高黏度骨水泥弥散程度对老年女性骨质疏松椎体压缩性骨折治疗效果的影响
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摘要
背景:高黏度骨水泥是在传统聚甲基丙烯酸甲酯的基础上改进得到,具有可注射时间长、黏度高、聚合温度低等特点,进一步增加了椎体成形手术的安全性。目的:分析椎体成形治疗老年女性骨质疏松椎体压缩性骨折中高黏度骨水泥弥散程度对临床疗效的影响。方法:纳入120例女性首次、单一节段骨质疏松椎体压缩性骨折患者,年龄53-83岁,均进行高黏度骨水泥椎体成形手术。根据术后侧位X射线片将骨水泥弥散至上下终板两侧的患者记为A组(n=54),其他患者记为B组(n=66);根据CT横断位骨水泥弥散情况,将A组中均匀弥散至双侧椎弓根的患者记为Ⅰ度,其他患者记为Ⅱ度。术后所有患者均随访6个月以上,对比各组末次随访的椎体前缘高度恢复率、局部后凸角改善率、目测类比评分与Oswestry功能障碍指数评分。结果与结论:(1)A组末次随访的椎体前缘高度恢复率、末次随访局部后凸角改善率均高于B组(P <0.05);(2)末次随访时,A、B组目测类比评分与Oswestry功能障碍指数评分均较治疗前明显改善(P <0.05),两组间比较差异无显著性意义(P> 0.05);(3)Ⅰ度组与Ⅱ度组末次随访的椎体前缘高度恢复率、局部后凸角改善率比较差异均无显著性意义(P> 0.05);(4)A组中骨水泥渗漏9例,术后发热4例,低血压2例;B组中骨水泥渗漏8例,发热6例,术后血压升高2例,术后皮肤浅层渗液1例,两组间不良反应发生情况比较差异无显著性意义(P> 0.05);(5)结果表明,高黏度骨水泥椎体成形治疗老年女性单节段骨质疏松椎体压缩性性骨折疗效肯定,骨水泥弥散程度愈高临床疗效愈佳,但高黏度骨水泥的注入要适量,过多的弥散会增加渗漏风险。
BACKGROUND: High-viscosity bone cement is modified on the basis of traditional polymethylmethacrylate with the long injection time, high-viscosity and low polymerized temperature feature and further improves the safety of percutaneous vertebroplasty. OBJECTIVE: To analyze the effect of high-viscosity bone cement dispersion on the clinical outcomes in elderly female patients with osteoporotic vertebral compression fracture who have undergone percutaneous vertebroplasty. METHODS: Totally 120 elderly female patients with primary single-segmental osteoporotic vertebral compression fracture aged from 53 to 83 years were included, and percutaneous vertebroplasty with high-viscosity bone cement was performed in all the enrolled patients. The patients were assigned into two groups according to the bone cement dispersion shown on the lateral X-ray film. The bone cement dispersed to both endplates in the fractured vertebral bodyof 54 patients, who were marked as group A, and the other 66 patients were classified as group B. The group A patients were further divided into two subgroups in term of CT cross-sectional image, and the patients with the bone cement dispersing to the bilateral pedicles were taken as degree I(25 patients) and the others were termed as degree II(29 patients). All patients were followed up for more than 6 months, and the recovery rate of anterior height of the vertebra, local kyphosis angle improvement rate, visual analog scale scores and Oswestry dysfunction index score at the last follow-up were compared among groups. RESULTS AND CONCLUSION:(1) The recovery rate of anterior height of the vertebra and local kyphosis angle improvement rate in group A were better than those in group B at the last follow-up(P < 0.05).(2) The visual analog scale scores and Oswestry dysfunction index scores in both A and B groups were significantly improved at the last follow-up compared to the baseline data(P < 0.05), but there was no significant difference between the two groups(P > 0.05).(3) The subgroups of degree I and II showed no significant difference in the recovery rate of anterior height of the vertebra and local kyphosis angle improvement rate at the last follow-up(P > 0.05).(4) There were nine patients with bone cement leakage, four patients with postoperative fever, two patients with low blood pressure in group A and eight patients with bone cement leakage, six patients with postoperative fever, two patients with high blood pressure, one patient with superficial skin infection in group B, but there was no significant difference in the postoperative complications between the two groups(P > 0.05). All the results suggest that percutaneous vertebroplasty with high-viscosity bone cement has positive efficacy in treating elderly women with single-segmental osteoporotic vertebral compression fracture. The better dispersion of bone cement in the fractured vertebrae indicates the better clinical effects. However, high-viscosity bone cement should be injected in an appropriate amount, as excessive dispersion will increase the risk of leakage.
