【摘要】 目的 探讨不同程度椎体压缩骨折行经皮穿刺椎体成形术(PVP)术后骨水泥的弥散分布规律。方法 回顾性分析青岛大学医学院骨外科2016年7月—2017年3月因骨质疏松椎体压缩骨折(OVCF)行PVP100例患者的临床资料。根据术前MRI检查骨折水肿信号的面积及椎体压缩程度,对所选病例分为4组(Ⅰ型1组24例,Ⅱ型2组26例,Ⅲ型3组27例,Ⅳ型4组23例),并将骨水泥弥散等级分为3级。记录术前、术后1周、术后3个月的VAS评分、ODI评分、骨水泥弥散等级情况,并对术后1周ODI评分、骨水泥沿骨折线弥散等级与骨折类型3个变量进行Spearman相关性分析。结果 患者均顺利完成手术,无神经损伤、脑脊液漏及感染等严重手术并发症发生,其中4例(Ⅲ组1例,Ⅳ组3例)骨水泥少量渗漏至椎旁静脉丛,无椎管内及椎间隙骨水泥渗漏。各组患者术后VAS评分、ODI评分较术前显著下降,差异有统计学意义(P<0.05),其中术后1周ODI评分Ⅰ组(37.92±8.43)、Ⅱ组(39.67±9.26)与Ⅲ组(30.53±8.65)、Ⅳ组(32.48±9.24)分别比较,差异有统计学意义(P<0.05)。余各组间比较差异无统计学意义(P>0.05)。骨水泥弥散等级情况:对4组患者行独立样本非参数检验,差异有统计学意义(P<0.05)。其中Ⅰ组、Ⅱ组与Ⅲ组、Ⅳ组分别比较,差异有统计学意义(P<0.05)。余各组间比较差异无统计学意义(P>0.05)。术后1周评分与骨折类型、骨水泥弥散等级呈负相关,骨折类型与骨水泥弥散等级呈显著正相关。结论 术前水肿信号的面积大小将影响骨水泥沿骨折线的弥散等级从而导致早期临床效果的差异,其面积越大,术后早期效果越好,临床上要尽量使骨水泥均匀且充分地弥散。更多还原

【Abstract】 Objective To investigate the distribution of bone cement after percutaneous vertebroplasty( PVP) in different degrees of osteoporotic vertebral compression fracture( OVCF). Methods A retrospective analysis of clinical data of 100 patients with PVP due to osteoporotic vertebral compression fracture( OVCF) was conducted,who were admitted in Department of Spinal Surgery of Linyi People’s Hospital from Jul. 2016 to Mar. 2017.According to the preoperative MRI examination of the area of fracture edema signal and the degree of vertebral compression,the selected cases were divided into 4 groups( 24 in type Ⅰ,26 in type Ⅱ,27 in type Ⅲ,and 23 in type Ⅳ). According to the distribution range of preoperative MRI fracture edema signal and the postoperative X-ray positive lateral slice,the bone cement dispersion grade was divided into 3 grades. VAS score,ODI score and bone cement dispersion grade before,1 week after and 3 months after the operation were recorded,and Spearman correlation analysis was carried out for three variables: ODI score,bone cement dispersion grade along fracture line and fracture degree at 1 week after the operation. Results All patients were successfully completed surgery,and had no nerve damage,cerebrospinal fluid leakage or severe surgical complications such as infection. Among them,4 cases( 1 group in group Ⅲ,3 cases in group Ⅳ) had a small amount of bone cement leaking into the paraspinal venous plexus,and there was no leakage of cement in the spinal canal and intervertebral space. The VAS score and ODI score of the patients in each group were significantly lower than those before operation( P < 0. 05). Among them,the ODI score was( 37. 92 ± 8. 43) points in group Ⅰand( 39. 67 ± 9. 26) points in group aⅡ t 1 week after operation. Compared with group Ⅲ( 30. 53 ± 8. 65) and group Ⅳ( 32. 48 ± 9. 24),the difference was statistically significant( P < 0. 05),and there was no significant difference among the other groups( P > 0. 05). The independent sample nonparametric test was performed on the bone cement diffusion grade of the 4 groups,and the difference was statistically significant( P < 0. 05). There were significant differences between groups Ⅰ and Ⅱ and groups Ⅲand Ⅳ( P < 0. 05). There was no significant difference among the other groups( P > 0. 05). The 1-week postoperative score was negatively correlated with fracture degree and bone cement diffusion grade,and the degree of fracture was significantly positively correlated with the cement cement diffusion grade. Conclusion The size of the preoperative edema signal can affect the diffusion grade of bone cement along the fracture line,which leads to the difference in the early clinical effects. The larger the area is,the better the early postoperative effect is. Therefore,it is necessary to make the bone cement uniform and sufficient in clinical practice.更多还原