两种不同注射材料治疗老年骨质疏松性椎体压缩性骨折疗效评价
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摘要
目的评价两种不同注射材料治疗老年骨质疏松性椎体压缩性骨折疗效。方法自2013年1月至2017年1月接受手术治疗的65岁以上老年骨质疏松性椎体压缩性骨折患者84例,注射PMMA传统骨水泥组36例,注射Confidence高粘度骨水泥48例,对两组患者手术前后及末次随访时的VAS评分、椎体前缘高度、伤椎Cobb角变化及ODI功能评分进行比较。结果所有患者均顺利完成手术。随访6-21个月,平均13.5个月。两组患者术后VAS评分及ODI评分同术前相比均有明显改善,具有统计学意义(P<0.05),而末次随访VAS评分及ODI评分同术后相比,无统计学差异(P>0.05);传统骨水泥组术后椎体前缘高度及Cobb角同术前相比无统计学差异(P>0.05),末次随访椎体前缘高度及Cobb角同术后相比亦无统计学差异(P>0.05);高粘度骨水泥组术后椎体前缘高度及Cobb角同术前相比均有明显改善,具有统计学意义(P<0.05),而末次随访椎体前缘高度及Cobb角同术后相比,无统计学差异(P>0.05)。结论 PMMA传统骨水泥和高粘度骨水泥均为治疗老年骨质疏松性椎体压缩性骨折的有效手段,均能快速缓解疼痛,提高患者生活质量,高粘度骨水泥能同时恢复骨折椎体部分高度。
Objective To evaluate the curative effects of two different viscosity bone cements on osteoporotic vertebral compression fractures in the elderly.Methods 84 elderly over 65 years old with osteoporotic vertebral compression fracture treated surgically during the period from Jan.,2013 to Jan.,2017 were enrolled and divided into 2 groups based on the viscosity bone cements selected:PMMA(Polymethacrylates) group(n = 36) and Confidence High-viscosity Bone Cement group(n = 48); the scores of visual analogue scale(VAS),height of vertebral anterior margin,Cobb angle,and Oswestry Disability Index(ODI) before surgery,after surgery and of the last follow-up were compared in all the cases.Results All the surgical treatments were successful; follow-up lasted from 6 to 12 months with the average of 13.5 months; there existed an obvious statistical difference between VAS and ODI scores before surgery and those after surgery in both groups(P<0.05) while no statistical difference between VAS and ODI scores after surgery and those of the last follow-up(P>0.05); the height of vertebral anterior margin and Cobb angle of cases in PMMA group after surgery were of no statistical difference from those before surgery and of the last follow-up(P>0.05); the height of vertebral anterior margin and Cobb angle of cases in Confidence High-viscosity Bone Cement group after surgery were greatly improved than those before surgery(P<0.05) but were of no statistical difference from those of the last follow-up(P>0.05).Conclusions PMMA and Confidence High-viscosity Bone Cement are both effective on osteoporotic vertebral compression fractures in the elderly,they can relieve pain quickly and promote the quality of life of the patients,and Confidence High-viscosity Bone Cement,at the same time,can restore certain height of fractured vertebra.
Objective To evaluate the curative effects of two different viscosity bone cements on osteoporotic vertebral compression fractures in the elderly.Methods 84 elderly over 65 years old with osteoporotic vertebral compression fracture treated surgically during the period from Jan.,2013 to Jan.,2017 were enrolled and divided into 2 groups based on the viscosity bone cements selected:PMMA(Polymethacrylates) group(n = 36) and Confidence High-viscosity Bone Cement group(n = 48); the scores of visual analogue scale(VAS),height of vertebral anterior margin,Cobb angle,and Oswestry Disability Index(ODI) before surgery,after surgery and of the last follow-up were compared in all the cases.Results All the surgical treatments were successful; follow-up lasted from 6 to 12 months with the average of 13.5 months; there existed an obvious statistical difference between VAS and ODI scores before surgery and those after surgery in both groups(P<0.05) while no statistical difference between VAS and ODI scores after surgery and those of the last follow-up(P>0.05); the height of vertebral anterior margin and Cobb angle of cases in PMMA group after surgery were of no statistical difference from those before surgery and of the last follow-up(P>0.05); the height of vertebral anterior margin and Cobb angle of cases in Confidence High-viscosity Bone Cement group after surgery were greatly improved than those before surgery(P<0.05) but were of no statistical difference from those of the last follow-up(P>0.05).Conclusions PMMA and Confidence High-viscosity Bone Cement are both effective on osteoporotic vertebral compression fractures in the elderly,they can relieve pain quickly and promote the quality of life of the patients,and Confidence High-viscosity Bone Cement,at the same time,can restore certain height of fractured vertebra.
引文
[1]CHEN A T,COHEN D B,SKOLASKY R L.Impact of nonoperative treatment,vertebroplasty,and kyphoplasty on survival and morbidity after vertebral compression fracture in the medicare population[J].J Bone Joint Surg Am,2013,95(19):1729-36.
[2]印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.
