经皮椎体成形高黏度骨水泥注入修复老年椎体压缩骨折：椎体高度恢复评价

doi:10.3969/j.issn.2095-4344.2015.38.011

摘要/Abstract

摘要：

背景：在应用高黏度骨水泥以及椎体成形修复骨质疏松性椎体压缩骨折的过程中，骨水泥的推注量-压缩椎体高度的恢复-临床疗效”之间是否存在必然联系以及内在的规律，目前缺乏此方面的循证医学证据，且存在一定争议。
目的：观察经皮椎体成形高黏度骨水泥注入修复老年骨质疏松椎体压缩性骨折的椎体高度恢复情况。
方法：选取2011年1月至2012年12月新疆维吾尔自治区中医医院脊柱外科收治的骨质疏松压缩性骨折老年患者110例，共139椎，均由同一组外科医生采用经皮椎体成形治疗，在骨水泥拉丝期时在“G”形臂监视下将高黏度骨水泥注入骨折椎体内。治疗后随访12个月，以目测类比评分、Barthel指数、椎体高度恢复为观察评价指标。
结果与结论：110例患者共139椎，修复过程顺利，单个椎体骨水泥平均注入量为3-6 mL，平均3.5 mL。患者的目测类比评分由治疗前平均7.9分降到了治疗后12个月的平均1.8分；Barthel指数治疗前平均为40.25，治疗后12个月时为82.21，治疗后与治疗前比较目测类比评分和Barthel指数均有明显改善(P < 0.05)。治疗后139个椎体前、中部的高度增加到了原椎体高度的(81.25±9.26)%和(78.22±10.65)%，治疗后24 h、3个月、12个月与治疗前相比椎体前部、中部高度均有显著恢复(P < 0.05)。治疗后通过随访观察发现，发生高黏度骨水泥渗漏的椎体有5个，以上患者未出现临床症状，未发生神经损伤或肺栓塞等严重并发症。提示经皮椎体成形高黏度骨水泥注入修复骨质疏松性椎体压缩性骨折的过程中，不仅可以有效缓解患者疼痛，在不同程度上恢复压缩椎体的高度，而且并发症发生率低，患者恢复时间短。

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

关键词: 生物材料, 骨生物材料, 椎体骨折, 经皮椎体成形术, 骨质疏松, 高黏度骨水泥, 新疆维吾尔自治区自然科学基金

Abstract:

BACKGROUND: Whether there is a necessary connection or internal patterns between the amount of bone cement-recovery of vertebral height-clinical efficacy has no evidence-based medicine findings in the treatment of osteoporotic vertebral compression fractures using percutaneous vertebroplasty with high-viscosity bone cement injection.
OBJECTIVE: To observe the change of vertebral height in the elderly with osteoporotic vertebral compression fractures after percutaneous vertebroplasty with high-viscosity bone cement injection.
METHODS: A total of 110 elderly patients with osteoporotic vertebral compression fractures (139 vertebrae) were admitted at the Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region from January 2011 to December 2012. All the patients received percutaneous vertebroplasty by the same group of surgeons. Bone cement at drawing stage was injected into the fractured vertebra. During the 12-month follow-up, visual analogue scale, Barthel index and vertebral height restoration were observed as evaluation indexes.
RESULTS AND CONCLUSION: The surgical treatment was done successfully in the 110 patients (139 vertebrae). The amount of bone cement per vertebra was 3-6 mL, with a mean of 3.5 mL. At 12 months after surgery, the visual analog scale scores were decreased from 7.9 to 1.8, Barthel index was increased from 40.25 to 82.21, both of which were improved significantly (P < 0.05). After surgery, the vertebral heights at the anterior and middle parts were increased by (81.25±9.26)% and (78.22±10.65)%, respectively, and there was significant differences before ant at 24 hours, 3 months and 12 months after surgery (P < 0.05). During the follow-up, there were five vertebrae with bone cement leakage, but no clinical symptoms occurred, and no nerve injury or pulmonary embolism happened. These findings indicate that percutaneous vertebroplasty with high-viscosity bone cement injection can effectively relieve pain, restore the vertebral height, reduce the incidence of complications and shorten the recovery time in patients with osteoporotic vertebral compression fractures.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Key words: Spinal Fractures, Vertebroplasty, Osteoporosis, Pain Measurement

中图分类号:

R318

牛广续，刘振峰，王振斌，顾文飞，涂来勇，赵疆. 经皮椎体成形高黏度骨水泥注入修复老年椎体压缩骨折：椎体高度恢复评价[J]. 中国组织工程研究, 2015, 19(38): 6126-6132.