BACKGROUND: High-viscosity bone cement is modified on the basis of traditional polymethylmethacrylate with the long injection time, high-viscosity and low polymerized temperature feature and further improves the safety of percutaneous vertebroplasty. OBJECTIVE: To analyze the effect of high-viscosity bone cement dispersion on the clinical outcomes in elderly female patients with osteoporotic vertebral compression fracture who have undergone percutaneous vertebroplasty. METHODS: Totally 120 elderly female patients with primary single-segmental osteoporotic vertebral compression fracture aged from 53 to 83 years were included, and percutaneous vertebroplasty with high-viscosity bone cement was performed in all the enrolled patients. The patients were assigned into two groups according to the bone cement dispersion shown on the lateral X-ray film. The bone cement dispersed to both endplates in the fractured vertebral bodyof 54 patients, who were marked as group A, and the other 66 patients were classified as group B. The group A patients were further divided into two subgroups in term of CT cross-sectional image, and the patients with the bone cement dispersing to the bilateral pedicles were taken as degree I(25 patients) and the others were termed as degree II(29 patients). All patients were followed up for more than 6 months, and the recovery rate of anterior height of the vertebra, local kyphosis angle improvement rate, visual analog scale scores and Oswestry dysfunction index score at the last follow-up were compared among groups. RESULTS AND CONCLUSION:(1) The recovery rate of anterior height of the vertebra and local kyphosis angle improvement rate in group A were better than those in group B at the last follow-up(P < 0.05).(2) The visual analog scale scores and Oswestry dysfunction index scores in both A and B groups were significantly improved at the last follow-up compared to the baseline data(P < 0.05), but there was no significant difference between the two groups(P > 0.05).(3) The subgroups of degree I and II showed no significant difference in the recovery rate of anterior height of the vertebra and local kyphosis angle improvement rate at the last follow-up(P > 0.05).(4) There were nine patients with bone cement leakage, four patients with postoperative fever, two patients with low blood pressure in group A and eight patients with bone cement leakage, six patients with postoperative fever, two patients with high blood pressure, one patient with superficial skin infection in group B, but there was no significant difference in the postoperative complications between the two groups(P > 0.05). All the results suggest that percutaneous vertebroplasty with high-viscosity bone cement has positive efficacy in treating elderly women with single-segmental osteoporotic vertebral compression fracture. The better dispersion of bone cement in the fractured vertebrae indicates the better clinical effects. However, high-viscosity bone cement should be injected in an appropriate amount, as excessive dispersion will increase the risk of leakage.
引文
[1]李祖浩,王辰宇,王中汉,等.骨质疏松性骨缺损的治疗进展:支架植入与局部药物递送[J].中国组织工程研究,2018,22(18):2939-2945.
[2]Anne RC,Dolores MS.Osteoporosis Therapy in Postmenopausal Women with High Risk of Fracture.JAMA.2016;316(7):715-716.
[3]刘韵婷,郭辉,张一民.骨骼肌含量、身体活动水平与骨密度的相关性[J].中国组织工程研究,2018,22(16):2478-2482.
[4]Orchard T,Yildiz V,Steck SE,et al.Dietary Inflammatory Index,Bone Mineral Density,and Risk of Fracture in Postmenopausal Women:Results from the Women's Health Initiative.J Bone Miner Res.2017;32(5):1136-1146.
[5]Yang EZ,Xu JG,Huang GZ,et al.Percutaneous Vertebroplasty Versus Conservative Treatment in Aged Patients With Acute Osteoporotic Vertebral Compression Fractures:A Prospective Randomized Controlled Clinical Study.Spine(Phila Pa 1976).2016;41(8):653-660.
[6]林玉江,林茜,杨利民,等.弯角椎体成形术治疗胸腰椎骨质疏松性椎体压缩骨折的疗效分析[J].中国脊柱脊髓杂志,2017,27(5):423-428.
