骨水泥在椎体中线的分布对经皮椎体成形术治疗效果的影响

doi:10.3969/j.issn.2095-378X.2025.01.018

摘要/Abstract

摘要： 目的　探究经皮椎体成形术治疗骨质疏松性椎体压缩性骨折（OVCF）中骨水泥在椎体中线的分布对治疗效果的影响。方法　回顾性分析2020年3月—2021年7月在泉州市第一医院收治的95例胸腰段（T11-L2） OVCF患者的诊疗资料。根据骨水泥在椎体中线的分布情况,将患者分为骨水泥单侧分布组（n=40）和骨水泥双侧分布组（n=55）。采用视觉模拟评分法（VAS）评价患者疼痛强度。通过影像学分析比较患者治疗前后的椎体高度及治疗前后的Cobb角。采用Oswestry失能指数（ODI）评估患者失能程度。发放满意度调查问卷评估患者对治疗方案的满意度。结果　术后6个月,骨水泥双侧分布组VAS评分较骨水泥单侧分布组降低（P<0.05）。术后7 d及6个月,骨水泥双侧分布组椎体高度较骨水泥单侧分布组增加,Cobb角降低,ODI降低,差异均有统计学意义（P<0.05）。骨水泥双侧分布组非常满意率和总满意率均高于骨水泥单侧分布组（P<0.05）。结论　骨水泥分布在椎体中线两侧对椎体高度恢复和Cobb角矫正效果更好,提示骨水泥双侧分布能获得更好的临床恢复。

关键词: 骨水泥, 经皮椎体成形术, 骨质疏松, 椎体压缩性骨折

Abstract: Objective To investigate the effect of the distribution of bone cement along the midline of the vertebral body on the treatment of osteoporotic vertebral compression fractures （OVCF） using percutaneous vertebroplasty. Methods This retrospective study collected the diagnosis and treatment data of 95 patients with thoracolumbar （T11-L2） OVCF admitted to Quanzhou First Hospital from March 2020 to July 2021. According to the distribution of bone cement along the midline of the vertebral body, the patients were divided into a unilateral distribution group of bone cement （n=40） and a bilateral distribution group of bone cement （n=55）. Visual analogue scores were used to evaluate pain intensity. The vertebral height and Cobb angles of patients before and after treatment were compared by imaging analysis. The Oswestry disability index （ODI） was used to assess the degree of disability in patients. Questionnaires were distributed to evaluate patients' satisfaction with treatment plans. Results Six months after surgery, the VAS scores of the bilateral distribution group of bone cement were lower than those of the unilateral distribution group of bone cement （P<0.05）. At 7 d and 6 months postoperatively, the vertebral height increased, the Cobb angle decreased, and the ODI decreased in the bilateral distribution group of bone cement compared to the unilateral distribution group of bone cement （P<0.05）. The very satisfied and total satisfaction rates of the bilateral distribution group of bone cement were higher than those of the unilateral distribution group of bone cement （P<0.05）. Conclusion The distribution of bone cement on both sides of the vertebral midline has a good effect on correcting vertebral height and Cobb angle, indicating its satisfactory clinical recovery.

Key words: Bone cement, Percutaneous vertebroplasty, Osteoporosis, Vertebral compression fracture

中图分类号:

R683.4

闻博. 骨水泥在椎体中线的分布对经皮椎体成形术治疗效果的影响[J]. 外科研究与新技术（中英文）, 2025, 14(1): 73-77.

WEN Bo. Influence of bone cement distribution in midline of vertebral body on therapeutic effect of percutaneous vertebroplasty[J]. Surgical Research and New Technique, 2025, 14(1): 73-77.

