不同黏度骨水泥治疗骨质疏松性椎体压缩性骨折疗效比较
|
摘要
目的:探讨不同黏度骨水泥治疗骨质疏松性椎体压缩性骨折的临床疗效。方法:选择2016年1月～2018年6月滁州市第一人民医院收治的骨质疏松性椎体压缩性骨折患者90例,按照随机数字表法分为高黏度组42例和低黏度组48例,分别采用高黏度骨水泥经皮椎体后凸成形术和低黏度骨水泥经皮椎体后凸成形术治疗。比较两组单个椎体手术时间、骨水泥注入量、骨水泥渗漏发生情况。所有患者术后随访3个月,比较两组术前、术后3个月疼痛数字评分量表(NRS)评分、Oswestry功能(ODI)评分、椎体中间高度和Cobb角变化。结果:高黏度组单个椎体手术时间少于低黏度组(P<0.05),两组骨水泥注入量、骨水泥弥散体积比较无统计学差异(P>0.05)。高黏度组骨水泥总渗漏率低于低黏度组(P<0.05)。两组患者术前NRS评分、ODI评分、椎体中间高度和Cobb角比较差异无统计学意义(P>0.05);术后3个月两组NRS评分、ODI评分和Cobb角较术前降低,椎体中间高度较术前升高,且高黏度组NRS评分、ODI评分和Cobb角低于低黏度组,椎体中间高度高于低黏度组(P<0.05)。结论:高黏度骨水泥经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效较低黏度骨水泥更佳,术后总渗漏率更低,脊柱畸形矫正、脊柱功能恢复更佳,同时疼痛也明显降低,适于临床推广。
Objective: To explore the clinical effect of different viscosities bone cement in the treatment of osteoporotic vertebral compression fractures. Methods: 90 patients with osteoporotic vertebral compression fractures who were treated in The First People's Hospital of Chuzhou from January 2016 to June 2018 were selected, they were divided into high viscosity group(42 cases) and low viscosity group(48 cases) according to the method of digital random table. Percutaneous kyphoplasty with high-viscosity bone cement and percutaneous kyphoplasty with low-viscosity bone cement were used respectively. The operation time, cement injection volume and bone cement leakage of two groups were compared. All patients were followed up for 3 months. The changes of NRS score, Oswestry function(ODI) score, vertebral height and Cobb angle before and after operation were compared between the two groups. Results: The operation time of single vertebral body in the high viscosity group was less than that in the low viscosity group(P<0.05). There was no significant difference between the two groups in the bone cement injection volume and the bone cement dispersion volume(P>0.05). The total bone cement leakage rate of high viscosity group was significantly lower than that of low viscosity group, there were statistical differences between the two groups(P<0.05). There were no significant differences in preoperative NRS score, ODI score, intervertebral height and Cobb angle between the two groups(P>0.05). The NRS score, ODI score and Cobb angle of the two groups at 3 months after operation were lower than those before operation, the intervertebral height was higher than that before operation. The NRS score, ODI score and Cobb angle of the high viscosity group were lower than those of the low viscosity group, The intervertebral height was higher than that of low viscosity group(P<0.05). Conclusion: Percutaneous kyphoplasty with high-viscous bone cement is better than percutaneous kyphoplasty with low-viscous bone cement. The total leakage rate is lower, spinal deformity correction and spinal function recovery is better,while the pain is also significantly reduced, which is suitable for clinical promotion.
Objective: To explore the clinical effect of different viscosities bone cement in the treatment of osteoporotic vertebral compression fractures. Methods: 90 patients with osteoporotic vertebral compression fractures who were treated in The First People's Hospital of Chuzhou from January 2016 to June 2018 were selected, they were divided into high viscosity group(42 cases) and low viscosity group(48 cases) according to the method of digital random table. Percutaneous kyphoplasty with high-viscosity bone cement and percutaneous kyphoplasty with low-viscosity bone cement were used respectively. The operation time, cement injection volume and bone cement leakage of two groups were compared. All patients were followed up for 3 months. The changes of NRS score, Oswestry function(ODI) score, vertebral height and Cobb angle before and after operation were compared between the two groups. Results: The operation time of single vertebral body in the high viscosity group was less than that in the low viscosity group(P<0.05). There was no significant difference between the two groups in the bone cement injection volume and the bone cement dispersion volume(P>0.05). The total bone cement leakage rate of high viscosity group was significantly lower than that of low viscosity group, there were statistical differences between the two groups(P<0.05). There were no significant differences in preoperative NRS score, ODI score, intervertebral height and Cobb angle between the two groups(P>0.05). The NRS score, ODI score and Cobb angle of the two groups at 3 months after operation were lower than those before operation, the intervertebral height was higher than that before operation. The NRS score, ODI score and Cobb angle of the high viscosity group were lower than those of the low viscosity group, The intervertebral height was higher than that of low viscosity group(P<0.05). Conclusion: Percutaneous kyphoplasty with high-viscous bone cement is better than percutaneous kyphoplasty with low-viscous bone cement. The total leakage rate is lower, spinal deformity correction and spinal function recovery is better,while the pain is also significantly reduced, which is suitable for clinical promotion.
