两种黏度骨水泥对老年重度胸腰段骨质疏松性椎体压缩骨折患者PVP手术效果影响的对比研究

目的比较两种黏度骨水泥对老年重度胸腰段骨质疏松性椎体压缩骨折(OVCF)患者经皮椎体成形术(PVP)手术效果的影响。方法选取2017年5月至2019年4月于我院骨科择期行PVP治疗的老年重度胸腰段OVCF患者152例,利用随机数字表法分成观察组(n=76)及对照组(n=76)。所有对象均行PVP治疗,观察组于PVP术中采取高黏度骨水泥治疗,而对照组采用低黏度骨水泥治疗。汇总两组术后并发症的发生情况;并于术前及术后第1 d和第3、6个月时运用视觉模拟评分法(VAS)评价受试者当时主观疼痛的程度,使用Oswestry功能障碍指数(ODI)评估被调查者运动功能的恢复情况;同时于术前及术后第3、6个月时采用双能X线骨密度仪检测病人腰椎骨密度(BMD)。结果两组疼痛VAS评分均随术后时间的延长而逐渐降低(P0.05),且两组术后第1 d和第3、6个月时疼痛VAS评分均较术前显著下降(P0.05)。两组疼痛VAS评分组间同时间点对比差异均无统计学意义(P0.05)。随术后时间的延长,两组ODI评分均逐渐降低(P0.05);且两组术后第1 d和第3、6个月时ODI评分均显著低于术前(P0.05)。同时观察组术后第3、6个月时ODI评分则均显著低于对照组同期(P0.05)。随术后时间的延长,两组腰椎BMD均逐渐增加(P0.05),且两组术后第3、6个月时腰椎BMD均较术前显著增高(P0.05)。但术后同时间点,两组腰椎BMD比较差异均无统计学意义(P0.05)。两组术后压疮、坠积性肺炎及肺栓塞的发生率对比差异均无统计学意义(P0.05);但观察组术后骨水泥渗漏率5.26%(4/76)]显著低于对照组19.74%(15/76),P0.05]。结论与低黏度骨水泥相比,将高黏度骨水泥应用于老年重度胸腰段OVCF病人PVP术中能显著降低患者术后骨水泥渗漏的发生风险。

A comparative study of the effect of two kinds of viscosity cement on PVP in elderly patients with severe thoracolumbar osteoporotic vertebral compression fractures

Objective To compare the effect of viscosity between two kinds of cement on the operation of percutaneous vertebroplasty (PVP) in elderly patients with severe thoracolumbar osteoporotic vertebral compression fractures (OVCF). Methods from May 2017 to April 2019, 152 elderly patients with severe thoracolumbar OVCF were selected for PVP treatment in orthopedics department of our hospital. They were divided into observation group (n = 76) and control group (n = 76) by random number table method. All the patients were treated with PVP. Patients in the observation group was treated with high viscosity bone cement while the patients in the control group was treated with low viscosity bone cement. Before and after the operation, the height of Cobb angle and injured vertebral body were compared. The occurrence of postoperative complications in the two groups was summarized. The degree of subjective pain was evaluated by visual analogue scale (VAS) before and on the first day and the third and the sixth month after the operation. The recovery of motor function was evaluated with Oswestry dysfunction index (ODI). Results At 24 hours after operation, the Cobb angle was significantly lower than that before operation (P< 0.05). The height percentage of anterior and posterior edge of injured vertebrae was significantly higher than that before operation (P < 0.05), and the improvement in the observation group was more significant (P< 0.05). The VAS score of pain in the two groups decreased gradually with the prolongation of postoperative time (P< 0.05). The VAS score of pain at the first day, the third month, and the sixth month after operation in the two groups was significantly lower than that before operation (P< 0.05). There was no significant difference in VAS score between the two groups at the same time (P > 0.05). With the prolongation of postoperative time, the ODI scores in the two groups decreased gradually (P< 0.05). The ODI scores of the first day and the third and the sixth month were significantly lower than those before the operation (P< 0.05). At the same time, the ODI score in the observation group was significantly lower than that in the control group (P< 0.05). There was no significant difference between the two groups in the incidence of pressure sore, falling pneumonia, and pulmonary embolism (P > 0.05). The leakage rate of bone cement in the observation group (5.26%, 4/76) was significantly lower than that in the control group (19.74%, 15/76, P< 0.05). Conclusion Compared with low viscosity bone cement, the application of high viscosity bone cement in PVP of elderly patients with severe thoracolumbar OVCF significantly reduces the risk of bone cement leakage.