CPC/PMMA复合骨水泥在老年椎体后凸成形术中的初步应用研究

目的:从临床应用角度分析磷酸钙骨水泥(calcium phosphate bone cement,CPC)/聚甲基丙烯酸甲酯(polymethyl methacrylate,PMMA)骨水泥在老年骨质疏松性胸腰椎骨折患者椎体后凸成形术(percutanous kyphoplasty,PKP)治疗中的有效性及可靠性。方法:对2016年2月至2016年12月收治的单椎体胸腰段骨质疏松性压缩骨折接受PKP手术且骨密度≤-3.0 SD的62例患者进行回顾性分析,其中CPC/PMMA复合骨水泥组23例,年龄为(77.6±2.2)岁,PMMA骨水泥组39例,年龄为(77.1±1.1)岁。比较两组患者手术前后疼痛、椎体前缘高度比、局部Cobb角变化、术中骨水泥渗漏及术后邻椎骨折发生情况。结果:两组患者性别、年龄、随访时间以及术前疼痛、椎体前缘高度比、局部Cobb角等基本情况差异无统计学意义(P0.05)。术后1 d两组患者的疼痛、椎体前缘高度比、局部Cobb角均有所改善(P0.05),术后1 d及末次随访疼痛、椎体前缘高度比、局部Cobb角组间比较差异无统计学意义(P0.05),同时新发邻椎骨折、骨水泥渗漏情况组间比较差异也无统计学意义(P0.05)。两组患者术后随访疼痛均有持续改善(P0.05),局部Cobb角略有增加(P0.05);椎体前缘高度比略有下降(P0.05)。随访X线片或CT影像资料无法证实CPC降解及新骨形成长入。结论:CPC/PMMA复合骨水泥用于PKP治疗老年骨质疏松性胸腰椎压缩骨折安全可靠,可以有效缓解疼痛,维持椎体稳定,和PMMA骨水泥疗效相当。但目前尚无直接临床证据支持CPC/PMMA复合骨水泥可降低邻椎骨折发生率以及CPC降解、新骨长入骨水泥中,需要进一步研究。

Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly

Objective: From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures.Methods: A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them,23 patients were in CPC/PMMA group,with an average age of (77.6±2.2) years old,39 patients in PMMA group,with an average age of (77.1±1.1) years old. The indexes between two groups were compared,including the visual analogue scale (VAS),height ratio of anterior vertebra (AVHR),local Cobb angle,cement leakage,new adjacent vertebral fracture (NAVF).Results: There were no significant difference in gender,age,follow-up time and preoperative VAS,AVHR,local Cobb angle between two groups (P>0.05),at the 1 day after operation,VAS,AVHR,local Cobb angle in all patients got obvious improvement (P<0.05),which was no significant difference at 1 day after operation and final follow-up (P>0.05). At the same time,there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (P>0.05). The pain in both groups continued to improve at follow-up after operation (P<0.05),the local Cobb angle increased (P<0.05) and AVHR decreased slightly (P<0.05). However,the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth.Conclusion: CPC/PMMA composite bone cement is safe and reliable in PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures,which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future,although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture,CPC degeneration or new bone ingrowth.