[7]Corcos G,Dbjay J,Mastier C,et al.Cement leakage in Percutaneous vertebroplasty for Spinal metastases:a retrospective evaluation of incidence and risk factors.Spine(Phila Pa 1976).2014;39(5):E332-E338.
[8]邹向南.高粘度骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折的椎体高度恢复情况及相关影响因素[J].中国脊柱脊髓杂志,2017,27(11):991-996.
[9]何涛,杨定焯,刘忠厚.骨质疏松症诊断标准的探讨[J].中国骨质疏松杂志,2010,16(2):151-156,104.
[10]杜桂迎,余卫,林强,等.WHO双能X线吸收仪骨质疏松症诊断标准及其相关问题[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(3):330-338.
[11]朱敏,李玉前,王晓东,等.椎体成形中病椎内骨水泥弥散与骨折时间的关系[J].中国组织工程研究,2015,19(52):8391-8395.
[12]李全修,陈晓东,梁鹏展,等.椎体成形术后相邻椎体骨折患者脊柱矢状面参数变化及其临床意义[J].中国骨与关节损伤杂志,2017,32(5):464-467.
[13]周毅,海涌,苏庆军,等.影响椎体后凸成形术椎体高度恢复的相关因素及临床意义[J].中国骨与关节外科,2011,4(4):288-293.
[14]Phillips FM,Ho E,Campbell Hupp M,et al.Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fracture.Spine J.2003;28(19):2260-2265.
[15]Joyce CR,Zutshi DW,Hrubes V,et al.Comparison of fixed interval and visual analogue scales for rating chronic pain.Eur JClin Pharmacol.1975;8(6):415-420.
[16]Roland M,Fairbank J.The Roland Morris disability questionnaire and the Oswestry disability questionnaire.Spine(Phila Pa 1976).2000;25(24):3115-3124.
[17]曾森炎,季卫锋,董玉鹏,等.高粘度与低粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折的Meta分析[J].中国骨与关节损伤杂志,2018,33(3):240-243.
[18]张晓刚,赵希云,宋敏,等.骨质疏松性椎体压缩骨折的生物力学研究进展[J].医用生物力学,2017,32(2):199-204.
[19]朱智敏,钟华,黄艳,等.PVP治疗骨质疏松性椎体压缩骨折预防相邻椎体骨折的随机对照研究[J].中国骨与关节损伤杂志,2016,31(9):919-922.
[20]车晓明,陈亮,顾勇,等.茶多酚治疗骨质疏松症的研究进展[J].中国骨质疏松杂志,2015,21(2):235-240.
[21]Ohtori S,Inoue G,Orita S,et al.Comparison of teriparatide and bisphosphonate treatment to reduce pedicle screw loosening after lumbar spinal fusion surgery in postmenopausal women with osteoporosis from a bone quality perspective.Spine(Phila Pa 1976).2013;38(8):E487-E492.
[22]吕晓双,王晓丽,孙侃,等.老年女性血HCY水平与骨密度的相关性研究[J].中国骨质疏松杂志,2018,24(4):454-457.
[23]Hansen EJ,Simony A,Carreon L,et al.Rate of Unsuspected Malignancy in Patients With Vertebral Compression Fracture Undergoing Percutaneous Vertebroplasty.Spine(Phila Pa 1976).2016;41(6):549-552.
[24]Takahara K,Kamimura M,Moriya H,et al.Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women.BMC Musculoskelet Disord.2016;17:12.
[25]杨惠林,刘昊,殷国勇,等.我国经皮椎体后凸成形术治疗骨质疏松性椎体骨折现状与创新[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(1):12-19.
[26]盛朝辉,李田珂,王健军,等.单侧与双侧穿刺后凸成形术治疗骨质疏松性胸腰椎骨折的比较[J].中国矫形外科杂志,2018,26(12):1094-1097.
[27]张彤童,任龙喜,郭函,等.高粘度骨水泥椎体成形术在骨质疏松性椎体压缩性骨折中临床应用价值研究[J].创伤与急危重病医学,2018,6(2):71-74.
[28]Zhang ZF,Huang H,Chen S,et al.Comparison of high-and low-viscosity cement in the treatment of vertebral compression fractures:A systematic review and meta-analysis.Medicine.2018;97(12):e0184.
[29]Chevalier Y,Pahr D,Charlebois M,et al.Cement distributin,volume,and compliance in vertebroplasty:some answers from an anatomy-based nonlinear finite element study.Spine(Phila Pa 1976).2008;33(16):1722-1730.
