摘要
目的 探讨经皮椎体成形术(PVP)联合自固化磷酸钙人工骨(CPC)混合聚甲基丙烯酸甲酯(PMMA)骨水泥治疗骨质疏松性椎体压缩性骨折(OVCF)的疗效,并分析术后并发症.方法 回顾性分析2020年10月-2023年10月南京大学医学院附属泰康仙林鼓楼医院骨科行PVP治疗的111例OVCF患者临床资料,其中男性20例,女性91例;年龄52～86岁,平均67.8岁;跌倒伤68例,道路交通伤31例,其他12例.按照填充物的不同分为PMMA组(PMMA骨水泥为填充物,53例)和混合组(填充物为CPC与PMMA骨水泥1∶1混合,58例),比较两组患者疼痛、影像学指标、功能障碍、生活质量、治疗有效率和并发症发生率.结果 与术前比较,两组术后2 d、1、3、6个月VAS降低(P＜0.05);与PMMA组比较,混合组术后2 d、1、3、6个月VAS比较差异无统计学意义(P＞0.05).与术前比较,两组术后2d、1、3、6个月Cobb角、椎体矢状指数比较差异无统计学意义(P＞0.05);与PMMA组比较,混合组术后2d、1、3、6个月Cobb角、椎体矢状指数比较差异无统计学意义(P＞0.05).两组术后1、3、6个月Oswestry功能障碍指数(ODI,PMMA组:54.62±6.58、38.40±6.11、36.30±6.58,混合组:55.52±6.22、35.57±6.20、32.62±4.22)、国际骨质疏松生活质量评估量表(QUALEF-FO-41)评分[PMMA 组:(37.58±5.86)分、(35.96±6.26)分、(34.74±5.93)分;混合组:(39.02±5.70)分、(32.66±5.19)分、(31.64±4.98)分]低于术前[ODI:PMMA 组 75.19±8.97,混合组 74.88±9.84;QUALEFFO-41评分:PMMA组(66.30±9.09)分,混合组(65.59±9.01)分],差异有统计学意义(P＜0.05),与PMMA组比较,混合组术后3、6个月ODI、QUALEFFO-41评分更低(P＜0.05).PMMA组与混合组治疗有效率(98.1％vs.98.3％)、骨水泥渗漏率(15.1％vs.27.6％)、邻近椎体骨折率(11.3％vs.19.0％)比较差异无统计学意义(P均＞0.05).结论 与PVP联合PMMA骨水泥为填充物相比,PVP联合CPC混合PMMA骨水泥治疗OVCF患者,可更有效改善功能障碍,提高生活质量,不会增加并发症.
Abstract
Objective To explore the clinical effect of self-curing calcium phosphate bone cement(CPC)mixed with polymethylmethacrylate(PMMA)bone cement in percutaneous vertebroplasty(PVP)of osteoporotic vertebral compression fractures(OVCFs),and to analyze the postoperative complications.Methods A retrospective analysis was conducted on clinical data of 111 OVCF patients treated by PVP in the Orthopedics Department of Tai-kang Xianlin Gulou Hospital Affiliated to Nanjing University School of Medicine from Oct.2020 to Oct.2023,inclu-ding 20 males and 91 females aged 52-86(mean 67.8)years.There were 68 cases of falls,31 road traffic injuries,and 12 others.According to different fillers,patients were divided into PMMA group(filled with PMMA bone ce-ment,n=53)and mixed group(filled with a mixture of CPC and PMMA bone cement at a 1∶1 ratio,n=58).The pain,imaging indicators,functional impairment,quality of life,and complications were compared between the two groups.Results Compared with before surgery,the VAS of both groups decreased at 2 d,1,3 and 6 months after surgery(P＜0.05),but comparison between the two groups revealed no significant difference at all time points(P＞0.05).The Cobb angle and sagittal index of the vertebral body at 2 d,1,3 and 6 months after surgery neither re-vealed any significant differences compared with before surgery nor between the two groups(all P＞0.05).However,compared with before surgery,both groups at 1,3 and 6 months after surgery showed significantly reduced Oswestry dysfunction index(OD1,PM MA group:54.62±6.58,38.40±6.11,36.3±6.58 vs.75.19±8.97;Mixed group:55.52±6.22,35.57±6.20,32.62±4.22 vs.74.88±9.84)and Quality of Life Questionnaire of the European Foun-dation for Osteoporosis-41(QUALEFFO-41)scores(PMMA group:37.58±5.86,35.96±6.26,34.74±5.93 vs.66.30±9.09;Mixed group:39.02±5.70,32.66±5.19,31.64±4.98 vs.65.59±9.01,all P＜0.05),moreover,comparison between the two groups showed significantly lower ODI and QUALEFFO-41 scores in the mixed group at 3 and 6 months after surgery(all P＜0.05).But the PMMA group and mixed group showed similar total effective rate(98.1％vs.98.3％),bone cement leakage rate(15.1％vs.27.6％)and fracture rate of surrounding verte-brae(11.3％vs.19.0％,all P＞0.05).Conclusion In the treatment of OVCFs by PVP,the mixture of CPC and PMMA bone cement at a 1∶1 ratio can effectively improve functional impairment and quality of life and at the same time will not increase the incidence of complications,compared with PMMA alone.
维普
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