不同粘度骨水泥治疗老年性骨质疏松椎体压缩骨折的疗效比较

Comparison of Curative Effect of Different Viscosity Bone Cement on Senile Osteoporotic Vertebral Compression Fracture

摘要: 目的：对比高粘度骨水泥椎体成形术与普通粘度骨水泥椎体后凸成形术治疗骨质疏松性椎体压缩骨折(OVCF)的临床效果。方法：2015年9月~2020年9月对行PVP治疗的60例老年骨质疏松性椎体压缩骨折患者进行前瞻性随机对照研究。将患者随机化分为高粘度组(PVP使用高粘度PMMA骨水泥，30例)和低粘度组(PVP使用低粘度PMMA骨水泥，30例，(其中1例为分别使用高粘度和低粘度水泥注射治疗比较))。两组患者年龄、性别比、体重指数(BMI)及手术节段差异无统计学差异(p > 0.05)。采用视觉模拟量表(VAS)进行疼痛评分，采用0swestry功能障碍指数(ODI)进行脊柱功能评分，观察并比较两组患者的VAS评分、ODI，骨水泥静脉渗漏、椎间盘渗漏、椎旁渗漏等发生情况。结果：60例患者均获随访，随访时间2~5年，两组平均随访时间无统计学差异(P > 0.05)。高粘度组VAS评分由术前8.2 ± 1.2分降低到末次随访时0.4 ± 0.6分，ODI由术前(58.7 ± 17.0)%降低到末次随访时(7.9 ± 4.6)%；低粘度组VAS评分由术前8.2 ± 1.4分降低到末次随访时0.8 ± 0.8分，ODI由术前(66.7 ± 11.5)%降低到末次随访时(8.4 ± 7.3)% (p < 0.05)。高粘度组骨水泥渗漏率(7.2%)明显低于低粘度组(36.3%)，p < 0.05。结论：采用高粘度骨水泥椎体成形术治疗OVCF，不仅可以达到与普通骨水泥椎体后凸成形术相同的临床效果，还可以一定程度上减少椎间盘渗漏率、椎旁渗漏率，减少X线暴露时间及手术时间。

Abstract: Objectives: To compare the clinical effect of high viscosity cemented vertebroplasty with normal viscosity cemented kyphoplasty in the treatment of osteoporotic vertebral ompression fracture (OVCF). Methods: From Sep. 2015~Sep. 2020, 60 patients with OVCF were enrolled in this study. The patients were randomized into the high-viscosity group (high-viscosity bone cement, 30 patients) and the low-viscosity group (low-viscosity bone cement, 30 patients, one case was treated with high viscosity cement injection and low viscosity cement injection). There was no significant difference in age, gender, BMI or the number of segments between the two groups (p > 0.05). Clinical outcomes were assessed in terms of back pain visual analogue scale (VAS) and 0swestIy disability index (ODI) after surgery. The outcomes of back pain VAS score, ODI, venous leakage rate, discoidal leak rate, rate of amund vertebral body were compared between two groups. Results: All of the 60 patients were followed up for 2~5 years, and there was no statistical difference in the mean follow-up time between the two groups (p > 0.05). In the high viscosity group, the VAS score decreased from 8.2 ± 1.2 before operation to 0.4 ± 0.6 at the last follow-up, and ODI decreased from (58.7 ± 17.0)% before operation to (7.9 ± 4.6)% at the last follow-up. In the low viscosity group, the VAS score decreased from 8.2 ± 1.4 points preoperatively to 0.8 ± 0.8 points at the last follow-up, and ODI decreased from (66.7 ± 11.5)% preoperatively to (8.4 ± 7.3)% at the last follow-up (p < 0.05). The leakage rate of bone cement vein in high viscosity group (7.2%) was significantly lower than that in low viscosity group (36.3%), p < 0.05. Conclusion: The use of high viscosity bone cement vertebroplasty in the treatment of OVCF can not only achieve the same clinical effect as conventional bone cement kyphoplasty, but also reduce the rate of intervertebral disc leakage and paraspinal leakage, and reduce the X-ray exposure time and operation time to a certain extent.