双侧经皮椎体成形术中骨水泥注入量对压缩性颈椎骨折的影响

Influences of bone cement injection amounts during bilateral percutaneous vertebroplasty on compression fracture of cervical vertebrae

摘要:

目的 探讨双侧经皮椎体成形术治疗骨质疏松性压缩性骨折中不同骨水泥注入量对临床疗效的影响。方法 前瞻性收集浙江省温州市中西医结合医院收治的骨质疏松性压缩性骨折患者82 例，将患者随机分为观察组和对照组，每组41 例。两组患者经双侧经皮椎体成形术，注入高黏度骨水泥，观察组骨水泥注入量为1.5 ～ 2.5 ml，对照组为2.6 ～ 3.5 ml。观察两组患者的临床疗效和不良反应。结果 与对照组比较，观察组患者骨水泥注入量、渗漏率较低（P <0.05）。两组患者椎间盘渗漏和椎旁渗漏均无明显临床症状，未予特殊处理。对照组椎管内渗漏2 例，术后出现肌体无力，给予椎板切除减压，取出椎管内骨水泥并行营养神经治疗，术后1 个月症状消失。两组患者术前、术后1 和6 个月时视觉模拟评分法评分、手术时间、透视次数、颈椎功能障碍指数、匹兹堡睡眠指数、健康相关的生存质量及Cobb 角比较，差异无统计学意义（P >0.05）。结论 不同剂量骨水泥注入均可改善患者临床症状，但注入低剂量骨水泥可以降低其渗漏率。

Abstract:

Objective To explore different amounts of bone cement injection on clinical efficacy of bilateral percutaneous vertebroplasty for osteoporotic compression fracture of cervical vertebrae. Methods Eighty-two patients with osteoporotic compression fracture of cervical vertebrae were collected prospectively in our hospital and were randomly divided into observation group and control group, each included 41 cases. The patients of both groups received bilateral percutaneous vertebroplasty with injection of high-viscosity bone cement. The amounts of the injection in the observation group were 1.5-2.5 ml, and those in the control group were 2.6-3.5 ml. The clinical effect and the adverse reactions were observed. Results Compared with the control group, the amount of the injection of bone cement in the observation group decreased (P < 0.05); the bone cement leakage rate was decreased (P < 0.05).There was no obvious clinical symptom on intervertebral leakage or paravertebral leakage in both groups without any special treatment. In the 2 cases of the control group with intraspinal leakage, body weakness occurred after operation, they were then given laminectomy decompression followed by intraspinal bone cement extraction and the neurotrophic therapy, and the symptom mentioned above disappeared 1 month after operation. There was no statistical difference in Visual Analogue Scales (VAS) score, operation time, times of X-ray examination, cervical vertebra dysfunction index, Pittsburgh Sleep Quality Index (PSQI), health-related quality of life (SF-36) or Cobb angle between the two groups before operation, 1 month and 6 months after operation (P > 0.05). Conclusions Different dosages of injection of bone cement can significantly improve the patients’ clinical symptoms, but low dosage of injection can significantly reduce the bone cement leakage rate.