骨质疏松性椎体压缩骨折椎体成形修复效果与骨水泥注入量及弥散程度的关系

文题释义：骨质疏松性椎体压缩骨折：指有病理性改变，骨量减低、骨强度降低、骨脆性增加，易发生脆性骨折，是骨质疏松的严重后果，常发于中老年人群，以绝经后女性最为高发，临床表现为腰背部剧烈疼痛、活动受限，严重时脊柱形态发生改变，导致后凸畸形，临床常采用椎体成形治疗。 椎体成形：是向病变椎体内注入骨水泥或人工骨等，以达到强化椎体、缓解疼痛及纠正椎体畸形的目的，是临床常用治疗骨质疏松性椎体压缩骨折的微创手术，由于其可快速缓解临床症状、疗效确切及术后不良反应少，在中老年骨质疏松性椎体压缩骨折治疗中得到广泛应用。背景：研究显示，椎体成形治疗中骨水泥注入量和弥散程度对骨质疏松性椎体压缩骨折患者术后恢复有一定影响，但关于椎体成形治疗中骨水泥注入量和弥散程度与椎体恢复相关性的研究报道较少。目的：探讨骨质疏松性椎体压缩骨折椎体成形后效果与骨水泥注入量及弥散程度的关系。方法：纳入2017年1月至2018年8月三亚市中医院收治的102例(109个椎体)骨质疏松性椎体压缩骨折患者，其中男42例，女60例，年龄52-76岁，均进行椎体成形骨水泥注射治疗。根据骨水泥注入量分为观察1组(注入量>4 mL，n=57)和对照1组(注入量≤4 mL，n=45)，根据骨水泥弥散程度分为观察2组(填充率>15%，n=61)和对照2组(填充率≤15%，n=41)，观察手术前后的目测类比评分、Oswestry功能障碍指数评分、椎体前缘高度、Cobb角变化与骨水泥渗漏发生情况，并分析骨水泥注入量、弥散程度与椎体恢复高度相关性。试验经三亚市中医院伦理委员会批准。结果与结论：①观察1组、对照1组术后3 d的目测类比评分、Oswestry功能障碍指数评分均较术前明显改善(P < 0.05)，并且观察1组的改善情况优于对照1组(P < 0.05)；观察2组、对照2组术后3 d的目测类比评分、Oswestry功能障碍指数评分均较术前明显改善(P < 0.05)，并且观察2组的改善情况优于对照组2组(P < 0.05)；②观察1组、对照1组术后3 d的椎体前缘高度与Cobb角均较术前明显改善(P < 0.05)，并且观察1组的改善情况优于对照1组(P < 0.05)；观察2组、对照2组术后3 d的椎体前缘高度与Cobb角均较术前明显改善(P < 0.05)，并且观察2组的改善情况优于对照组2组(P < 0.05)；③观察1组、对照1组骨水泥渗漏率比较差异无显著性意义(P > 0.05)，观察2组、对照2组骨水泥渗漏率比较差异无显著性意义(P > 0.05)；④椎体恢复高度与骨水泥注入量、弥散程度均呈正相关性(P < 0.05)；⑤结果表明，适当增加骨水泥注入量和弥散程度可缓解骨质疏松性椎体压缩骨折患者的疼痛，改善活动能力，纠正椎体后凹畸形，较好恢复椎体高度，骨水泥注入量、弥散程度与椎体恢复高度呈正相关。ORCID: 0000-0001-8214-7150(吴海波)中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Correlation of percutaneous vertebroplasty effect on osteoporotic vertebral compression fracture with injection amount and dispersion degree of bone cement

BACKGROUND: Previous studies show that the amount and diffusion degree of bone cement in vertebroplasty have some influence on the postoperative recovery of patients with osteoporotic vertebral compression fracture, but there are few reports about the corr elation between the amount and diffusion degree of bone cement in vertebroplasty and the recovery of vertebral body. OBJECTIVE: To investigate the relationships between the effect of percutaneous vertebroplasty on osteoporotic vertebral compression fractures and the injection amount and dispersion degree of bone cement. METHODS: Totally 102 osteoporotic vertebral compression fracture patients(109 vertebrae) who received treatment in the Sanya Hospital of Traditional Chinese Medicine from January 2017 to August 2018, including 42 males and 60 females at the age of 52-76 years, were retrospectively analyzed. All patients received percutaneous vertebroplasty. According to the injection amount of bone cement, they were divided into two groups: observation group 1(injection > 4 mL, n=57) and control group 1(injection ≤ 4 mL, n=45). According to the degree of dispersion of bone cement, they were divided into two groups: observation group 2(filling rate > 15%, n=61) and control group 2(filling rate ≤ 15%, n=41). Visual analogue scale score, Oswestry disability index, anterior vertebral height, Cobb angle, and the occurrence of cement leakage were observed before and after surgery. The correlations of the injection amount and dispersion degree of bone cement with the height of vertebral body recovered were analyzed. This study was approved by the Medical Ethics Committee of Sanya Hospital of Traditional Chinese Medicine. RESULTS AND CONCLUSION:(1) The visual analogue scale score and Oswestry dysfunction index of patients in the observation group 1 and control group 1 at 3 days after operation were decreased compared with before operation(P < 0.05), while those in the observation group 1 were lower than those in the control group 1(P < 0.05). The visual analogue scale score and Oswestry disability index were decreased in the observation group 2 and control group 2 at 3 days after operation compared with before operation(P < 0.05), while those of the observation group 2 were lower than those of the control group 2(P < 0.05).(2) The anterior height of vertebral body and the Cobb angle in the observation group 1 and control group 1 at 3 days after operation were improved than those before operation(P < 0.05), while those in observation group 1 were better than those in control group 1(P < 0.05). The anterior height of vertebral body and the Cobb angle in observation group 2 and control group 2 at 3 days after operation were improved than those before operation(P < 0.05), while those in observation group 2 were better than those in control group 2(P < 0.05).(3) There was no significant difference in the incidence of cement leakage between observation group 1 and control group 1(P > 0.05). There was no significant difference in the incidence of cement leakage between observation group 2 and control group 2(P > 0.05).(4) The height of vertebral body recovery was positively correlated with the injection amount and dispersion degree of bone cement(P < 0.05).(5) The results suggest that increases of the injection amount and dispersion degree of bone cement properly can alleviate the pain, improve the mobility, correct the deformity of vertebral posterior concave, and restore the height of vertebral body of osteoporotic vertebral compression fracture patients. The injection amount and dispersion degree of bone cement are positively correlated with the recovery height of vertebral body.