矿化胶原改性骨水泥在骨质疏松性椎体压缩骨折中的应用

文题释义：矿化胶原改性骨水泥：是在普通聚甲基丙烯酸甲酯骨水泥中加入适量人工骨修复材料。普通聚甲基丙烯酸甲酯骨水泥的主要成分是丙烯酸甲酯-甲基丙烯酸甲酯聚合物和为氧化锆，硬度较大，缺乏生物活性；人工骨修复材料的主要成分是Ⅰ型胶原和羟基磷灰石，它具有与天然骨相似的微结构，具有很好的传导成骨活性，利于新骨的形成。两者按照适当比例混合制成矿化胶原改性骨水泥。经皮椎体成形：是一种微创脊柱外科技术，经皮通过椎弓根或椎弓根外侧向压缩椎体内注入骨水泥从而增加椎体强度和稳定性，防止进一步塌陷，恢复椎体部分高度，矫正后凸畸形，缓解腰背部疼痛。可用于治疗骨髓瘤、脊椎血管瘤、溶骨性转移瘤等癌性疼痛，但主要用于治疗老年椎体压缩性骨折，常见并发症有邻近椎体骨折、骨水泥渗漏、椎体坏死等。背景：单纯骨水泥由于硬度较大，易造成邻近椎体再骨折，当前迫切需要一种能够降低邻近椎体骨折发生率的骨水泥材料。目的：观察使用矿化胶原改性骨水泥行经皮椎体成形治疗骨质疏松性椎体压缩骨折的临床效果。方法：选择行经皮椎体成形治疗的骨质疏松性椎体压缩骨折患者60例，均为新鲜单椎体骨折，随机分为2组，每组30例。单纯骨水泥组采用单纯聚甲基丙烯酸甲酯骨水泥，改性骨水泥组采用人工骨修复材料与单纯聚甲基丙烯酸甲酯骨水泥混合的矿化胶原改性骨水泥。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。随访时间6-12个月，于术前、术后2 d、术后末次随访时根据目测类比评分、Oswestry功能障碍指数、脊柱后凸局部Cobb角及椎体前缘高度百分比评定临床效果，并记录术后并发症的发生情况。结果与结论：①所有患者手术均顺利完成，共发现4例患者出现不同程度的骨水泥渗漏，所有骨水泥渗漏患者均未出现明显临床不适症状；②2组患者术后2 d、末次随访与术前相比，目测类比评分、Oswestry功能障碍指数显著改善(P < 0.05)，伤椎前缘高度、脊柱后凸局部Cobb角变化不明显(P > 0.05)；以上指标2组间相同时间段比较差异均无显著性意义(P > 0.05)；③单纯骨水泥组邻近椎体骨折发生例数多于改性骨水泥组，但2组邻近椎体骨折发生率相比，差异无显著性意义(P > 0.05)；④提示矿化胶原改性骨水泥与单纯骨水泥相比无明显缺点，且在保证骨水泥支撑强度、减轻疼痛的同时，矿化胶原改性骨水泥可赋予其更好的生物学特性，降低邻近椎体骨折的发生率有待进一步研究。ORCID: 0000-0002-5714-2566(姜文康)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Application of mineralized collagen modified bone cement in the treatment of osteoporotic vertebral compression fractures

BACKGROUND:Simple bone cement is easy to cause refracture of adjacent vertebra due to its high hardness.Currently,a material that can reduce the incidence of adjacent vertebra fracture is urgently needed.OBJECTIVE:To observe the clinical efficacy of percutaneous vertebroplasty using mineralized collagen modified bone cement.METHODS:Totally 60 patients with fresh single osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty were randomly divided into two groups,with 30 cases in each group.Patients in the simple bone cement group were given polymethyl methacrylate bone cement.Patients in the modified bone cement group were given mineralized collagen modified bone cement mixed with artificial bone repair material and simple polymethyl methacrylate bone cement.All patients signed the informed consent.This study was approved by the Hospital Ethics Committee.The follow-up time was 6-12 months.The clinical effect was assessed by the visual analogue scale,Oswestry Disability Index,Cobb angle and percentage of vertebral anterior edge height before surgery,at 2 days after surgery and during the last follow-up.Postoperative complications were recorded.RESULTS AND CONCLUSION:(1)All patients underwent successful operation.A total of four patients were found to have different degrees of bone cement leakage,and none of the patients presented obvious clinical discomfort symptoms.(2)Compared with pre-operation,visual analogue scale and Oswestry Disability Index were significantly improved(P<0.05);the height of the anterior border of the injured vertebrae and the Cobb angle of the kyphosis were not significantly changed(P>0.05)at 2 days after operation and during the last follow-up in the two groups.There were no significant differences in above indexes between the two groups at the same time point(P>0.05).(3)The number of adjacent fractures in the simple bone cement group was more than that in the modified bone cement group,but there was no statistically significant difference in the incidence of adjacent vertebral fractures between the two groups(P>0.05).(4)It is confirmed that compared with simple bone cement,mineralized collagen modified bone cement has no obvious disadvantages.In addition,mineralized collagen modified bone cement can give better biological properties while ensuring the strength of bone cement support and reducing pain.Further studies are needed to reduce the incidence of adjacent vertebral fractures.