高粘度骨水泥结合膨胀式椎体成形器械治疗骨质疏松性椎体压缩骨折的效果观察*

目的观察并分析高粘度骨水泥结合膨胀式椎体成形器械和经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）的临床效果。方法选取2014年10月至2017年2月期间在我院住院的OVCF患者共224例为研究对象。采用随机双盲法分为两组，观察组112例采用高粘度骨水泥结合膨胀式椎体成形器械进行椎体成形术治疗，对照组112例采用高粘度骨水泥PKP治疗。比较两组手术时间、术中出血量、骨水泥注射量、骨水泥渗漏发生率和骨水泥弥散系数，术前、术后1 d及术后1年两组Cobb角、椎体高度及视觉模拟评分法（visual analogue scale，VAS）评分变化，术后满意度。结果观察组手术时间、术中出血量及骨水泥注射量均显著少于对照组（P＜0.05），观察组骨水泥渗漏发生率显著低于对照组（P＜0.05），两组骨水泥弥散系数比较差异无统计学意义（P＞0.05）；术后1 d及术后1年，两组Cobb角和伤椎前缘高度比较差异无统计学意义（P＞0.05）；术后1 d及术后1年，两组VAS评分比较差异无统计学意义（P＞0.05）；两组术后满意度比较差异无统计学意义（P＞0.05）。结论高粘度骨水泥结合膨胀式椎体成形器械治疗OVCF患者与高粘度骨水泥PKP治疗效果相似，但可有效缩短手术时间，减少出血量，降低骨水泥渗漏率，纠正后凸畸形，恢复椎体高度，减轻疼痛，提高术后满意度。

英文摘要:

Objective To observe and analyze the clinical effect of high viscosity bone cement combined with bone expander system and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods A total of 224 patients with OVCF admitted to our hospital from October 2014 to February 2017 were enrolled. They were divided into two groups by random double-blind method. A total of 112 patients in the observation group were treated with high viscosity bone cement combined with bone expander system for vertebroplasty. The other 112 patients in the control group were treated with high viscosity bone cement PKP. The operation time, intraoperative blood loss, injection volume of bone cement, incidence of bone cement leakage and diffusion coefficient of bone cement, and changes of Cobb angle, vertebral height and visual analogue scale (VAS) score before operation, at 1d and 1 year after operation, and postoperative satisfaction were compared between the two groups. Results The operation time, intraoperative blood loss and injection volume of bone cement in the observation group were significantly fewer than those in the control group (P<0.05). The incidence of bone cement leakage in the observation group was significantly lower than that in the control group (P<0.05). There was no significant difference in the diffusion coefficient of bone cement between the two groups (P>0.05). There was no significant difference in Cobb angle, or anterior height of the injured vertebra between the two groups at 1 d and 1 year after operation (P>0.05). There was no significant difference in VAS score between the two groups at 1 d and 1 year after operation (P>0.05). There was no significant difference in postoperative satisfaction between the two groups (P>0.05). Conclusion The effect of high viscosity bone cement combined with bone expander system is similar to that of high viscosity bone cement PKP in the treatment of patients with OVCF. However, the combined treatment can effectively shorten the operation time, reduce the bleeding volume, and reduce the rate of bone cement leakage.

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