参考文献

[1] Yan D, Duan L,Li J,et al.Comparative study of percutaneous vertebroplasty and kypho-plasty in the treatment of osteoporotic vertebral compression fractures.Arch Orthop Trauma Surg. 2011;13l(5):645-650.
[2] Roghani T, Torkaman G, Movasseghe S, et al. Effects of short-termecercise with and without external loading on bone metabolism and balance in postmen-opansal women with osteoporosis.Rheumatol Int. 2013;33(2):291-298.
[3] Taylor RS,Taylor RJ, Fritzell P.Baloon kyphoplasty and vertebroplasty for vertebral com-pression fractures:a comarative systematic review of eficacy and safety.Spine. 2006;31(23):2747-2755.
[4] Ck JC,Nachtiqal D,Humphrey SC,et al.Comparison of vertebroplasty and balloon kypho plasty for treatment of vertebral compression fractures:a meta-analysis of the literature. Spine J. 2008;8(3):488-497.
[5] 中国老年学会骨质疏松委员会骨质疏松诊断标准学科组.《中国人骨质疏松症建议诊断标准》(第二稿) [J] .中国骨质疏松杂志, 2000,6(1):123.
[6] 刘涛,周章武,周正新,等.经皮椎体成形和后凸成形治疗老年骨质疏松性椎体骨折的比较[J].中国组织工程研究,2013,17(39): 6920-6925.
[7] 葛建忠,王凯红,戈朝晖,等.改良经皮椎体成形术在老年骨质疏松性椎体压缩骨折中的临床应用[J].中国骨伤,2013,26(6): 464-467.
[8] 杨惠林,Hansen A,王根林,等.Catheterfabric椎体后凸成形术的初步临床应用[J].中华创伤骨科杂志,2010,12(2):105-108.
[9] 田伟,韩骁,刘波,等.经皮椎体后凸成形术后骨水泥分布与手术椎体再骨折的关系[J].中华创伤骨科杂志,2012,14(3): 211-215.
[10] Shengzhong M,Dongjin W,Shiqing W,et al.Modification of precut-aneous vertebropla sty for painful old osteoporotic veaebral compression fracture in the elderly:preliminary report.Injury. 2012;43(4):486-489.
[11] Aquarius R,Homminga J,Verdonschot N,et al.The fracture risk of adjacent vertebrae is increased by the changed losding direction after a wedge fracture.Spine (PhilaPa 1976). 2011; 36:E408-412.
[12] Nieuwenhuijse MJ,van Erkel AR,Dijkstra PD.Percutaneous vertebro plasty for subacute and chronic painful osteoporotic vertebral compression fractures can safely be undertaken in the first year after the onset of symptoms.J Bohe Joint Surg Br.2012;94(6):815-820.
[13] Marlin E,Nathoo N,Mendel E.Use of percutaneous kyphoplasty and vertebroplasty in spinal SUrgery.J Neurosurg Sci.2012;56(2):105-112.
[14] Itshayek E, Miller P, Barzilay Y, et al.Vertebral augmentation in the treatment of vertebral compression fractures:review and new insights from recent studies.J Clin Neurosci.2012;19(6):786-791.
[15] Young C,Mnnk PL,Heran MK,et al.Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty.Skeletal Radiol.2011;40:1531-1536.
[16] Ahn Y,Lee JH,Lee HY,et al.Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty.J Neurosurg Spine. 2008;9:129-136.
[17] Nieuwenhuijse MJ,vail Erkel AR,Dijkstra PD.Percutaneous vertebroplasty in very severe osteoporotic vertebralcompression fractures:feasible and beneficial.J Vasc Interv Radiol. 2011;22:1017-1023.
[18] Heo DH,Chin DK,Yoon YS,et al.Recollapse of previous vertebral compression fracture after pereutaneous vertebroplasty.Osteoporos Int. 2009;20:473-480.
[19] 罗亚平,常小波,王勤业,等.掌侧锁定加压钢板结合支垫钉技术治疗背侧不稳定性桡骨远端骨折[J].国际骨科学杂志,2013, 34(3):219-221.
[20] 王平,廖晓辉,李峻,等.桡骨远端骨折掌背侧入路的疗效比较[J].实用骨科杂志,2011,17(4):316-318.
[21] 卢强,陈华,许猛,等.锁定加压钢板内固定治疗桡骨远端C型骨折[J].中国矫形外科杂志,2008,16(22):1698-1699.
[22] Machado R,Silva UX,Carneiro E,et al.Lack of correlation between tubular dentine cement penetration,adhesiveness and leakage in Roots filled with gutta percha and an endodontic cement based on epoxy amine resin.J Appl Oral Sci. 2014;22(1):22-28.