[3]GOLDSTEIN C L,CHUTKAN N B,CHOMA T J,et al.Management of the Elderly With Vertebral Compression Fractures[J].Neurosurgery,2015,77 Suppl 4(4):S33-45.
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[7]马志锋,凌云,王延涛.经皮椎体成形术和保守疗法治疗老年骨质疏松性胸腰椎压缩性骨折的效果对比[J].中国医学创新,2016,13(18):19-21.
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[10]王佳,周耀,竺智雄,李伟,杨方.PVP和PKP治疗骨质疏松性椎体压缩骨折疗效比较[J].实用骨科杂志,2012,18(10):872-875.
[11]WANG H,SRIBASTAV S S,YE F,et al.Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures:A Meta-analysis of the Literature.[J].Pain Physician,2015,18(3):209-22.
[12]SVEDBOM A,ALVARES L,COOPER C,et al.Balloon kyphoplasty compared to vertebroplasty and nonsurgical management in patients hospitalised with acute osteoporotic vertebral compression fracture:a UK cost-effectiveness analysis.[J].Osteoporos Int,2013,24(1):355-367.
[13]包利,唐海,王炳强,朱富强,董益鹏,邓介超.CPC/PMMA双向骨水泥性能及生物相容性的初步研究[J].中国骨质疏松杂志,2012,18(5):420-424.
[14]葛付涛,牛丰,张新.磷酸钙骨水泥球囊撑开椎体成形术治疗骨质疏松性椎体骨折[J].中国骨伤,2014,27(2):128-132.
[15]赵刚,刘宏建,周英杰.不同充填材料应用于经皮椎体成形术的效果及影像特征[J].中国组织工程研究与临床康复,2010,14(16):3007-3010.
[16]RAPAN S,KRNI C'K,RAPAN V,et al.Application of high viscosity bone cement in vertebroplasty for treatment of painful vertebral body fracture.[J].Medicinski glasnik,2016,13(2):148-53.
[17]WANG C H,MA J Z,ZHANG C C,et al.Comparison of high-viscosity cement vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures[J].Pain Physician,2015,18(2):187-94.
[2]印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.
[3]GOLDSTEIN C L,CHUTKAN N B,CHOMA T J,et al.Management of the Elderly With Vertebral Compression Fractures[J].Neurosurgery,2015,77 Suppl 4(4):S33-45.
[4]董继胜,董力军,闫兵勇.经皮椎体成形术和经皮椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效观察[J].中国矫形外科杂志,2015,23(8):748-751.
[5]SAVAGE J W,SCHROEDER G D,ANDERSON P A.Vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures[J].J Am Acad Orthop Surg,2014,22(10):653-64.
[6]EDIDIN A A,ONG K L,LAU E,et al.Morbidity and Mortality After Vertebral Fractures:Comparison of Vertebral Augmentation and Nonoperative Management in the Medicare Population[J].Spine,2015,40(15):1228-41.
[7]马志锋,凌云,王延涛.经皮椎体成形术和保守疗法治疗老年骨质疏松性胸腰椎压缩性骨折的效果对比[J].中国医学创新,2016,13(18):19-21.
[8]孙阳.经皮穿刺椎体成形术与保守法治疗骨质疏松性椎体压缩性骨折短期疗效对比[J].中国老年医学杂志,2014,34(17):5005-5006.
[9]李山珠,李国华,曾至立,等.椎体后凸成形术和椎体成形术治疗骨质疏松性椎体骨折疗效的对比研究[J].中国骨与关节损伤杂志,2014,29(1):24-26.
[10]王佳,周耀,竺智雄,李伟,杨方.PVP和PKP治疗骨质疏松性椎体压缩骨折疗效比较[J].实用骨科杂志,2012,18(10):872-875.
[11]WANG H,SRIBASTAV S S,YE F,et al.Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures:A Meta-analysis of the Literature.[J].Pain Physician,2015,18(3):209-22.
[12]SVEDBOM A,ALVARES L,COOPER C,et al.Balloon kyphoplasty compared to vertebroplasty and nonsurgical management in patients hospitalised with acute osteoporotic vertebral compression fracture:a UK cost-effectiveness analysis.[J].Osteoporos Int,2013,24(1):355-367.
[13]包利,唐海,王炳强,朱富强,董益鹏,邓介超.CPC/PMMA双向骨水泥性能及生物相容性的初步研究[J].中国骨质疏松杂志,2012,18(5):420-424.
[14]葛付涛,牛丰,张新.磷酸钙骨水泥球囊撑开椎体成形术治疗骨质疏松性椎体骨折[J].中国骨伤,2014,27(2):128-132.
[15]赵刚,刘宏建,周英杰.不同充填材料应用于经皮椎体成形术的效果及影像特征[J].中国组织工程研究与临床康复,2010,14(16):3007-3010.
[16]RAPAN S,KRNI C'K,RAPAN V,et al.Application of high viscosity bone cement in vertebroplasty for treatment of painful vertebral body fracture.[J].Medicinski glasnik,2016,13(2):148-53.
[17]WANG C H,MA J Z,ZHANG C C,et al.Comparison of high-viscosity cement vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures[J].Pain Physician,2015,18(2):187-94.