经皮椎体成形术中骨水泥弥散容积比与疗效相关性的临床研究

doi:10.3969/j.issn.1009-976X.2020.05.011

摘要/Abstract

摘要： 目的评价椎体成形术中骨水泥弥散容积比与疗效的关系。方法 2016年1月至2018年5月,43例骨质疏松性椎体压缩骨折患者在我科施行经皮椎体成形术,术后Mimics软件上计算出伤体内骨水泥弥散容积。骨水泥弥散容积比=骨水泥弥散容积/伤锥体积,将骨水泥弥散容积比分为3级,1级<25%,25%<2级<50%,3级>50%,对比术前与术后随访（12个月）的模拟VAS评分与腰疼ODI评分。结果 37例患者实施PVP,术后获12~27个月随访（平均16.8个月）,患者背部疼痛均有不同程度缓解或者消失。骨水泥弥散容积比分为1级、2级、3级各组之间的疼痛缓解疗效的差异无统计学意义（P>0.05）。结论经皮椎体成形术中骨水泥弥散容积比<25%即可获得满意疗效,增加骨水泥弥散容积比不能获得更好的疗效。

关键词: 椎体成形术, 骨水泥体积

Abstract: Objective To assess the volume ratio of bone cement on the therapeutic results in percutaneous vertebroplasty. Methods From January 2016 to May 2018, 43 patients suffered from osteoporotic vertebral compression fracture were performed percutaneous vertebroplast. CT scans of pre-operative and post-operative were imported into Mimics software and the diffusion volume of bone cement in vertebral body was calculated. Bone cement diffusion volume ratio = bone cement diffusion volume / wound cone volume. Bone cement diffusion volume ratio was divided into three grades, grade 1 <25%, 25<grade 2<50%, grade 3>50%. The VAS scores and Oswestry Disability Index scores were compared at preoperation, 12 months after operation. Results Thirty-seven vertebral bodies were operated in percutaneous vertebroplast. They were followed up for 12 to 27 months （average 16.8 months）. The back pain of the patients was alleviated or disappeared. There was no significant difference in pain relief between the groups with cement diffusion volume ratio of grade 1, grade 2 and grade 3（P<0.05）. Conclusion In the present study, cement volume ratio less than 25% was an effective therapy for osteoporotic vertebralcompression fractures in vertebroplasty. Increasing the diffusion volume ratio of bone cement couldn't achieve better curative effect.

Key words: percutaneousvertebroplasty, bone cement volume

中图分类号:

R683.2

陈嘉裕, 刘展亮, 张惠城, 杨永迁, 黄岭志, 杨志发. 经皮椎体成形术中骨水泥弥散容积比与疗效相关性的临床研究[J]. 岭南现代临床外科, 2020, 20(05): 597-600.

CHEN Jia-yu, LIU Zhan-liang, ZHANG Hui-cheng, YANG Yong-qian, HUANG Ling-zhi, YANG Zhi-fa. Clinical research of the volume ratio of bone cement on the therapeutic results in percutaneous vertebroplast[J]. Lingnan Modern Clinics in Surgery, 2020, 20(05): 597-600.

参考文献

[1] Yang EZ, Xu JG, Huang GZ et al. Percutaneous Vertebroplasty Versus Conservative Treatment inAged Patients With Acute Osteoporotic Vertebral Compression Fractures: A Prospective Randomized Controlled Clinical Study[J]. Spine (Phila Pa 1976), 2016, 41(8):653-660.
[2] Wang B, Guo H, Yuan L et al. A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplastyor facet blocking[J]. Eur Spine J, 2016, 25(11):3486-3494.
[3] Jin YJ, Yoon SH, Park KW et al. The volumetric analysis of cement in vertebroplasty: relationship with clinical outcome and complications[J]. Spine (Phila Pa 1976), 2011, 36:E761-72.
[4] 候文根, 孙晓辉, 张超, 杨素敏.骨水泥体积分布对单节段骨质疏松性腰椎压缩性骨折行经皮椎体成形术患者邻近椎体骨折的影响[J]. 2015, 32(12): 1119-1121.
[5] Komemushi A, Tanigawa N, Kariya S et al. Percutaneous vertebroplasty for compression fracture: analysis of vertebral body volume by CT volumetry[J]. Acta Radiol, 2005, 46(3):276-279.
[6] Mousavi P, Roth S, Finkelstein J, et al.Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae[J]. J Neurosurg, 2003, 99(1 Suppl):56-59.
[7] 林鹏, 洪正华, 陈海啸, 等. 经皮椎体成形术穿刺失误致并发症的治疗[J]. 中华骨科杂志, 2016, 36(17): 1107-1113.
[8] Webb JCJ, Spencer RF.The role of polymethylmethacrylate bone cement inmodern orthopaedic surgery[J]. J Bone Joint Surg Br, 2007, 89(7):851-857.
[9] Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture [J]. Cochrane Database Syst Rev, 2018, 4(4):CD006349.
[10] Dragan SF, Urbański W, Zywirski B, et al.Kyphosiscorrection aftervertebroplastyin osteoporotic vertebral compression fractures[J]. Acta BioengBiomech, 2012, 14(4):63-69.
[11] Komemushi A, Tanigawa N, Kariya S, et al.Percutaneous vertebroplastyfor compression fracture: analysis of vertebral body volumeby CT volumetry[J]. Acta Radiol, 2005, 46(3): 276-279.
[12] Kaufmann TJ, Trout AT, Kallmes DF.The effects of cement volumeon clinical outcomes of percutaneous vertebroplasty[J]. AJNR Am J Neuroradiol, 2006, 27(9): 1933-1937.
[13] Al-Ali F, Barrow T, Luke K.Vertebroplasty: what is important andwhat is not[J]. AJNR Am J Neuroradiol, 2009, 30(10): 1835-1839.
[14] Jin YJ, Yoon SH, Park KW, et al.The volumetric analysis of cementin vertebroplasty: relationship with clinical outcome and complications[J]. Spine (Phila Pa 1976), 2011, 36(12): E761-E772.
[15] Nieuwenhuijse MJ, Bollen L, van Erkel AR, Dijkstra PD. Optimal intravertebral cement volume in percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures[J]. Spine (Phila Pa 1976), 2012, 37(20): 1747-1755.
[16] Nieuwenhuijse MJ, Muijs SP, van Erkel AR, et al. A clinicalcomparative study on low versus medium viscosity polymethylmetacrylatebone cement in percutaneous vertebroplasty: viscosityassociated with cement leakage[J]. Spine (Phila Pa 1976), 2010, 35(20):E1037-E1044.
[17] Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD.Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors[J]. Spine J, 2011, 11(9): 839-848.
[18] Yu W, Liang D, Yao Z, Qiu T, et al.Risk factors for recollapseof the augmented vertebrae after percutaneous vertebroplasty forosteoporotic vertebral fractures with intravertebral vacuum cleft[J]. Medicine, 2017, 96(2):e5675.