参考文献

[1] Dai C, Liang G, Zhang Y, et al.Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2022, 17(1): 161.
[2] Qin DA, Song JF, Liang QY.Adjacent intravertebral cement leakage during percutaneous vertebroplasty for osteoporotic vertebral compression fractures[J]. Pain Med, 2021, 22(6):1453-1455.
[3] Imamudeen N, Basheer A, Iqbal AM, et al.Management of osteoporosis and spinal fractures: contemporary guidelines and evolving paradigms[J]. Clin Med Res, 2022, 20(2): 95-106.
[4] Cheng Y, Cheng X, Wu H.Risk factors of new vertebral compression fracture after percutaneous vertebroplasty or percutaneous kyphoplasty[J]. Front Endocrinol (Lausanne), 2022, 13(8): 964578.
[5] Zhang ZL, Yang JS, Hao DJ, et al.Risk factors for new vertebral fracture after percutaneous vertebroplasty for osteoporotic vertebral compression fractures[J]. Clin Interv Aging, 2021, 16(6): 1193-1200.
[6] 王彪,詹乙,孔令擘,等. 新型骨水泥桥接螺钉系统联合经皮椎体成形术治疗伴椎体内真空裂隙的症状性陈旧性胸腰椎骨质疏松性骨折的疗效[J]. 中华创伤杂志,2022,38(4):301-306.
[7] Park JS, Park YS.Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture[J]. Spine J, 2021, 21(8): 1355-1361.
[8] Peng J, Qin J, Huang T, et al.Clinical outcomes of fracture haemorrhage aspiration for percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures[J]. J Pain Res, 2021, 14(10): 3951-3959.
[9] Wu Z, Y L, Mo L, et al. Comparison of cement leakage rate and severity after percutaneous vertebroplasty for osteoporotic vertebral compression fractures using front-opening versus side-opening cannulas[J]. Orthopedics, 2021, 44(3): 134-140.
[10] Lu Q, Gao S, Zhou M.The effect of bone cement on the curative effect of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture[J]. Ann Palliat Med, 2021, 10(10): 11013-11023.
[11] Zhang G, Zhu J, Zhang Q, et al.Effects of high viscosity bone cement percutaneous vertebroplasty on pain, bone specific alkaline phosphatase, Type-Ⅰ collage cross-linked-telopeptide and Boneglaprotein levels in patients with osteoporotic vertebral compression fractures[J]. Pak J Med Sci, 2022, 38(6): 1552-1556.
[12] Lu K, Yin Y, Li C, et al.Efficacy of annual zoledronic acid in initial percutaneous kyphoplasty patients with osteoporotic vertebral compression fractures: a 3-year follow-up study[J]. Osteoporos Int, 2021, 32(7): 1429-1439.
[13] Li W, Wang H, Dong S, et al.Establishment and validation of a nomogram and web calculator for the risk of new vertebral compression fractures and cement leakage after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures[J]. Eur Spine J, 2022, 31(5): 1108-1121.
[14] Choi SS, Kim H, Choung YJ, et al.Risk factors for new vertebral compression fracture after kyphoplasty and efficacy of osteoporosis treatment: a STROBE-compliant retrospective study[J]. Medicine (Baltimore), 2022, 101(49): e32018.
[15] Wang Q, Sun C, Zhang L, et al.High- versus low-viscosity cement vertebroplasty and kyphoplasty for osteoporotic vertebral compression fracture: a meta-analysis[J]. Eur Spine J, 2022, 31(5): 1122-1130.
[16] An Y, Li L, Lin X, et al.Risk assessment for sandwich vertebral fractures in the treatment of osteoporosis vertebral compression fractures using two methods of bone cement reinforcement[J]. J Orthop Surg Res, 2023, 18(1): 524.
[17] Tang J, Liu J, Gu Z, et al.Outcomes of augmentation in osteoporotic vertebral compression fractures showing a cleft sign on MRI[J]. Cardiovasc Intervent Radiol, 2021, 44(3):428-435.
[18] Gao W, Chen Y, Wang X, et al.Establishment and verification of a predictive nomogram for new vertebral compression fracture occurring after bone cement injection in middle-aged and elderly patients with vertebral compression fracture[J]. Orthop Surg, 2023, 15(4): 961-972.
[19] Pan M, Ge J, Li Q, et al.Percutaneous vertebral augmentation in special Genant Ⅳ osteoporotic vertebral compression fractures[J]. J Orthop Translat, 2020, 20(8):94-99.
[20] Pang J, Liu B, Chen H, et al.Precise puncture combined with simplified percutaneous vertebroplasty to treat osteoporotic vertebral compression fractures: a comparative analysis with conventional percutaneous vertebroplasty[J]. Am J Transl Res, 2021, 13(12): 14195-14202.