中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (10): 2015-2022.doi: 10.12307/2025.226

• 组织工程骨材料 tissue-engineered bone • 上一篇    下一篇

单侧经皮椎体成形骨水泥分布对椎体压缩性骨折修复疗效的影响

阿卜杜吾普尔·海比尔1，2，库提鲁克·守克尔1，2，阿里木江·玉素甫1，2，林  航1，2，吐尔洪江·阿布都热西提1，2   

  1. 1新疆医科大学，新疆维吾尔自治区乌鲁木齐市  830054；2新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市  830002
  • 收稿日期:2023-12-22 接受日期:2024-02-22 出版日期:2025-04-08 发布日期:2024-08-21
  • 通讯作者: 吐尔洪江·阿布都热西提，硕士，主任医师，硕士生导师，新疆医科大学，新疆维吾尔自治区乌鲁木齐市 830054；新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市 830002 并列通讯作者：林航，新疆医科大学，新疆维吾尔自治区乌鲁木齐市 830054；新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市 830002
  • 作者简介:第一作者：阿卜杜吾普尔·海比尔，男，新疆维吾尔自治区和田市人，维吾尔族，新疆医科大学在读硕士，主要从事脊柱创伤、骨质疏松症治疗等相关研究。 共同第一作者：库提鲁克·守克尔，男，新疆维吾尔自治区乌鲁木齐市人，维吾尔族，新疆医科大学在读硕士，主要从事脊髓损伤修复、周围神经损伤修复等相关研究。

Effect of cement distribution on clinical efficacy of vertebral compression fractures in unilateral percutaneous vertebroplasty

Abuduwupuer·Haibier1, 2, Kutiluke·Shoukeer1, 2, Alimujiang·Yusufu1, 2, Lin Hang1, 2, Tuerhongjiang·Abudurexiti1, 2   

  1. 1Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; 2Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • Received:2023-12-22 Accepted:2024-02-22 Online:2025-04-08 Published:2024-08-21
  • Contact: Corresponding author: Tuerhongjiang·Abudurexiti, Master, Chief physician, Master’s supervisor, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China Co-corresponding author: Lin Hang, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • About author:Kutiluke·Shoukeer, Master candidate, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China Abuduwupuer·Haibier and Kutiluke·Shoukeer contributed equally to this article.

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摘要：

文题释义：
经皮椎体后凸成形术：属于一种脊柱微创手术，是指在影像系统介导下通过经皮穿刺向伤椎椎体内注入骨水泥以达到恢复椎体高度、增加椎体稳定性的目的，从而减少对椎体内神经末梢的刺激，有效缓解伤椎椎体的疼痛，已经成为治疗骨质疏松性椎体压缩骨折的标准手术方案之一。
经皮椎体成形：是临床治疗骨质疏松性椎体压缩性骨折的一种有效方法。使用穿刺针从椎弓根穿透椎体，注射骨水泥，可增强椎体的强度和结构稳定性，减轻骨痛。

