可弯曲骨水泥注入器单侧PVP治疗胸、腰椎压缩性骨折临床效果研究
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摘要
目的:评价可弯曲骨水泥注入器单侧经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗胸、腰椎压缩性骨折的临床效果,为其临床治疗方法的选择提供可靠的参考依据。方法:选取2015年1月至2017年12月于院内进行骨科治疗的胸、腰椎压缩性骨折患者88例,按随机数表法分为实验组及对照组(每组44例),分别采用可弯曲骨水泥注入器及普通直型骨水泥注入器进行PVP。对比2组手术时间、放射暴露时间,术前及术后1周、术后3个月、术后12个月视觉模拟评分法(visual analogue score,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)脊柱评分、病变椎体相对高度、Cobb角,术后1周骨水泥渗漏发生率。采用SPSS 22.0软件进行统计学分析。结果:实验组手术时间和放射暴露时间显著少于对照组,差异有统计学意义(P<0.05)。术前2组患者VAS评分及ODI脊柱评分对比,差异无统计学意义(P>0.05),术后VAS评分及ODI脊柱评分均显著下降且实验组显著低于对照组,差异有统计学意义(P<0.05)。术前及术后1周,2组患者病变椎体相对高度及Cobb角对比,差异均无统计学意义(P>0.05);术后3个月及术后12个月,病变椎体相对高度及Cobb角均显著降低且2组差异有统计学意义(P<0.05)。实验组术后1周骨水泥渗漏发生率显著低于对照组,差异有统计学意义(P<0.05)。结论:可弯曲骨水泥注入器单侧PVP治疗胸、腰椎压缩性骨折远期效果明显,与普通直型骨水泥注入器对比,能够显著改善患者VAS评分、ODI脊柱评分以及病变椎体相对高度,而且显著降低术后骨水泥渗漏等并发症发生率,安全有效,值得在临床应用中进一步推广。
Objective To evaluate the clinical effect of single-side percutaneous vertebroplasty(PVP) by flexible bone cement injector for the patients with thoracic or lumbar vertebral compression fractures so as to facilitate clinical treatment.Methods Totally 88 cases with thoracic or lumbar vertebral compression fractures were selected in the 983 rd Hospital from January 2015 to December 2017, and all the patients were divided equally into an experimental group and a control group by random number table method. PVP was executed by flexible bone cement injector in the experimental group and by ordinary straight bone cement injector in the control group. The two groups were compared on operation time, radiation exposure time,the results of visual analogue scores(VAS), spine score by Oswestry disability index(ODI), relative height of lesion vertebral body, Cobbe angle before and one week, three months and twelve months after operation and incidence rate of bone cement leakage one week after operation. SPSS 22.0 software was used for statistical analysis. Results The experimental group had the operation time and radiation exposure time significantly lower than those of the control group(P <0.05); there were no obvious differences between VASs and ODI spine scores of the two groups before operation(P>0.05); the VASs and ODI spine scores both decreased statistically, and the experimental group had them significantly lower than those of the control group(P<0.05); the relative height of lesion vertebral body and Cobbe angle before and one week after operation had no statistical differences in the two groups(P >0.05), while did three months and 12 months after operation(P <0.05); there was no difference between the incidence rates of bone cement leakage of the two groups(P<0.05). Conclusion Single-side PVP by flexible bone cement injector has late clinical effects on thoracic or lumbar vertebral compression fractures. The flexible bone cement injector behaves significantly better than the ordinary cement injector in VAS, ODI spine score, relative height of lesion vertebral body and incidence rate of bone cement leakage, and thus is worthy promoting clinically.
Objective To evaluate the clinical effect of single-side percutaneous vertebroplasty(PVP) by flexible bone cement injector for the patients with thoracic or lumbar vertebral compression fractures so as to facilitate clinical treatment.Methods Totally 88 cases with thoracic or lumbar vertebral compression fractures were selected in the 983 rd Hospital from January 2015 to December 2017, and all the patients were divided equally into an experimental group and a control group by random number table method. PVP was executed by flexible bone cement injector in the experimental group and by ordinary straight bone cement injector in the control group. The two groups were compared on operation time, radiation exposure time,the results of visual analogue scores(VAS), spine score by Oswestry disability index(ODI), relative height of lesion vertebral body, Cobbe angle before and one week, three months and twelve months after operation and incidence rate of bone cement leakage one week after operation. SPSS 22.0 software was used for statistical analysis. Results The experimental group had the operation time and radiation exposure time significantly lower than those of the control group(P <0.05); there were no obvious differences between VASs and ODI spine scores of the two groups before operation(P>0.05); the VASs and ODI spine scores both decreased statistically, and the experimental group had them significantly lower than those of the control group(P<0.05); the relative height of lesion vertebral body and Cobbe angle before and one week after operation had no statistical differences in the two groups(P >0.05), while did three months and 12 months after operation(P <0.05); there was no difference between the incidence rates of bone cement leakage of the two groups(P<0.05). Conclusion Single-side PVP by flexible bone cement injector has late clinical effects on thoracic or lumbar vertebral compression fractures. The flexible bone cement injector behaves significantly better than the ordinary cement injector in VAS, ODI spine score, relative height of lesion vertebral body and incidence rate of bone cement leakage, and thus is worthy promoting clinically.
引文
[1]王兴斌,王洪伟,陈语,等.创伤性胸腰椎骨折的临床特点分析[J].局解手术学杂志,2017,26(2):110-114.
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[3]刘业伟.X线评估骨质疏松性胸腰椎压缩性骨折经皮椎体成形术疗效[J].医疗卫生装备,2016,37(10):72-74.