[23] La Maida GA,Giarratana LS,Acerbi A,et al.Cement leakage:safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions.Eur Spine J. 2012;21Suppl 1:S61-S68.
[24] Wang Y,Huang F,Chen L,et al.Clinical measurement of intravertebral pressure during vertebroplasty and kyphoplasty.Pain Physician. 2013;16(4):E411-E418.
[25] Bozkurt M, Ahilogullari G,Ozdemir M,et al.Comparative analysis of vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures.Asian Spine J. 2014;8(1): 27-34.
[26] Zhao H,Ni CF,Huang J,et al.Effects of bone cement on intervertebral disc degeneration.Exp Ther Med. 2014; 7(4):963-969.
[27] Hargunani R,Le Corroller T,Khashoggi K,et al.An overview of vertebroplasty:current status,controversies,and future directions.Can Assoc Radiol J. 2012;63(3 Supp1):S11-17.
[28] Yen CH,Teng MM,Yuan WH,et al.Preventive vertebroplasty for adjacent vertebral bodies:a good solution to reduce adjacent ver-tebral fracture after percutaneous vertebroplasty.AJNR Am J Neuroradiol. 2012;33(5): 826-832.
[29] Han S,Wan S,Ning L,et al.Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotie vertebral eom-pression fracture:a meta-analysis of randomised and non-ran-domised controlled trials.Int Orthop. 2011;35(9):1349-1358.
[30] Papanastassiou ID,Phillips FM,Van Meirhaeghe J,et al. Compar-ing effects of kyphoplasty,vertebroplasty,and non-surgical man-agement in a systematic review of ran domized and non--random--ized controlled studies.Eur Spine J. 2012;21(9):1826-1843.
[31] Ma XL,Xing D,Ma JX,et al.Balloon kyphoplasty versus percuta-neous vertebroplasty in treating osteoporotic vertebral compres-sion fracture:grading the evidence through a systematic review and meta-analysis.Eur Spine J. 2012; 21(9):1844-1859.
[32] Zou J,Mei X,Zhu X,et al.The long-term incidence of subse-quent vertebral body fracture after vertebral augmentation therapy:a systemic review and meta-analysis. Pain Physician. 2012;15(4):E515-522.
[33] Chen C,Wei H,Zhang W,et al.Comparative study of kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approach.J Spinal Disord Tech. 2011;24(7):E62-65.
[34] Li LH,Sun TS,Liu Z,et al.Comparison of unipedieular and bipe-dicular percutaneous kyphoplasty for treating osteoporotic verte-bral compression fractures:a meta-analysis. Chin Med J (Engl). 2013;126(20):3956-3961.
[35] Rho YJ,Choe WJ,Chun YI.Risk factors predicting the new symp-tomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty.Eur Spine J. 2012;21(5):905-911.
[36] Kim MH,Lee AS,Min SH,et al.Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty.Asian Spine J. 2011;5(3): 180-187.
[37] Chen LH,Hsieh MK,Liao JC,et al.Repeated percutaneous verte-broplasty for refracture of cemented vertebrae.Arch Othop Trauma Surg. 2011;131(7):927-933.
[38] Wu AM,Chi YL,Ni WF.Vertebral compression fracture with in-travertebral vacuum cleft sign:pathogenesis,image,and surgical intervention.Asian Spine J. 2013;7(2):148-155.
[39] Zhang Z,Fan L, Ding Q,et al.Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty:a systematic review and meta-analysis.J Spinal Disord Tech. 2013;26(4):E150-157.
[40] 张其亮,王峻,林勇.不同时间骨质疏松性椎体压缩骨折的经皮椎体成形治疗[J].中国组织工程研究,2013,17(21):3831-3838.