经皮椎体成形术湿沙期与拉丝期骨水泥注入比较

Comparison of percutaneous vertebroplasty with low-viscosity bone cement in wet-sand phase versus wire-drawing phase

摘要:

［目的］比较低黏度湿沙期与拉丝期骨水泥经皮椎体后凸成形术（percutaneous kyphoplasty, PKP）治疗骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture, OVCF）的临床效果。［方法］ 2018 年 1 月—2020 年 6 月，146 例明确诊断为 OVCF 患者纳入本研究。根据医患沟通结果，80 例采用低黏度湿沙期骨水泥 PKP（湿沙期组），66 例采用低黏度拉丝期骨水泥 PKP（拉丝期组）。比较两组围手术期及随访结果。［结果］两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。两组手术时间、术中透视次数、骨水泥用量、住院费用差异均无统计学意义 （P>0.05）。但是，湿沙期组的骨水泥分布优良率显著高于拉丝期组 （P<0.05），湿沙期组患者的骨水泥渗漏率显著低于拉丝期组 （P<0.05）。患者随访 （23.23±7.94） 个月，术后随时间推移，两组患者 VAS 评分均显著降低（P<0.05）；术后 7、30 d 和末次随访时，湿沙期组 VAS 评分均显著低于拉丝期组（P<0.05）。［结论］ 低黏度湿沙期骨水泥 PKP 治疗 OVCF 可以获得更好的治疗效果。

Abstract:

[Objective] To compare clinical outcomes of percutaneous vertebroplasty (PKP) with low- viscosity bone cement in wetsand phase (WSP) versus wire- drawing phase (WDP) for osteoporotic vertebral compressive fracture (OVCF) . [Methods] From January 2018 to June 2020, a total of 146 patients with OVCF were enrolled in this study. According to the doctor-patient communication, 80 pa- tients had PKP performed with low- viscosity bone cement in WSP, whereas 66 patients received PKP with low-viscosity bone cement in WDP. The perioperative period and follow-up consequences were compared between the two groups. [Results] All the patients had opera- tion done successfully in both groups without neurovascular injury and other serious complications. There were no significant differences in operation time, intraoperative fluoroscopy times, amount of bone cement and hospitalization cost between 2 groups (P＜0.05) . However, WSP group had significantly higher excellent and good ratio of bone cement distribution than the WDP group (P＜0.05) , additionally, the former had significantly less occurrence of bone cement leakage than the latter (P＜0.05) . As time went during the follow up period lasted for (23.23±7.94) months, the VAS score in both groups decreased significantly (P＜0.05) . At 7 d, 30 d and the latest follow-up, the WSP group had significantly lower VAS score than the WDP group (P＜0.05) . [Conclusion] The PKP with low viscosity bone cement in wet-sand phase does achieve better therapeutic effect on OVCF than that in the wire-drawing phase.