[4]廖旭昱,周雷杰,马维虎,等.经皮椎体后凸成形术中单侧经椎弓根穿刺角度与骨水泥分布情况的关系[J].临床骨科杂志,2012,15(3):241-244.
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[7]程继伟,王振林,刘伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27(3):235-241.
[8]李玉伟,崔红领,王海蛟.应用可弯曲骨水泥注入器单侧穿刺行经皮椎体成形术的可行性及疗效[J].中华放射学杂志,2017,51(4):293-298.
[9]刘尚礼,叶伟,李春海.经皮椎体成形术的研究进展[J].脊柱外科杂志,2008,6(1):58-61.
[10]徐昕,云雄,邓迎生,等.椎体压缩骨折术后骨折改善率相关影响因素分析[J].临床骨科杂志,2012,15(3):258-260.
[11]ZDERIC I,STEINMETZ P,WINDOLF M,et al.Bone cement flow analysis by stepwise injection through medical cannulas[J].Med Eng Phys,2016,38(12):1 434-1 438.
[12]卢昌怀,刘志军,张宏波,等.骨水泥量及分布对椎体成形术后相邻椎体生物力学影响的三维有限元分析[J].中国骨质疏松杂志,2015(1):29-33.
[13]费琦,李秋军,李东,等.椎体后凸成形术后骨水泥椎间盘渗漏对邻近节段力学影响的有限元分析[J].中华医学杂志,2011,91(1):51-55.
[14]文坤树,蔡勇平,张家金,等.PKP术中骨水泥的灌注量与分布对OVCF早期疗效的影响[J].重庆医学,2016(1):62-65.
[15]翁科捷,钟志刚,张育锋,等.三种椎弓根入路行椎体后凸成形术的骨水泥弥散分布及临床对比研究[J].山西医药杂志,2016,45(13):1 501-1 503.
[16]蔡佳,郝应文,李超,等.经皮椎体成形骨水泥注入修复骨质疏松性胸腰椎体压缩骨折:椎弓根入路方案[J].中国组织工程研究,2015,19(30):4 892-4 897.
[17]陈柏龄,谢登辉,黎艺强,等.单侧PKP骨水泥注射过中线分布对压缩性骨折椎体两侧刚度的影响[J].中国脊柱脊髓杂志,2011,21(2):118-121.
[18]刘亮,蔡丰,杨安礼.椎体成形术骨水泥渗漏的原因分析及预防对策[J].中国骨与关节损伤杂志,2010,25(7):615-616.
[2]贺宝荣,许正伟,郝定均.胸腰椎骨折伴完全性脊髓损伤治疗的相关问题探讨[J].中华创伤杂志,2015,31(6):494-495.
[3]刘业伟.X线评估骨质疏松性胸腰椎压缩性骨折经皮椎体成形术疗效[J].医疗卫生装备,2016,37(10):72-74.
[4]廖旭昱,周雷杰,马维虎,等.经皮椎体后凸成形术中单侧经椎弓根穿刺角度与骨水泥分布情况的关系[J].临床骨科杂志,2012,15(3):241-244.
[5]谭明生.胸腰椎骨折的分类与治疗选择[J].中国骨伤,2008,21(1):1-4.
[6]KARABIS A,NIKOLAKOPOULOS S,PANDHI S,et al.High correlation of VAS pain scores after 2 and 6 weeks of treatment with VAS pain scores at 12 weeks in randomised controlled trials in rheumatoid arthritis and osteoarthritis:meta-analysis and implications[J].Arthritis Res Ther,2016,18(1):1-7.
[7]程继伟,王振林,刘伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27(3):235-241.
[8]李玉伟,崔红领,王海蛟.应用可弯曲骨水泥注入器单侧穿刺行经皮椎体成形术的可行性及疗效[J].中华放射学杂志,2017,51(4):293-298.
[9]刘尚礼,叶伟,李春海.经皮椎体成形术的研究进展[J].脊柱外科杂志,2008,6(1):58-61.
[10]徐昕,云雄,邓迎生,等.椎体压缩骨折术后骨折改善率相关影响因素分析[J].临床骨科杂志,2012,15(3):258-260.
[11]ZDERIC I,STEINMETZ P,WINDOLF M,et al.Bone cement flow analysis by stepwise injection through medical cannulas[J].Med Eng Phys,2016,38(12):1 434-1 438.
[12]卢昌怀,刘志军,张宏波,等.骨水泥量及分布对椎体成形术后相邻椎体生物力学影响的三维有限元分析[J].中国骨质疏松杂志,2015(1):29-33.
[13]费琦,李秋军,李东,等.椎体后凸成形术后骨水泥椎间盘渗漏对邻近节段力学影响的有限元分析[J].中华医学杂志,2011,91(1):51-55.
[14]文坤树,蔡勇平,张家金,等.PKP术中骨水泥的灌注量与分布对OVCF早期疗效的影响[J].重庆医学,2016(1):62-65.
[15]翁科捷,钟志刚,张育锋,等.三种椎弓根入路行椎体后凸成形术的骨水泥弥散分布及临床对比研究[J].山西医药杂志,2016,45(13):1 501-1 503.
[16]蔡佳,郝应文,李超,等.经皮椎体成形骨水泥注入修复骨质疏松性胸腰椎体压缩骨折:椎弓根入路方案[J].中国组织工程研究,2015,19(30):4 892-4 897.
[17]陈柏龄,谢登辉,黎艺强,等.单侧PKP骨水泥注射过中线分布对压缩性骨折椎体两侧刚度的影响[J].中国脊柱脊髓杂志,2011,21(2):118-121.
[18]刘亮,蔡丰,杨安礼.椎体成形术骨水泥渗漏的原因分析及预防对策[J].中国骨与关节损伤杂志,2010,25(7):615-616.
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