单侧穿刺椎体成形术治疗不同骨密度脊椎压缩性骨折的疗效分析
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摘要
目的评估单侧穿刺椎体成形术(PVP)治疗不同骨密度(BMD)脊椎压缩性骨折的临床疗效。方法2009年1月至2012年12月广州医科大学附属第一医院采用单侧穿刺PVP治疗86例脊椎压缩性骨折老年患者,根据术前BMD的不同分为A组(BMD<—2.5 S,n=54)和B组(BMD≥—2.5 S,n=32),比较两组手术前后疼痛视觉模拟量表(VAS)评分、术后椎体骨水泥填充效果及并发症发生情况。结果 86例患者获随访6~12个月(平均8.3个月)。两组术后VAS评分均优于术前,差异有统计学意义(P<0.05)。对两组术前、术后VAS评分,并发症发生率进行比较,差异无统计学意义(P>0.05);A组椎体骨水泥填充优秀率高于B组(P<0.05),填充效果更为理想。结论单侧穿刺椎体成形术治疗不同BMD脊椎压缩性骨折,术后均能明显改善患者腰背部疼痛,疗效良好;在椎体骨水泥填充满意度方面,BMD更低的患者似乎更有优势,BMD可能是影响椎体骨水泥填充效果的重要因素。
Objective To evaluate the efficiency of unilateral percutaneous vertebroplasty(PVP) in the treatment of vertebral compression fracture(VCF) with various bone mineral densities(BMD). Methods Eighty-six elderly patients with VCF performed unilateral PVP in the First Affiliated Hospital of Guangzhou Medical University. They were divided into 2 groups according to the preoperative BMD, group A(BMD<—2.5 S, n = 54) and group B(BMD≥—2.5 S, n = 32). Perioperative visual analog scale(VAS) score, postoperative radiological images of bone cement distribution and complications were compared between 2 groups. Results All patients were followed up for 6-12 months(average, 8.3 months). Postoperative VAS scores improved compared with the preoperative data in two groups(P <0.05); there were no significant differences in either VAS score or complication incidence(P >0.05). The excellent rate of bone cement distribution in A group was better than that in B group(P <0.05). Conclusions Unilateral PVP could relieve back pain and thus obtain good therapeutic effects for VCF patients with various BMD. There seems to have advantages in patients with lower BMD for bone cement distribution, and BMD might be one of the impact factors for bone cement distribution.
Objective To evaluate the efficiency of unilateral percutaneous vertebroplasty(PVP) in the treatment of vertebral compression fracture(VCF) with various bone mineral densities(BMD). Methods Eighty-six elderly patients with VCF performed unilateral PVP in the First Affiliated Hospital of Guangzhou Medical University. They were divided into 2 groups according to the preoperative BMD, group A(BMD<—2.5 S, n = 54) and group B(BMD≥—2.5 S, n = 32). Perioperative visual analog scale(VAS) score, postoperative radiological images of bone cement distribution and complications were compared between 2 groups. Results All patients were followed up for 6-12 months(average, 8.3 months). Postoperative VAS scores improved compared with the preoperative data in two groups(P <0.05); there were no significant differences in either VAS score or complication incidence(P >0.05). The excellent rate of bone cement distribution in A group was better than that in B group(P <0.05). Conclusions Unilateral PVP could relieve back pain and thus obtain good therapeutic effects for VCF patients with various BMD. There seems to have advantages in patients with lower BMD for bone cement distribution, and BMD might be one of the impact factors for bone cement distribution.
引文
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[8]隆全利,宓士军.应用有限元对比分析椎体成形术中单侧入路退针法与双侧固定点注射骨水泥的生物力学变化[J].中国组织工程研究与临床康复,2010,14(17):3069-3072.
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[11]Belkoff SM,Maroney M,Fenton DC,et al.An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty[J].Bone,1999,25(2 Suppl):23-26.
[12]Molloy S,Mathis JM,Belkoff SM.The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty[J].Spine,2003,28(3):1549-1554.
[13]Cotten A,Dewatre F,Cortet B,et al.Percutaneous vertebroplasty for osteolytic metastases and myeloma:effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up[J].Radiology,1996,200(2):525-530.
[14]Teng MM,Cheng H,Ho DM,et al.Intraspinal leakage of bone cement after vertebroplasty:a report of 3 case[J].AJNR,2006,27(1):224-229.
[15]Rousing R,Andersen MO,Jespersen SM,et a1.Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures:three-months follow-up in a clinical randomized study[J].Spine,2009,34(13):1349-1354.
[2]Chen LH,Lai PL,Chen WJ.Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft[J].Clin Orthop Relat Res,2005,(435):148-153.
[3]Knavel EM,Rad AE,Thielen KR,et a1.Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty[J].AJNR,2009,30(3):496-499.
[4]Aslam E,Muhammad T,Sharif S.Percutaneous vertebroplasty in osteoporotic vertebral compression fracture:our initial experience[J].J Pak Med Assoc,2008,58(9):498-501.
[5]Galibert P,Deramond H,Rosat P,et al.Preliminary note on the treatment of vertebral angioma by percutaneous acryIic vertebroplasty[J].Neurochirurgie,1987,33(2):166-168.
[6]Liebschner MA,Rosenberg WS,Keaveny TM.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J].Spine,2001,26(14):1547-1554.
[7]潘承中,赵辉,李立人,等.经单、双侧椎弓根人路椎体成形术生物力学比较研究[J].交通医学,2008,22(3):224-226.
[8]隆全利,宓士军.应用有限元对比分析椎体成形术中单侧入路退针法与双侧固定点注射骨水泥的生物力学变化[J].中国组织工程研究与临床康复,2010,14(17):3069-3072.
[9]Heini PF,Berlemann U,Kaufmann M,et al.Augmentation of mechanical properties in osteoporotic vertebral bones:a biomechanical investigation of vertebroplasty efficacy with different bone cements[J].Eur Spine J,2001,10(2):164-171.
[10]Higgins KB,Harten RD,Langrana NA,et al.Biomechanical effects of unipedicular vertebroplasty on intact vertebrae[J].Spine,2003,28(14):1540-1548.
[11]Belkoff SM,Maroney M,Fenton DC,et al.An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty[J].Bone,1999,25(2 Suppl):23-26.
[12]Molloy S,Mathis JM,Belkoff SM.The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty[J].Spine,2003,28(3):1549-1554.
[13]Cotten A,Dewatre F,Cortet B,et al.Percutaneous vertebroplasty for osteolytic metastases and myeloma:effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up[J].Radiology,1996,200(2):525-530.
[14]Teng MM,Cheng H,Ho DM,et al.Intraspinal leakage of bone cement after vertebroplasty:a report of 3 case[J].AJNR,2006,27(1):224-229.
[15]Rousing R,Andersen MO,Jespersen SM,et a1.Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures:three-months follow-up in a clinical randomized study[J].Spine,2009,34(13):1349-1354.