[30]田伟,韩骁,刘波,等.经皮椎体后凸成形术后骨水泥分布与手术椎体再骨折的关系[J].中华创伤骨科杂志,2012,14(3):211-215.
[31]唐冲,吴四军,刘正,等.高粘度骨水泥在单侧经皮椎体成形术中的弥散分布特点[J].实用骨科杂志,2017,23(10):884-887.
[32]余博臣,张亮,高梁斌.PVP/PKP术后手术椎体再发骨折的研究进展[J].中国脊柱脊髓杂志,2012,22(2):183-185.
[33]李亮,聂艳,姜保恩,等.经皮椎体成形术后手术椎体再发骨折的相关因素分析[J].实用骨科杂志,2014,20(4):339-343.
[34]梅贤忠,刘修华,甘学文,等.椎体成形术中高粘度骨水泥与普通骨水泥渗漏的比较[J].中国中医骨伤科杂志,2017,25(6):57-60.
[35]王想福,范有福,石瑞芳,等.单侧穿刺椎体后凸成形术骨水泥分布与穿刺角度的关系[J].中国骨伤,2015,28(8):704-707.
[36]Steinmann J,Tingey CT,Cruz G,et al.Biomechanical comparison of unipedicular versus bipedicular kyphoplasty.Spine(Phila Pa1976).2005;30(2):201-205.
[37]左华,黄永辉,李大鹏,等.经皮椎体成形术及经皮后凸成形术治疗老年骨质疏松性椎体压缩性骨折的长期临床疗效比较[J].中国矫形外科杂志,2015,23(22):2021-2025.
[2]Anne RC,Dolores MS.Osteoporosis Therapy in Postmenopausal Women with High Risk of Fracture.JAMA.2016;316(7):715-716.
[3]刘韵婷,郭辉,张一民.骨骼肌含量、身体活动水平与骨密度的相关性[J].中国组织工程研究,2018,22(16):2478-2482.
[4]Orchard T,Yildiz V,Steck SE,et al.Dietary Inflammatory Index,Bone Mineral Density,and Risk of Fracture in Postmenopausal Women:Results from the Women's Health Initiative.J Bone Miner Res.2017;32(5):1136-1146.
[5]Yang EZ,Xu JG,Huang GZ,et al.Percutaneous Vertebroplasty Versus Conservative Treatment in Aged Patients With Acute Osteoporotic Vertebral Compression Fractures:A Prospective Randomized Controlled Clinical Study.Spine(Phila Pa 1976).2016;41(8):653-660.
[6]林玉江,林茜,杨利民,等.弯角椎体成形术治疗胸腰椎骨质疏松性椎体压缩骨折的疗效分析[J].中国脊柱脊髓杂志,2017,27(5):423-428.
[7]Corcos G,Dbjay J,Mastier C,et al.Cement leakage in Percutaneous vertebroplasty for Spinal metastases:a retrospective evaluation of incidence and risk factors.Spine(Phila Pa 1976).2014;39(5):E332-E338.
[8]邹向南.高粘度骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折的椎体高度恢复情况及相关影响因素[J].中国脊柱脊髓杂志,2017,27(11):991-996.
[9]何涛,杨定焯,刘忠厚.骨质疏松症诊断标准的探讨[J].中国骨质疏松杂志,2010,16(2):151-156,104.
[10]杜桂迎,余卫,林强,等.WHO双能X线吸收仪骨质疏松症诊断标准及其相关问题[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(3):330-338.
[11]朱敏,李玉前,王晓东,等.椎体成形中病椎内骨水泥弥散与骨折时间的关系[J].中国组织工程研究,2015,19(52):8391-8395.
[12]李全修,陈晓东,梁鹏展,等.椎体成形术后相邻椎体骨折患者脊柱矢状面参数变化及其临床意义[J].中国骨与关节损伤杂志,2017,32(5):464-467.
[13]周毅,海涌,苏庆军,等.影响椎体后凸成形术椎体高度恢复的相关因素及临床意义[J].中国骨与关节外科,2011,4(4):288-293.
[14]Phillips FM,Ho E,Campbell Hupp M,et al.Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fracture.Spine J.2003;28(19):2260-2265.
