累及椎体中1/3的急性骨质疏松性骨折经皮椎体成形术后骨水泥分布与疗效的关系

目的探讨骨折线累及椎体中1/3的急性骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)病人行经皮椎体成形术(percutaneous vertebroplasty,PVP)后骨水泥的差异分布与临床疗效的关系及术后近期疗效的影响因素。方法收集西安交通大学附属红会医院2016年1月1日至2016年12月31日收治的急性OVCF且骨折线位于椎体中1/3而接受PVP手术的病人92例,根据术前及术后影像资料判断骨折线位置并评估骨水泥与骨折线的差异分布,将研究对象分为两组,骨水泥与骨折线相对位置良好的43例纳入A组,骨水泥与骨折线相对位置较差的49例纳入B组。对比分析两组的疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、健康调查简表(the MOS item short from health survey,SF-36)评分、Cobb角等。结果所有病人术后1 d及末次随访时VAS评分、ODI、SF-36评分、椎体前缘高度、Cobb角较术前均得到显著改善(P均<0.05);但A组病人术后1 d时的VAS评分显著低于B组,差异有统计学意义(P<0.05);末次随访时,两组的VAS评分比较,差异无统计学意义(P>0.05)。多元线性回归分析显示骨水泥与骨折线相对位置、病程与病人术后1 d时症状改善程度密切相关(P<0.05)。结论PVP可明显改善急性OVCF病人的症状和功能,虽然骨折线累及椎体中1/3时骨水泥分布与骨折线的相对位置会影响病人的近期疗效,但远期临床结果相似。未来如何使骨水泥更均匀地分布在骨折线内仍需要进一步的研究。

Relationship between cement distribution and curative effect of PVP in middle 1/3 of acute osteoporotic fractures

Objective To investigate the relationship between the different distribution of bone cement and clinical effect after percutaneous vertebroplasty(PVP)in patients with acute osteoporotic vertebral compression fracture(OVCF)whose fracture line involved the middle 1/3 of the vertebral body.Methods From January 2016 to December 2016,92 patients with OVCF who underwent PVP were analyzed retrospectively,and all cases have fracture lines involving the middle 1/3 of the vertebral body.The distribution of vertebral fracture lines was determined based on preoperative CT or MRI.According to the relationship between bone cement and fracture lines on postoperative X-ray or CT,43 patients with great relative position of bone cement and fracture line were allocated to group A,and 49 patients with poor relative position of bone cement and fracture line were allocated to group B.The visual analogue scale(VAS)score,Oswestry disability index(ODI),the MOS item short from health survey(SF-36)score and the local kyphotic angle of involved vertebral bodies preoperation,at 1 st day after the operation and at the last follow-up were compared between two groups.Results The VAS scores,ODI,SF-36 scores,the height and kyphotic angle of involved vertebrae one the day 1 postoperatively and at the last follow up were significantly different from those preoperation in both groups(P<0.05).Meanwhile,there was significant difference in VAS scores on the day 1 postoperatively between two groups(P<0.05).At the final follow-up,there was no remarkable difference between the two groups(P>0.05).Multiple linear regression analysis showed that relationship between bone cement and fracture line and course were closely related to the improvement of symptoms on the first day after operation.Conclusion Although the relative position of the bone cement distribution and the fracture line when the fracture line affects the middle 1/3 of the vertebral body will affect the short-term clinical results of the patients,the long-term clinical results are similar.This study demonstrates that PVP can significantly improve the symptoms and function of patients with OVCF,but how to make bone cement more even distributed within the fracture line needs to be further studied.