引文
[1]Pourtaheri S,Luo W,Cui C,et al.Vertebral Augmentation is Superior to Nonoperative Care at Reducing Lower Back Pain for Symptomatic Osteoporotic Compression Fractures:A Meta-Analysis[J].Clin Spine Surg,2018,31(8):339-344
[2]Hu KZ,Chen SC,Xu L.Comparison of percutaneous balloon dilation kyphoplasty and percutaneous vertebroplasty in treatment for thoracolumbar vertebral compression fractures[J].Eur Rev Med Pharmacol Sci,2018,22(1):96-102
[3]张亮,王静成,冯新民,等.高粘度骨水泥椎体成形术与普通粘度椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的效果比较[J].中国老年学杂志,2017,37(18):4601-4603
[4]李自强,杜科伟,杜夏铭,等.椎体成形术与椎体后凸成形术治疗骨质疏松性椎体压缩性骨折发生骨水泥渗漏的相关临床评价[J].解放军医药杂志,2016,28(5):54-58
[5]Shim J,Lee K,Kim H,et al.Outcome of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fracture in patients with rheumatoid arthritis[J].BMC Musculoskelet Disord,2016,17(1):365
[6]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨折诊断及治疗原则)[J].中华骨与关节外科杂志,2015,8(5):371-374
[7]Cheng X,Long HQ,Xu JH,et al.Comparison of unilateral versus bilateral percutaneo us kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):a systematic review and meta-analysis[J].Eur Spine J,2016,25(11):3439-3449
[8]Alghadir AH,Anwer S,Iqbal ZA.The psychometric properties of an Arabic numeric pain rating scale for measuring osteoarthritis knee pain[J].Disabil Rehabil,2016,(24):2392-2397
[9]张国华,杜伟,罗鹏明,等.PVP与PKP治疗骨质疏松脊柱压缩性骨折的临床治疗效果比较[J].现代生物医学进展,2017,17(5):909-912
[10]Shen G,Zhang H,Jia P,et al.GOLM1 Stimulation of Glutamine Metabolism Promotes Osteoporosis via Inhibiting Osteogenic Differentiation of BMSCs[J].Cell Physiol Biochem,2018,50(5):1916-1928
[11]Lewiecki EM.New and emerging concepts in the use of denosumab for the treatment of osteoporosis[J].Ther Adv Musculoskelet Dis,2018,10(11):209-223
[12]Yang CC,Chien JT,Tsai TY,et al.Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures:A Retrospective Study[J].Pain Physician,2018,21(5):E483-E491
[13]中国健康促进基金会骨质疏松防治中国白皮书编委会.骨质疏松症中国白皮书[J].中华健康管理杂志,2009,3(3):148-154
[14]曾日祥,马勇,邓颂波,等.高粘度骨水泥治疗骨质疏松性椎体压缩性骨折效果观察[J].赣南医学院学报,2016,36(2):221-224
[15]Qi Y,Zeng Y,Wang D,et al.Clinical application of the pedicle in vitro restorer in percutaneous kyphoplasty[J].J Orthop Surg Res,2018,13(1):268
[16]Zhang P,Zhong ZH,Yu HT,et al.Therapeutic effects of new-type hydraulic delivery vertebroplasty,balloon kyphoplasty and conventional pusher-type vertebroplasty on single segmental osteoporotic vertebral compression fracture[J].Exp Ther Med,2018,16(4):3553-3561
[17]刘洋.不同黏度骨水泥椎体成形系统治疗骨质疏松性椎体压缩性骨折的比较[J].中国组织工程研究,2018,22(30):4774-4776
[18]黄晓楠.骨质疏松性椎体压缩骨折治疗:注入高黏度与低黏度骨水泥的对比[J].中国组织工程研究,2014,18(16):2461-2467
[19]Park JS,Kim J,Lee Y,et al.Intra-cardiac Embolism of a Large Bone Cement Material after Percutaneous Vertebroplasty Removed through a Combination of an Endovascular Procedure and an Inferior Vena Cava Exploration:a Case Report[J].J Korean Med Sci,2018,33(19):e141
[20]Denoix E,Viry F,Ostertag A,et al.What are the predictors of clinical success after percutaneous vertebroplasty for osteoporotic vertebral fractures[J].Eur Radiol,2018,28(7):2735-2742
[21]Zhao WT,Qin DP,Zhang XG,et al.Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture:a three-dimensional finite element analysis[J].J Orthop Surg Res,2018,13(1):32
