| 骨水泥弥散类型对治疗骨质疏松性椎体压缩骨折的影响 |
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投稿时间：2016-06-12
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| 作者 | Author | 单位 | Address | E-Mail |
| 赵永生 |
ZHAO Yong-sheng |
青岛市市立医院脊柱外科中心, 山东 青岛 266011 |
Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China |
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| 李强 |
LI Qiang |
青岛市市立医院脊柱外科中心, 山东 青岛 266011 |
Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China |
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| 历强 |
LI Qiang |
青岛市市立医院脊柱外科中心, 山东 青岛 266011 |
Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China |
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| 郑燕平 |
ZHENG Yan-ping |
山东大学齐鲁医院骨科, 山东 济南 250012 |
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zhengspine@163.com |
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| 期刊信息：《中国骨伤》2017年，第30卷，第5期，第446-452页 |
| DOI：10.3969/j.issn.1003-0034.2017.05.011 |
| 基金项目: |
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中文摘要:
目的：观察PVP、PKP及手法复位PVP术后不同骨水泥弥散类型构成及其对老年骨质疏松性椎体压缩骨折治疗效果和骨水泥渗漏率的影响。
方法：对2012年1月至2015年1月采用单侧经皮椎体成形术治疗的老年骨质疏松性椎体压缩骨折病例进行回顾性分析，其中PVP术式56例，男22例，女34例，年龄60～78岁；PKP术式48例，男17例，女31例，年龄61～79岁；手法复位PVP术式43例，男15例，女28例，年龄60～76岁。术后摄正侧位DR片，以AutoCAD图形处理软件计算椎体内骨水泥弥散区面积和团块区面积，然后计算正侧位DR片平均弥散区与平均团块区面积的比值（K），定义K<50%为团块型，50%≤ K ≤100%为混合型，K>100%为弥散型。分析不同椎体成形术式骨水泥弥散类型构成，然后按骨水泥弥散类型分为弥散型、混合型和团块型3组，观察各类型组的视觉模拟评分（VAS）、椎体压缩率、JOA评分以及骨水泥渗漏率等并进行统计学分析。
结果：所有患者获得随访，时间为12～24个月，平均17.2个月。PVP及PKP和手法复位PVP 3种术式的骨水泥弥散类型构成不同（P<0.05），PVP术式弥散型、混合型、团块型构成比分别为46.43%、35.71%和17.86%，PKP术式为16.67%、37.50%和45.83%，手法复位PVP术式为37.21%、44.19%和18.60%. PVP术式以及手法复位PVP术式以弥散型和混合型构成为主，而PKP术式以团块型和混合型构成为主。VAS评分及JOA评分以及骨水泥渗漏率3种弥散类型术后组间比较差异均无统计学意义。椎体压缩率：3种弥散类型术后比较差异有统计学意义（P<0.05），弥散型组术后24 h和末次随访时分别为（17.31±5.06）%和（18.58±4.91）%，混合型组为（14.21±5.15）%和（14.59±5.07）%，团块型组为（13.89±5.02）%和（14.28±4.94）%.
结论：PVP及PKP和手法复位PVP 3种不同术式骨水泥弥散类型构成不同，且团块型与混合型弥散方式较弥散型能更好地恢复压缩椎体的高度，而不同骨水泥弥散方式的中早期疗效差异不明显。 |
| 【关键词】椎体成形术 骨水泥弥散类型 椎体压缩率 骨水泥渗漏 |
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| Effect of different bone cement dispersion types in the treatment of osteoporotic vertebral compression fracture |
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ABSTRACT
Objective: To observe different bone cement dispersion types of PVP,PKP and manipulative reduction PVP and their effects in the treatment of senile osteoporotic vertebral compression fractures and the bone cement leakage rate.
Methods: The clinical data of patients with osteoporotic vertebral compression fractures who underwent unilateral vertebroplasty from January 2012 to January 2015 was retrospectively analyzed. Of them,56 cases including 22 males and 34 females aged from 60 to 78 years old were treated by PVP operation;Fouty-eight cases including 17 males and 31 females aged from 61 to 79 years old were treated by PKP operation;Forty-three cases including 15 males and 28 females aged from 60 to 76 years old were treated by manipulative reduction PVP operation. AP and lateral DR films were taken after the operation;the vertebral bone cement diffusion district area and mass district area were calculated with AutoCAD graphics processing software by AP and lateral DR picture,then ratio(K) of average diffusion area and mass area were calculated,defining K<50% as mass type,50% ≤K ≤100% as mixed type and K>100% as diffusion type. Different bone cement dispersion types of PVP,PKP and manipulative reduction PVP operation were analyzed. According to bone cement dispersion types,patients were divided into diffusion type,mixed type and mass type groups.Visual analogue scale (VAS),vertebral body compression rate,JOA score and bone cement leakage rate were observed.
Results: All patients were followed up for 12-24 months with an average of 17.2 months. There was significant difference in bone cement dispersion type among three groups (P<0.05). The constituent ratio of diffusion type,mixed type and mass type in PVP operation was 46.43%,35.71%,17.86%,in PKP was 16.67%,37.50%,45.83%,and in manipulative reduction PVP was 37.21%,44.19% and 18.60%,respectively. PVP operation and manipulative reduction PVP were mainly composed of diffusion type and mixed type,while PKP was mainly composed of mass type and mixed type. There was no significant difference in VAS score,JOA score and bone cement leakage rate among three groups. There was statistically significant difference in postoperative vertebral body compression rate among three bone cement dispersion types(P<0.05),postoperative vertebral body compression rate in diffusion type group at 24 h postoperatively and final follow-up was (17.31±5.06)% and(18.58±4.91)%,respectively. In mixed type group,it was(14.21±5.15)% and(14.59±5.07)%,respectively. In mass type group,it was(13.89±5.02)% and(14.28±4.94)%,respectively.
Conclusion: Bone cement dispersion type is different in PVP,PKP and manipulative reduction PVP operation. The bone cement dispersion of mass type and mixed type to recovery of compressed vertebral body is better than diffusion type,and there is no obvious difference in clinical effect in different bone cement dispersion type early and middle term. |
| KEY WORDS Vertebroplasty Bone cement dispersion type Vertebral body compression rate Bone cement leakage |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赵永生,李强,历强,郑燕平.骨水泥弥散类型对治疗骨质疏松性椎体压缩骨折的影响[J].中国骨伤,2017,30(5):446~452 |
| 英文格式: | ZHAO Yong-sheng,LI Qiang,LI Qiang,ZHENG Yan-ping.Effect of different bone cement dispersion types in the treatment of osteoporotic vertebral compression fracture[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(5):446~452 |
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