PKP 术中骨水泥的灌注量与分布对 OVCF 早期疗效的影响

目的：分析经皮椎体后凸成形术（PKP）治疗胸腰椎骨质疏松性压缩性骨折（OVCF）的骨水泥的灌注量与椎体内骨水泥的分布情况对早期疗效的影响。方法将该科2011年5月至2013年5月62例 OVCF 患者按常规行 PKP ，术中注射骨水泥PMMA 。术后将手术椎体做 CT 平扫并分区，将骨水泥的分布情况分为优、良、中、差4个等级，对患者进行定期随访，比较不同等级骨水泥分布情况及灌注量的术前、术后的疼痛视觉模拟（VAS）评分、Oswestry 功能障碍指数（ODI）、椎体高度、后凸 Cobb 角及并发症。结果本组62例随访时间3～36个月，平均（10．5±5．3）个月。术前与术后1周 VAS 评分有显著差异（P＜0．05）。术后3个月各等级间观察指标差异无统计学意义（P＞0．05）。骨水泥灌注量大于5 mL 的病例术后6个月、12个月分别有3例、6例出现邻椎骨折。骨水泥灌注量小于3 mL 的病例术后12个月有2例出现手术椎再骨折。术后6个月、12个月骨水泥分布优差等级之间的手术椎高度丢失差异有统计学意义（P＜0．05），邻椎体继发骨折率差异无统计学意义（P ＞0．05）。术后12个月骨水泥分布不同等级间疼痛、功能差异有统计学意义（P＜0．05）。结论经皮椎体后凸成形术治疗 OVCF ，按常规操作不同灌注量与分布均有良好的超早期（3个月内）疗效，但骨水泥灌注量适中，分布越均匀、越对称，可能早期疗效越好。

Influence of quantity and distribution of bone cement by percutaneous kyphoplasty on early clinical results of thoracolumbar osteoporotic compression fractures

Objective To detect the influence of the perfusion quantity and distribution of bone cement by percutaneous ky-phoplasty(PKP) on the early treatment result of thoracolumbar osteoporotic compression fractures(OVCF) .Methods From May 2011 to May 2013 ,62 cases of osteoporotic fractures of thoracic or lumber vertebra were treated by PKP .CT scans were performed postoperatively to analysis the distribution of the bone cement in the vertebra .According to the bone cement distribution on the transverse plane CT film ,the results were classified into four degrees :excellence ,good ,fair and poor .The cases were followed-up regularly .Preoperative and postoperative visual analogue scale(VAS) ,oswestry dysfunction index(ODI) ,height of the operated ver-tebra ,cobb angle ,the incidences of complications during and after the surgery were compared between groups of different degrees of bone cement distribution and different amount of bone cement injection .Results Among the 62 cases ,the follow-up time ranged from 3 to 36 months[average(10 .5 ± 5 .3)months] .In all of the cases ,there was statistically significant difference between the pre-operative and postoperative VAS scoring(P< 0 .05) .3 months after suergery ,there were no statistically significant influence on the results of VAS scoring ,the ODI scoring ,the height lost of the operated vertebra and the improvement of the Cobb angle(P> 0 .05) . In cases of bone cement injection more than 5 mL ,adjacent vertebra fractures happened in 3 cases 6 months postoperatively and 6 cases 12 months postoperatively .In cases of bone cement injection less than 4 mL ,there were only 2 cases of adjacent vertebra frac-tures happened 12 months posoperatively .The degree of vertebra height lost between the bone cement excellent group and poor group was statistically significant in 6 months and 12 months postoperatively .In cases when the distribution of bone cement was ex-cellent ,the improvement of pain and function was significantly different(P< 0 .05) .Conclusion OVCF is treated by PKP .Through conventional operation ,the ultra-early(within 3 months)efficacy is excellent ,in cases of different amount of bone cement injection and different degree of bone cement distribution .However ,with appropriate amount of bone cement ,the more eventfully and sym-metrically the distribution of the bone cement is ,the better of the early clinical results ,probably .