[22]Black DM,Rosen CJ.Clinical Practice.Postmenopausal Osteoporosis[J].N Engl J Med,2016,374(3):254-262
[23]Guo Z,Wang W,Gao WS,et al.Comparison the clinical outcomes and complications of high-viscosity versus low-viscosity in osteoporotic vertebral compression fractures[J].Medicine(Baltimore),2017,96(48):e8936
[24]Jacobson RE,Palea O,Granville M.Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation:Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra[J]Cureus,2017,9(10):e1776
[25]Zeng TH,Wang YM,Yang XJ,et al.The clinical comparative study on high and low viscosity bone cement application in vertebroplasty[J].Int J Clin Exp Med,2015,8(10):18855-18860
[26]Guo D,Cai J,Zhang S,et al.Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using highviscosity bone cement via bilateral percutaneous vertebroplasty[J].Medicine(Baltimore),2017,96(14):e6549
[27]Jin P,Liu X,Li M,et al.Clinical Experience Using a Remote Control Injection System in Vertebroplasty:Feasibility,Safety,and Cement Leakage of Osteoporotic and Malignant Compression Fractures[J]Clin Spine Surg,2017,30(3):E305-E309
[28]Deibert CP,Gandhoke GS,Paschel EE,et al.A Longitudinal Cohort Investigation of the Development of Symptomatic Adjacent Level Compression Fractures Following Balloon-assisted Kyphoplasty in a Series of 726 Patients[J].Pain Physician,2016,19(8):E1167-E1172
[29]Kopinski JE,Aggarwal A,Nunley RM,et al.Failure at the Tibial Cement-Implant Interface With the Use of High-Viscosity Cement in Total Knee Arthroplasty[J].J Arthroplasty,2016,31(11):2579-2582
[30]Walden JK,Chong AC,Dinh NL,et al.Intrusion Characteristics of Three Bone Cements for Tibial Component of Total Knee Arthroplasty in a Cadaveric Bone Model[J].J Surg Orthop Adv,2016,25(2):74-79
[2]Hu KZ,Chen SC,Xu L.Comparison of percutaneous balloon dilation kyphoplasty and percutaneous vertebroplasty in treatment for thoracolumbar vertebral compression fractures[J].Eur Rev Med Pharmacol Sci,2018,22(1):96-102
[3]张亮,王静成,冯新民,等.高粘度骨水泥椎体成形术与普通粘度椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的效果比较[J].中国老年学杂志,2017,37(18):4601-4603
[4]李自强,杜科伟,杜夏铭,等.椎体成形术与椎体后凸成形术治疗骨质疏松性椎体压缩性骨折发生骨水泥渗漏的相关临床评价[J].解放军医药杂志,2016,28(5):54-58
[5]Shim J,Lee K,Kim H,et al.Outcome of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fracture in patients with rheumatoid arthritis[J].BMC Musculoskelet Disord,2016,17(1):365
[6]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨折诊断及治疗原则)[J].中华骨与关节外科杂志,2015,8(5):371-374
[7]Cheng X,Long HQ,Xu JH,et al.Comparison of unilateral versus bilateral percutaneo us kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):a systematic review and meta-analysis[J].Eur Spine J,2016,25(11):3439-3449
[8]Alghadir AH,Anwer S,Iqbal ZA.The psychometric properties of an Arabic numeric pain rating scale for measuring osteoarthritis knee pain[J].Disabil Rehabil,2016,(24):2392-2397
[9]张国华,杜伟,罗鹏明,等.PVP与PKP治疗骨质疏松脊柱压缩性骨折的临床治疗效果比较[J].现代生物医学进展,2017,17(5):909-912
[10]Shen G,Zhang H,Jia P,et al.GOLM1 Stimulation of Glutamine Metabolism Promotes Osteoporosis via Inhibiting Osteogenic Differentiation of BMSCs[J].Cell Physiol Biochem,2018,50(5):1916-1928
[11]Lewiecki EM.New and emerging concepts in the use of denosumab for the treatment of osteoporosis[J].Ther Adv Musculoskelet Dis,2018,10(11):209-223