背景：虽然研究表明，骨水泥的对称分布可以减少术后椎体再次骨折并有助于改善预后，但是进行经皮椎体成形过程中获得更好的骨水泥分布仍然是外科医生面临的一个重要课题。
目的：探讨骨水泥分布对单侧经皮椎体成形术后疗效的影响，以提供有效的预防和治疗措施，防止术后椎体再次骨折。
方法：选择 2018年1月至2022年12月在新疆医科大学第六附属医院行单侧经皮椎体成形治疗的 193例患者，根据术后骨水泥分布分为Ⅰ组(骨水泥不接触上端和远端端板，n=59)、Ⅱ组(骨水泥只接触上端板或只接触下端板，n=80)和Ⅲ组(骨水泥同时接触上端和远端端板，n=54)。对比3组患者的基本资料，手术相关指标包括手术时间、总住院费用、术后住院时间、骨水泥注射量、腰痛目测类比评分及Oswestry功能障碍指数、术后椎体高度恢复率、椎体局部后凸角、损伤椎体及邻近椎体再骨折发生率等，记录所有患者的随访结果。
结果与结论：①Ⅲ组患者术后1年腰痛目测类比评分和Oswestry功能障碍指数明显低于Ⅰ组和Ⅱ组，差异有显著性意义(P < 0.05)；②Ⅰ组和Ⅱ组损伤椎体再次骨折发生率、总椎体骨折发生率高于Ⅲ组，差异均有显著性意义(P < 0.05)；③3组患者其余指标，包括骨水泥渗漏、腰痛术后1周、术后1个月和末次Oswestry功能障碍指数及目测类比评分、术后椎体高度恢复率、椎体局部凸角、手术时间、总住院费用及术后住院时间等指标均无显著性差异(P > 0.05)；④提示与骨水泥不接触上端和远端端板组和骨水泥只接触上端板或只接触下端板组相比，骨水泥同时接触上端和远端端板组患者可获得更好的长期预后，而且骨水泥同时接触上端和远端端板能够明显降低损伤椎体及总椎体骨折发生率，医生术中应充分掌握骨水泥的弥散情况，并制定有针对性的预防和治疗策略，从而有助于减少未来再发生骨折的风险。
https://orcid.org/0000-0001-7420-9761(阿卜杜吾普尔·海比尔)；https://orcid.org/0009-0000-2874-7382(库提鲁克·守克尔)；https://orcid.org/0000-0002-2604-0049(吐尔洪江·阿布都热西提)

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: 骨质疏松性椎体压缩性骨折, 经皮椎体成形, 骨水泥, 骨水泥弥散, 椎体再次骨折

Abstract: BACKGROUND: Although studies have shown that symmetrical distribution of bone cement can reduce postoperative vertebral refractures and help improve prognosis. However, achieving better bone cement distribution during percutaneous vertebroplasty remains an important issue for surgeons.
OBJECTIVE: To explore the effect of cement distribution on the efficacy of unilateral percutaneous vertebroplasty to provide effective preventive and therapeutic measures to prevent postoperative vertebral fracture.
METHODS: The 193 patients who underwent unilateral percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022 were selected and divided into group I (bone cement not touching the upper and distal end plates; n=59), group II (bone cement only touching the upper or lower end plate; n=80), and group III (bone cement touching both the upper and distal end plates; n=54). Basic data, operation-related indicators, including operation time, total hospital cost, postoperative hospital time, cement injection, visual analog scale and Oswestry disability index scores of low back pain, postoperative vertebral height recovery rate, local kyphosis angle, incidence of injured vertebral body and adjacent vertebrae were compared among the three groups. Follow-up results of all patients were recorded.
RESULTS AND CONCLUSION: (1) In group III, the visual analog scale and Oswestry disability index scores were significantly lower than those in groups I and II, and the difference was statistically significant (P < 0.05). (2) The incidence of injured vertebral refracture and incidence of total vertebral fractures in groups I and II were significantly higher than that in group III, and the differences were all statistically significant (P < 0.05). (3) There were no significant differences in other indicators of patients of the three groups, such as bone cement leakage, Oswestry disability index, and visual analog scale score at 1 week, 1 month after surgery, and during last follow-up, postoperative vertebral height recovery rate, local kyphosis angle, operation time, total hospital cost, and postoperative hospital stay (P > 0.05). (4) It is indicated that compared with groups I and II, patients of group III get better long-term prognosis, and bone cement touching both the upper and distal end plates can significantly reduce the incidence of injured vertebral and total vertebral fractures. Surgeons should fully grasp the diffusion of bone cement, and develop targeted prevention and treatment strategies, so as to reduce the risk of further fracture in the future.

Key words: osteoporotic vertebralcompression fracture, percutaneous vertebroplasty, bone cement, bone cement diffusion, vertebral refracture

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