摘要
目的探究骨质疏松性椎体压缩骨折(OVCF)经皮椎体后凸成形术(PKP)术后骨水泥的分布形态对病人早期预后的影响。方法选取2013年5月至2018年6月在北京市平谷区医院就诊的109例OVCF作为研究对象,根据椎体内骨水泥是否发生偏侧分为中位组68例,偏侧组41例。对比两组术前的临床资料;统计病人术后恢复情况;对比两组术后不同时期的手术效果指标及术后骨水泥渗漏率、再次骨折发生率;logistic回归分析影响病人预后的因素。结果两组年龄、性别、体质量指数(BMI)、术前视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)、后凸Cobb角、骨折椎体的前后缘高度比(AH/PH)及骨密度比较,均差异无统计学意义(P>0.05);所有病人术后1周及末次随访时VAS评分、ODI、后凸Cobb角及手术椎体高度均较术前有明显改善(P<0.05);两组术后3月VAS评分、ODI、后凸Cobb角及AH/PH比较,均差异无统计学意义(P>0.05),术后12月中位组ODI[(24.09±4.26)%比(26.96±3.92)%]、后凸Cobb角[(19.57±4.01)°比(21.65±3.76)°]改善均优于偏侧组(P<0.05);中位组骨水泥渗透率(5.88%比21.95%)及再次骨折发生率(2.94%比17.07%)均明显低于偏侧组(P<0.05);骨水泥分布形态及骨水泥渗漏率均是影响OVCF病人PKP术后预后的危险因素(P<0.05)。结论 PKP术后骨水泥的分布形态影响OVCF病人预后效果,其偏侧可增加病人骨水泥渗漏及再次骨折的几率,在手术过程中应尽量使骨水泥中位分布。
Objective To investigate the influence of bone cement distribution on the early prognosis of osteoporotic vertebral compression fracture(OVCF)patients after percutaneous kyphoplasty of vertebral body(PKP).Methods From May 2013 to June 2018,109 OVCF patients treated in Beijing Pinggu District Hospital were selected as the study objects,and according to whether there was deviation of bone cement in the vertebral body,they were assigned into middle position group(n=68)and lateralization group(n=41).The preoperative clinical data of the two groups were compared,the recovery of the patients was recorded,the indexes of operative effect,the permeability rate of bone cement and the incidence of re-fracture were compared between the two groups,and Logistic regression was used to analyze the factors affecting the prognosis of patients.Results There were no significant differences in age,gender,body mass index(BMI),preoperative visual analogue score(VAS),Oswestry dysfunction index(ODI),convex Cobb angle,anterior and posterior edge height ratio(AH/PH)and bone mineral density between the two groups(P>0.05).VAS score,ODI,convex Cobb angle and the operative vertebral height in all patients at 1 week after operation and the last follow-up were significantly improved than those before operation(P<0.05).There were no significant differences in VAS score,ODI,convex Cobb angle and AH/PH between the two groups at 3 months after operation(P>0.05),and the improvements in ODI[(24.09±4.26)%vs.(26.96±3.92)%]and convex Cobb angle[(19.57±4.01)°vs.(21.65±3.76)°]in the middle position group at 12 months after operation was better than those in the lateralization group(P<0.05).The permeability rate of bone cement(5.88%vs.21.95%)and the incidence of re-fracture(2.94%vs.17.07%)in the middle position group were significantly lower than those in the lateralization group(P<0.05).The distribution of bone cement and the permeability rate of bone cement were risk factors for the prognosis of OVCF patients after PKP(P<0.05).Conclusions The distribution pattern of bone cement after PKP affects the prognosis of OVCF patients.The deviation of bone cement can increase the probabilities of leakage of bone cement and re-fracture.The median distribution of bone cement should be achieved as much as possible during the operation.
作者
李云鹏
刘爱华
范江涛
LI Yunpeng;LIU Aihua;FAN Jiangtao(Department of'Orthopedics,Beijing Pinggu District Hospital,University,Beijing 101200,China)
出处
《安徽医药》
CAS
2021年第4期686-689,共4页
Anhui Medical and Pharmaceutical Journal
基金
国家自然科学基金(81472086)。