[15]Joyce CR,Zutshi DW,Hrubes V,et al.Comparison of fixed interval and visual analogue scales for rating chronic pain.Eur JClin Pharmacol.1975;8(6):415-420.
[16]Roland M,Fairbank J.The Roland Morris disability questionnaire and the Oswestry disability questionnaire.Spine(Phila Pa 1976).2000;25(24):3115-3124.
[17]曾森炎,季卫锋,董玉鹏,等.高粘度与低粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折的Meta分析[J].中国骨与关节损伤杂志,2018,33(3):240-243.
[18]张晓刚,赵希云,宋敏,等.骨质疏松性椎体压缩骨折的生物力学研究进展[J].医用生物力学,2017,32(2):199-204.
[19]朱智敏,钟华,黄艳,等.PVP治疗骨质疏松性椎体压缩骨折预防相邻椎体骨折的随机对照研究[J].中国骨与关节损伤杂志,2016,31(9):919-922.
[20]车晓明,陈亮,顾勇,等.茶多酚治疗骨质疏松症的研究进展[J].中国骨质疏松杂志,2015,21(2):235-240.
[21]Ohtori S,Inoue G,Orita S,et al.Comparison of teriparatide and bisphosphonate treatment to reduce pedicle screw loosening after lumbar spinal fusion surgery in postmenopausal women with osteoporosis from a bone quality perspective.Spine(Phila Pa 1976).2013;38(8):E487-E492.
[22]吕晓双,王晓丽,孙侃,等.老年女性血HCY水平与骨密度的相关性研究[J].中国骨质疏松杂志,2018,24(4):454-457.
[23]Hansen EJ,Simony A,Carreon L,et al.Rate of Unsuspected Malignancy in Patients With Vertebral Compression Fracture Undergoing Percutaneous Vertebroplasty.Spine(Phila Pa 1976).2016;41(6):549-552.
[24]Takahara K,Kamimura M,Moriya H,et al.Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women.BMC Musculoskelet Disord.2016;17:12.
[25]杨惠林,刘昊,殷国勇,等.我国经皮椎体后凸成形术治疗骨质疏松性椎体骨折现状与创新[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(1):12-19.
[26]盛朝辉,李田珂,王健军,等.单侧与双侧穿刺后凸成形术治疗骨质疏松性胸腰椎骨折的比较[J].中国矫形外科杂志,2018,26(12):1094-1097.
[27]张彤童,任龙喜,郭函,等.高粘度骨水泥椎体成形术在骨质疏松性椎体压缩性骨折中临床应用价值研究[J].创伤与急危重病医学,2018,6(2):71-74.
[28]Zhang ZF,Huang H,Chen S,et al.Comparison of high-and low-viscosity cement in the treatment of vertebral compression fractures:A systematic review and meta-analysis.Medicine.2018;97(12):e0184.
[29]Chevalier Y,Pahr D,Charlebois M,et al.Cement distributin,volume,and compliance in vertebroplasty:some answers from an anatomy-based nonlinear finite element study.Spine(Phila Pa 1976).2008;33(16):1722-1730.
[30]田伟,韩骁,刘波,等.经皮椎体后凸成形术后骨水泥分布与手术椎体再骨折的关系[J].中华创伤骨科杂志,2012,14(3):211-215.
[31]唐冲,吴四军,刘正,等.高粘度骨水泥在单侧经皮椎体成形术中的弥散分布特点[J].实用骨科杂志,2017,23(10):884-887.
[32]余博臣,张亮,高梁斌.PVP/PKP术后手术椎体再发骨折的研究进展[J].中国脊柱脊髓杂志,2012,22(2):183-185.
[33]李亮,聂艳,姜保恩,等.经皮椎体成形术后手术椎体再发骨折的相关因素分析[J].实用骨科杂志,2014,20(4):339-343.
[34]梅贤忠,刘修华,甘学文,等.椎体成形术中高粘度骨水泥与普通骨水泥渗漏的比较[J].中国中医骨伤科杂志,2017,25(6):57-60.
[35]王想福,范有福,石瑞芳,等.单侧穿刺椎体后凸成形术骨水泥分布与穿刺角度的关系[J].中国骨伤,2015,28(8):704-707.
[36]Steinmann J,Tingey CT,Cruz G,et al.Biomechanical comparison of unipedicular versus bipedicular kyphoplasty.Spine(Phila Pa1976).2005;30(2):201-205.
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