Percutaneous vertebroplasty with bone cement for the treatment of osteoporotic thoracolumbar vertebral compression fractures

doi:10.3969/j.issn.2095-4344.2014.52.002

Abstract

Abstract:

BACKGROUND: Percutaneous vertebroplasty with injection of bone cement is to reinforce the vertebral stability after vertebral compression fractures, to prevent further vertebral collapse, thereby playing a significant analgesic effect, but it is prone to develop complications such as bone cement leakage.

OBJECTIVE: To evaluate the efficacy and safety of percutaneous vertebroplasty with injection of polymethyl methacrylate bone cement for treating osteoporotic thoracolumbar vertebral compressive fractures.

METHODS: Totally 65 cases of osteoporotic thoracolumbar vertebral compressive fractures were treated by percutaneous vertebroplasty with injection of polymethylmethacrylate under DSA fluoroscopy image guiding. Visual analog scale score, Oswesty dysfunction index, vertebral height, vertebral kyphosis angle changes, as well as bone cement leakage were detected before and after treatment.

RESULTS AND CONCLUSION: At 1 day after treatment, the visual analogue scale score and Oswesty disability index decreased rapidly, which was significantly lower than that before treatment (P < 0.01); after 1 month, the visual analog scale score and Oswesty disability index were further reduced, and there was a significant difference at 1 day and 1 month after treatment (P < 0.05). However, there was no difference in the visual analogue scale score and Oswesty disability index at 1, 3, 6 months after treatment (P > 0.05). The anterior vertebral height and the central height were restored remarkable at 3 months after treatment, and the Cobb angle was obviously corrected, as compared with those before treatment (P < 0.05); at 6 months after treatment, the vertebral height and Cobb angle mostly remained stable. Imaging examination showed that a small amount of paravertebral bone cement leakage occurred in six cases, including two cases of paravertebral soft tissue leakage and four cases of adjacent intradiscal leakage. But there were no obvious clinical symptoms and no nerve injury. The results suggest that percutaneous vertebroplasty with injection of polymethyl methacrylate bone cement can relieve the pain of patients with osteoporotic vertebral compression fractures, increase the vertebral height in the majority of patients, improve kyphotic deformity, and lead to less adverse reactions.

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

全文链接：

Key words: vertebroplasty, methylmethacrylates, osteoporotic fractures

CLC Number:

R318

Chen An-gang, Zeng Ben-qiang, Yang Yong, Song Xiao-qiang, Hu Bing. Percutaneous vertebroplasty with bone cement for the treatment of osteoporotic thoracolumbar vertebral compression fractures [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(52): 8371-8375.

Figures/Tables 1

2.1 骨水泥注入量 65例患者手术操作均成功，胸椎注入骨水泥量为3.0-6.5 mL，平均(4.5±1.2) mL；腰椎注入骨水泥量为4.0-10.5 mL，平均(5.5±1.8) mL。出院后采用电话方式随访，随访6-15个月。 2.2 目测类比评分和Oswesty功能障碍指数变化治疗后1 d目测类比评分和Oswesty功能障碍指数均明显降低，与治疗前比较差异有非常显著性意义(P < 0.01)，治疗后1个月时目测类比评分和Oswesty功能障碍指数进一步降低，与治疗后1 d比较差异有显著性意义(P < 0.05)，余治疗后各时间点间两两比较差异无显著性意义(P > 0.05)，见表1。 2.3 椎体高度恢复程度和椎体后凸角度矫正情况治疗后3 d椎体前缘高度和中央高度较治疗前明显恢复(P < 0.05)。治疗后3 d椎体前缘、中央高度与治疗后6个月比较差异均无显著性意义(P > 0.05)，说明治疗后无明显高度丢失。治疗后3 d Cobb角较治疗前明显矫正(P < 0.05)，治疗后3 d Cobb角与治疗后6个月比较差异无显著性意义(P > 0.05)，见表2。 2.4 不良事件治疗后影像学复查显示椎旁骨水泥少量渗漏6例，其中椎旁软组织内渗漏2例，相邻椎间盘内渗漏4例，未见神经损伤病例，随访期间未见相邻椎体再骨折发生。6例患者术中心率稍减慢及血压轻度降低，均为一过性，未发现其他不良反应。 2.5 典型病例分析病例1：75岁女性患者，在家中不慎跌倒，因腰背部疼痛不适入院，查体腰椎棘突压痛及叩击痛明显，双下肢感觉、肌力及肌张力正常，腰椎MRI检查诊断为L1椎体压缩骨折伴骨髓水肿，腰椎退变伴椎间盘变性，在局部麻醉行经皮骨水泥注入椎体成形治疗，术后患者腰背部疼痛不适症状缓解明显，复查MRI示L1椎体轻度变扁，其内见斑片状致密影充填，未见骨水泥外溢表现，脊柱腰段序列连续，治疗前后影像学图片见图1。病例2：65岁女性患者，因车祸外伤入院，查体腰椎棘突压痛及叩击痛明显，MRI检查诊断为L2椎体轻度压缩骨折，L2，4椎体骨质水肿，在局部麻醉行经皮骨水泥注入椎体成形治疗，术后患者腰背部疼痛不适症状缓解明显，L2，4椎体骨折经皮椎体成形治疗后复查MRI示L2，4椎体右侧份见片状高密度影，骨水泥弥漫良好，椎体高度稍显变矮，椎间隙未见变窄，椎间孔未见变小，椎旁软组织未见确切异常改变，治疗前后影像学图片见图2。"

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