摘要
目的比较经皮椎体成形术(percutaneous vertebroplasty, PVP)中采用混合骨水泥[聚甲基丙烯酸甲酯(polymethylmethacrylate, PMMA)∶磷酸钙骨水泥(calcium phosphate cement, CPC)=1∶1]与单独采用PMMA治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)的临床疗效。方法采用病例对照研究的方法,收集2018年1-8月在我科行PVP手术满2年的OVCF患者的临床资料,共69例,其中36例填充物为混合骨水泥(混合组),33例填充物为PMMA(PMMA组)。比较两组患者的一般情况、临床疗效指标[疼痛视觉模拟量表(visual analog scale, VAS)评分和Oswestry功能障碍指数(Oswestry disability index, ODI)评分]、并发症(临近椎体骨折和骨水泥渗漏)以及放射学指标(椎体矢状指数和cobb角)。结果两组患者手术均顺利完成,未出现严重并发症,后期随访未出现严重的后凸畸形。混合组和PMMA组患者在年龄、性别、骨密度、骨折椎体分布情况、手术时间、术中出血量、骨水泥注入量方面差异无统计学意义;两组患者术后疼痛VAS评分、ODI评分较术前均明显下降(P<0.05),各时间点组间差异无统计学意义;在临近椎体骨折的发生方面,混合组低于PMMA组(11.1%vs 30.3%),差异有统计学意义(P=0.048);在骨水泥渗漏方面,混合组的渗漏多于PMMA组(27.8%vs 15.1%),但差异无统计学意义(P=0.204);同时,随访CT发现混合填充物在椎体中有部分被骨组织吸收替代。结论 PVP采用混合骨水泥治疗OVCF安全有效,且混合骨水泥在减少邻近椎体骨折的发生方面更有优势。
Objective To compare the efficacy of percutaneous vertebroplasty(PVP) using polymethyl methacrylate(PMMA)/calcium phosphate cement(CPC)(1∶1) and PMMA alone for osteoporotic vertebral compression fractures(OVCFs). Methods A retrospective case-control study was conducted in 69 OVCFs patients with whole clinical data of 2 year’s follow-up undergoing PVP in our department between January and August 2018. Thirty-six patients received PMMA/CPC(mixed group) and 33 patients PMMA alone(PMMA group). The general and perioperative data, clinical efficacy [visual analog scale(VAS) and Oswestry disability index(ODI)], postoperative complications(cement leakage and incidence of adjacent vertebral fracture within 2 years after operation) and postoperative radiological data(anterior vertebral height and Cobb angle) were compared between the 2 groups. Results The operations were successful among all the patients, and no severe complications or kyphosis occurred. There were no significant differences in age, gender, bone density, distribution of fracture vertebral body, operation time, volume of bleeding, and injection volume of bone cement between the mixed and PMMA groups. The pain VAS score and ODI score were decreased significantly in both groups after operation(P<0.05), and no differences were seen in the scores at each time point between them. The PMMA group had much higher in the incidence of adjacent vertebral failure than the mixed group(30.3% vs 11.1%, P=0.048) during the follow-up. The mixed group had significantly higher incidences of cement leakage(27.8% vs 15.1%), though no statistical difference(P=0.204). The follow-up CT scanning also found that mixed fillers were partially absorbed by bone tissue in the vertebral body. Conclusion Mixed bone cement PMMA/CPC is safe and effective in PVP treatment for OVCFs, and shows better performance in reducing the occurrence of adjacent vertebral fractures than PMMA alone.
作者
邓美超
张红军
张中卒
徐海涛
屈一鸣
廖娟
邵高海
DENG Meichao;ZHANG Hongjun;ZHANG Zhongzu;XU Haitao;QU Yiming;LIAO Juan;SHAO Gaohai(Department of Orthopedic Surgery,Yongchuan Hospital,Chongqing Medical University,Chongqing,402160,China;Laboratory Center,Yongchuan Hospital,Chongqing Medical University,Chongqing,402160,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2021年第7期655-662,共8页
Journal of Third Military Medical University
基金
重庆市科委、卫计委联合重点课题(2018ZDXM009)。
