北京生物医学工程

侧推椎体内注射聚甲基丙烯酸甲酯骨水泥治疗骨质疏松性椎体隐匿性骨折的应用研究

Application of lateral injection of polymethyl methacrylate bone cement in the treatment of osteoporotic vertebral occult fracture

作者：王建光许有银吴俊贤韩晓斌李玉民

单位：民航总医院骨科（北京 100123） <p>通信作者：王建光。E-mail：wangjianguang04272@163.com</p> <p> </p>

关键词：骨质疏松性椎体压缩性骨折；椎体隐匿性骨折；骨水泥分布；经皮椎体成形术；侧推技术

分类号：R318.01 

出版年·卷·期（页码）：2022·41·3（271-274）

摘要：

目的探讨侧推椎体内注射聚甲基丙烯酸甲酯骨水泥治疗骨质疏松性椎体隐匿性骨折的临床治疗效果。方法选择民航总医院2016年3月至2019年9月采用经皮椎体成形术（percutaneous vertebroplasty, PVP）治疗骨质疏松性椎体隐匿性骨折患者68例，侧推组40例，对照组28例，两组患者在年龄、性别、病情分级上无统计学差异。通过对比两组患者的骨水泥注入量以及骨水泥分布情况评价侧推的临床效果；采用术后随访的疼痛视觉模拟评分法（visual analogue,VAS）评价手术效果；测量对比Cobb角以及椎体前缘的椎体高度（vertebral height,VH）评价脊柱畸形的矫正效果。结果骨水泥注入量和分布侧推组与对照组差异具有统计学意义（P＜0.001)。侧推组术后3 d与对照组VAS比较，差异具有统计学意义（P＜0.001），侧推组和对照组术前和术后6个月、术后12个月VAS比较，差异无统计学意义（P＞0.05）。VH侧推组和对照组差异具有统计学意义（P＜0.001）。Cobb角术后12个月侧推组和对照组差异具有统计学意义（P＜0.05）。结论侧推PVP治疗骨质疏松性椎体隐匿性骨折，椎体骨水泥注入量大且骨水泥分布状况良好，术后患者疼痛缓解显著，椎体前缘高度恢复及Cobb角得到矫正，术后恢复快，可取得满意的中远期疗效，同时显著预防椎体进一步塌陷及脊柱后凸畸形的发生。

Objective To investigate the clinical effect of lateral push vertebra injection of polymethyl methacrylate bone cement in the treatment of osteoporotic vertebral occult fracture. Methods 68 patients, 40 in the lateral push group and 28 in the control group, were selected from percutaneous vertebroplasty (PVP) for the treatment of osteoporotic occultation vertebral fractures in Civil Aviation General Hospital from March 2016 to September 2019. There was no statistical difference in age, gender and disease grade between the two groups. The clinical effect of lateral thrusting was evaluated by comparing the amount of bone cement injection and the distribution of bone cement between the two groups. Visual analogue scale (VAS) was used to evaluate the outcome of surgery. Cobb angle and vertebral height (VH) were measured to evaluate the effect of vertebral deformity. Results There was significant difference in the amount and distribution of bone cement injection between the lateral push group and the control group (P＜0.001). VAS of the lateral push group was significantly different from that of the control group 3 days after surgery (P <0.001), while VAS of the lateral push group was not significantly different from that of the control group before surgery, 6 months after surgery and 12 months after surgery (P＞0.05). There was significant difference in the front of VH between the thrust group and the control group (P＜0.001). The Cobb angle of the lateral thrust group and the control group was significant 12 months after operation (P＜0.05), while the other differences were not significant (P＞0.05). Conclusions PVP treatment of osteoporotic vertebral body thrust technology hidden fracture vertebral body bone cement injection quantity and distribution of bone cement is in good condition, postoperative pain relief in patients with significant, fanterior flange height recovery and Cobb angle correction, postoperative recovery fast, can obtain satisfactory long-term curative effect, at the same time significantly prevent further collapse and convex deformity after spinal vertebral bodies.

参考文献：

[1] ?Aghebati-Maleki L, Dolati S, Zandi R, et al.Prospect of mesenchymal stem cells in therapy of osteoporosis: a review[J]. Journal Of Cellular Physiology，2019，234: 8570–8678.

[2] Zhou XS, Meng XT, Zhu HT, et al. Early versus late percutaneous kyphoplasty for treating osteoporotic vertebral compression fracture: a retrospective study[J]. Clinical Neurology and Neurosurgery，2019，180: 101–105.

[3]杨丰建，林伟龙，朱炯，等.经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折[J].中国脊柱脊髓杂志,2011,21（1）：50-54.

Yang FJ，Lin WL，Zhu J，et al.Percutaneous vertebroplasty and percutanous kyphoplasty for osteoporotic vertebral compression fractures[J]. Chinese Journal of Spine and Spinal Cord,2011,21（1）：50-54.

?[4]Buchbinder R, Osborne RH, Ebeling PR et al . A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures [J].The New England Journal of Medicine，2009，361:557–568.

[5] Hulme PA, Krebs J, Ferguson SJ，et al. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies[J]. Spine，2006，31:1983–2001.

[6]Klazen CA, Lohle PN, de Vries J，et al . Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial[J]. Lancet，2010，376 (9746):1085–1092.

[7]Benz BK, Gemery JM, McIntyre JJ ，et al. Value of immediate preprocedure magnetic resonance imaging in patients scheduled to undergo vertebroplasty or kyphoplasty[J]. Spine ，2009，34:609–612.

[8]Yang X, Mi S, Mahadevia AA，et al.Pain reduction in osteoporotic patients with vertebral pain without measurable compression [J]. Neuroradiology，2008，50:153–159.

[9]De Kong L, Meng LC, Shen Y et al: Effect of shape and severity of vertebral

fractures on the outcomes of kyphoplasty [J]. Acta Orthopaedica Belgica , 2013; 79(5):565–571.

[10]Pham T, Azulay-Parrado J, Champsaur P，et al: “Occult” osteoporotic vertebral fractures: Vertebral body fractures without radiologic collapse [J]. Spine? (Phila Pa 1976), 2005; 30(21): 2430–2435.

[11]Mao H, Zou J, Geng D，et al,. Osteoporotic vertebral fractures without compression: key factors of diagnosis and initial outcome of treatment with? cement augmentation[J]. Neuroradiology, 2012， 54(10): 1137–1143.

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