聚甲基丙烯酸甲酯与可吸收骨水泥治疗骨质疏松椎体压缩骨折的临床疗效对照研究

目的：回顾性分析骨质疏松椎体压缩骨折患者在行经皮椎体后凸成形术（percutaneous kyphoplasty, PKP）中使用聚甲基丙烯酸甲酯（polymethylmethacrylate, PMMA）与GeneX骨水泥的治疗结果差异，为PKP手术椎体填充材料的选择提供参考。方法： 回顾性分析2012年6月至2013年6月北京大学第三医院收治的89例骨质疏松椎体压缩骨折患者，于术后1个月、3个月、6个月、1年行问卷、X线片及CT检查随访，通过椎体高度恢复率、椎体Cobb角恢复率、计算机软件辅助CT数据分析、视觉模拟评分（visual analogue scale, VAS）减少情况、Oswestry评分以及并发症评估患者术后恢复情况。结果采用SPSS 18.0统计软件分析。结果： 两组间椎体高度恢复率、椎体Cobb角恢复率、椎体体积恢复率在术后3个月、6个月、1年差异有统计学意义（P<0.05），GeneX组的椎体高度、Cobb角、椎体体积丢失多于PMMA组。PMMA组发生骨水泥渗漏者3例，邻近椎体再骨折1例，GeneX-组发生骨水泥渗漏2例，均无神经症状，均无致死性并发症。结论： GeneX-骨水泥对于患者术后疼痛的缓解效果与PMMA相当，作为椎体成形材料近期维持椎体高度良好，可以迅速提高椎体的强度和刚度，且其并发症少，但术后中、远期对椎体高度的维持并不十分满意，故骨质疏松压缩骨折患者可使用GeneX-骨水泥作为椎体填充材料，而对于术前椎体压缩程度重且伴有严重骨质疏松患者，可使用PMMA骨水泥作为椎体填充材料，并应避免术后早期负重，更佳的生物可替代材料仍然需要进一步寻找和研究。

Clinical comparison of polymethylmethacrylate and bone cement in the treatment of osteoporotic vertebral compression fractures: a retrospective study

Objective:To analyze the outcomes of patients with osteoporotic vertebral compression fractures treated with polymethylmethacrylate (PMMA) and GeneX(R) bone cement in percutaneous kyphoplasty and to provide guidance in selecting the vertebral filling material for this procedure.Methods: In this study,86 patients with osteoporotic vertebral compression fractures treated at Peking University Third Hospital between June 2012 and June 2013 were retrospectively analyzed.The patients were followed-up with questionnaires and X-ray and CT examinations after 1 month,3 months,6 months,and 1 year.Postoperative conditions,including recovery rate of vertebral height,recovery rate of vertebral Cobb angle,CT data,reductions in visual analogue scale (VAS) and Oswestry scores,and postoperative complications,were evaluated.The results were analyzed using SPSS 18.0.Results: According to the rank sum test,there were significant differences in the recovery rate of vertebral height,vertebral Cobb angle and vertebral volume between the two groups after 3 months,6 months,and 1 year (P<0.05).The GeneX(R) group had greater losses in vertebral height,Cobb angle and volume than did the PMMA group.The PMMA group had 3 cases of cement leakage and 1 case of an adjacent vertebral fracture after percutaneous kyphoplasty.The GeneX(R) group had 2 cases of cement leakage.Conclusion: GeneX(R) bone cement is similar to PMMA in terms of postoperative pain relief.As the filling material in percuta-neous kyphoplasty,it is effective at maintaining vertebral height,quickly improves strength and stiffness of the vertebral body and has fewer complications.However,it is not satisfactory in maintaining long-term postoperative vertebral height.GeneX(R) bone cement can be used as the filling material for patients with osteoporotic vertebral compression fractures in percutaneous kyphoplasty.Patients with severe osteoporosis and vertebral compression should be treated with standardized osteoporosis treatment and should try to avoid early postoperative walking exercises.Sustained vertebral filling materials,such as PMMA,are more suitable for such patients.Research into better biodegradable materials is still needed.