[12]Yang CC,Chien JT,Tsai TY,et al.Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures:A Retrospective Study[J].Pain Physician,2018,21(5):E483-E491
[13]中国健康促进基金会骨质疏松防治中国白皮书编委会.骨质疏松症中国白皮书[J].中华健康管理杂志,2009,3(3):148-154
[14]曾日祥,马勇,邓颂波,等.高粘度骨水泥治疗骨质疏松性椎体压缩性骨折效果观察[J].赣南医学院学报,2016,36(2):221-224
[15]Qi Y,Zeng Y,Wang D,et al.Clinical application of the pedicle in vitro restorer in percutaneous kyphoplasty[J].J Orthop Surg Res,2018,13(1):268
[16]Zhang P,Zhong ZH,Yu HT,et al.Therapeutic effects of new-type hydraulic delivery vertebroplasty,balloon kyphoplasty and conventional pusher-type vertebroplasty on single segmental osteoporotic vertebral compression fracture[J].Exp Ther Med,2018,16(4):3553-3561
[17]刘洋.不同黏度骨水泥椎体成形系统治疗骨质疏松性椎体压缩性骨折的比较[J].中国组织工程研究,2018,22(30):4774-4776
[18]黄晓楠.骨质疏松性椎体压缩骨折治疗:注入高黏度与低黏度骨水泥的对比[J].中国组织工程研究,2014,18(16):2461-2467
[19]Park JS,Kim J,Lee Y,et al.Intra-cardiac Embolism of a Large Bone Cement Material after Percutaneous Vertebroplasty Removed through a Combination of an Endovascular Procedure and an Inferior Vena Cava Exploration:a Case Report[J].J Korean Med Sci,2018,33(19):e141
[20]Denoix E,Viry F,Ostertag A,et al.What are the predictors of clinical success after percutaneous vertebroplasty for osteoporotic vertebral fractures[J].Eur Radiol,2018,28(7):2735-2742
[21]Zhao WT,Qin DP,Zhang XG,et al.Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture:a three-dimensional finite element analysis[J].J Orthop Surg Res,2018,13(1):32
[22]Black DM,Rosen CJ.Clinical Practice.Postmenopausal Osteoporosis[J].N Engl J Med,2016,374(3):254-262
[23]Guo Z,Wang W,Gao WS,et al.Comparison the clinical outcomes and complications of high-viscosity versus low-viscosity in osteoporotic vertebral compression fractures[J].Medicine(Baltimore),2017,96(48):e8936
[24]Jacobson RE,Palea O,Granville M.Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation:Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra[J]Cureus,2017,9(10):e1776
[25]Zeng TH,Wang YM,Yang XJ,et al.The clinical comparative study on high and low viscosity bone cement application in vertebroplasty[J].Int J Clin Exp Med,2015,8(10):18855-18860
[26]Guo D,Cai J,Zhang S,et al.Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using highviscosity bone cement via bilateral percutaneous vertebroplasty[J].Medicine(Baltimore),2017,96(14):e6549
[27]Jin P,Liu X,Li M,et al.Clinical Experience Using a Remote Control Injection System in Vertebroplasty:Feasibility,Safety,and Cement Leakage of Osteoporotic and Malignant Compression Fractures[J]Clin Spine Surg,2017,30(3):E305-E309
[28]Deibert CP,Gandhoke GS,Paschel EE,et al.A Longitudinal Cohort Investigation of the Development of Symptomatic Adjacent Level Compression Fractures Following Balloon-assisted Kyphoplasty in a Series of 726 Patients[J].Pain Physician,2016,19(8):E1167-E1172
[29]Kopinski JE,Aggarwal A,Nunley RM,et al.Failure at the Tibial Cement-Implant Interface With the Use of High-Viscosity Cement in Total Knee Arthroplasty[J].J Arthroplasty,2016,31(11):2579-2582
[30]Walden JK,Chong AC,Dinh NL,et al.Intrusion Characteristics of Three Bone Cements for Tibial Component of Total Knee Arthroplasty in a Cadaveric Bone Model[J].J Surg Orthop Adv,2016,25(2):74-79