cm2,suggesting the existence of severe osteoporosis.The indexes of anterior and middle vertebral body height,kyphosis angle,subjective satisfaction（VAS score and the use of pain-killer scale）,and the incidence of bone cement leakage of the patients in 3 groups were compared before the surgery,1-week after the operation,and 8-week after the operation.The effect of different filling materials on the efficacy of PKP was observed.Results There were no significant differences in the age,preoperative anterior and middle vertebral body height,preoperative thoracolumbar kyphosis angle,VAS score,and the use of pain-killer scale of patients among the 3 groups（P0.05）.At 1 week after the operation,the results of anterior and middle vertebral body height and kyphosis angle of patients in 3 groups were significantly improved compared to the preoperative results（P0.01）.At 8 weeks after the operation,the middle vertebra height of patients in group C was slightly lower than that at 1 week after the operation（P0.05）.At 1 week after the operation,the results of VAS score and the use of pain-killer scale of patients in 3 groups were significantly improved compared to those of pre-operation（P0.05）.The pain relieve of patients in group A and B has no significant difference（P0.05）.However,the efficacy of patients in group A and B was better than that in group C（P0.05）.At 8-week after the operation,the pain relieve of patients in 3 groups has no significant difference（P0.05）.The bone cement amount during operation and bone cement leakage rate has no significant difference（P0.05）.Conclusion Filling materials may have some effects on the efficacy of PKP for the treatment of OVCF.PMMA and acrylic bone cement can definitely relieve pain in the early stage.Patients filled with CPC will have a long time in bed.However,the long term efficacy of CPC may be better than that of PMMA and acrylic bone cement.
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2012年第2期157-161,共5页
Chinese Journal of Osteoporosis
基金
南京市医学科技发展基金资助(QYK09156)
