骨填充网袋治疗老年骨质疏松性压缩骨折合并椎体内裂隙征
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摘要
背景:经皮椎体成形术治疗骨质疏松性椎体压缩骨折具有较好的疗效,但对于合并椎体裂隙征患者,较易发生骨水泥渗漏。目的:探讨骨填充网袋治疗老年骨质疏松性压缩骨折合并椎体内裂隙征的效果。方法:选择2017年10月至2018年7月青海大学附属医院收治的62例骨质疏松性压缩骨折合并椎体内裂隙征患者,年龄60-80岁,其中31例进行单侧椎体成形术骨水泥注入治疗(对照组),另31例进行骨填充网袋灌注骨水泥治疗(研究组),记录2组骨水泥渗漏情况、手术时间与透视次数。比较两组患者治疗前及治疗后7,30,60d的目测类比评分与功能障碍ODI评分;通过X射线评估治疗前及治疗后7d伤椎高度变化;采用SF-36量表评估患者治疗前与治疗后60 d的生活质量。结果与结论:(1)研究组手术时间与透视次数均少于对照组(P <0.05),研究组骨水泥渗漏率低于对照组(6%,39%,P <0.05);(2)两组治疗后7,30,60 d的目测类比评分与功能障碍ODI评分均较治疗前明显改善,研究组治疗后不同时间点的目测类比评分均低于对照组(P <0.05),两组治疗后不同时间点的功能障碍评分比较无差异(P> 0.05);(3)两组治疗后7 d的伤椎高度明显高于治疗前(P <0.05),且研究组高于对照组(P <0.05);(4)两组治疗后60 d的生活质量均较治疗前明显改善(P <0.05),两组间比较无差异(P> 0.05);(5)结果表明,相比于单侧椎体成形骨水泥注入治疗,骨填充网袋灌注骨水泥治疗老年骨质疏松性压缩骨折合并椎体内裂隙征,可降低骨水泥渗漏发生率、减轻疼痛、提高伤椎高度。
BACKGROUND: Percutaneous vertebroplasty is an effective method for osteoporotic thoracic vertebral compression fracture, but bone cement leakage is easy to occur in patients with intravertebral cleft. OBJECTIVE: To explore the therapeutic efficacy of bone-filling mesh containers in elderly patients with osteoporotic vertebral compression fractures combined with intravertebral cleft sign. METHODS: From October 2017 to July 2018, 62 patients aged from 60 to 80 years with osteoporotic vertebral compression fractures combined with intravertebral cleft sign were admitted at the Affiliated Hospital of Qinghai University. Among them, 31 cases were treated with unilateral percutaneous vertebroplasty (control group), and the other 31 cases were treated with bone-filling mesh containers (study group). The leakage of bone cement, the time of operation and the times of fluoroscopy were recorded in the two groups. The visual analogue scale score and Oswestry disability index score were compared between the two groups before and 7, 30, 60 days after treatment. The height changes of injured vertebrae were evaluated by X-ray before treatment and 7 days after treatment. The quality of life was evaluated by the MOS item short from health survey (SF-36) before and 60 days after treatment. RESULTS AND CONCLUSION:(1) The time of operation and the times of fluoroscopy in the study group were less than those in the control group (P < 0.05), and the leakage rate of bone cement in the study group was lower than that in the control group (6% vs. 39%, P < 0.05).(2) The visual analogue scale score and Oswestry disability index score of the two groups were significantly improved at 7, 30 and 60 days after treatment. The visual analogue scale scores of the study group were lower than those of the control group at different time points after treatment (P < 0.05). There was no difference in Oswestry disability index scores between the two groups at different time points after treatment (P > 0.05).(3) The height of injured vertebrae 7 days after treatment in both groups was significantly higher than that before treatment (P < 0.05), and there was a significant difference between the two groups (P < 0.05).(4) The quality of life of the two groups was significantly improved at 60 days after treatment (P < 0.05), but there was no difference between the two groups (P > 0.05). These findings indicate that compared with unilateral vertebroplasty with bone cement injection, bone-filling mesh containers with bone cement injection could reduce the incidence of cement leakage, relieve pain and increase the height of injured vertebrae in elderly patients with osteoporotic vertebral compression fracture combined with intravertebral cleft sign.
BACKGROUND: Percutaneous vertebroplasty is an effective method for osteoporotic thoracic vertebral compression fracture, but bone cement leakage is easy to occur in patients with intravertebral cleft. OBJECTIVE: To explore the therapeutic efficacy of bone-filling mesh containers in elderly patients with osteoporotic vertebral compression fractures combined with intravertebral cleft sign. METHODS: From October 2017 to July 2018, 62 patients aged from 60 to 80 years with osteoporotic vertebral compression fractures combined with intravertebral cleft sign were admitted at the Affiliated Hospital of Qinghai University. Among them, 31 cases were treated with unilateral percutaneous vertebroplasty (control group), and the other 31 cases were treated with bone-filling mesh containers (study group). The leakage of bone cement, the time of operation and the times of fluoroscopy were recorded in the two groups. The visual analogue scale score and Oswestry disability index score were compared between the two groups before and 7, 30, 60 days after treatment. The height changes of injured vertebrae were evaluated by X-ray before treatment and 7 days after treatment. The quality of life was evaluated by the MOS item short from health survey (SF-36) before and 60 days after treatment. RESULTS AND CONCLUSION:(1) The time of operation and the times of fluoroscopy in the study group were less than those in the control group (P < 0.05), and the leakage rate of bone cement in the study group was lower than that in the control group (6% vs. 39%, P < 0.05).(2) The visual analogue scale score and Oswestry disability index score of the two groups were significantly improved at 7, 30 and 60 days after treatment. The visual analogue scale scores of the study group were lower than those of the control group at different time points after treatment (P < 0.05). There was no difference in Oswestry disability index scores between the two groups at different time points after treatment (P > 0.05).(3) The height of injured vertebrae 7 days after treatment in both groups was significantly higher than that before treatment (P < 0.05), and there was a significant difference between the two groups (P < 0.05).(4) The quality of life of the two groups was significantly improved at 60 days after treatment (P < 0.05), but there was no difference between the two groups (P > 0.05). These findings indicate that compared with unilateral vertebroplasty with bone cement injection, bone-filling mesh containers with bone cement injection could reduce the incidence of cement leakage, relieve pain and increase the height of injured vertebrae in elderly patients with osteoporotic vertebral compression fracture combined with intravertebral cleft sign.
引文
[1]秦大平,张晓刚,宋敏,等.老年骨质疏松性胸腰椎压缩骨折治疗研究进展[J].中华中医药杂志,2017,32(2):679-684.
[2]Jun DS,An BK,Yu CH,et al.Practical use of bone scan in patients with an osteoporotic vertebral compression fracture.JKorean Med Sci.2015;30(2):194-198.
[3]Darko P,Igor B.Diagnostics and treatment of osteoporotic vertebral fractures.Reumatizam.2014;61(2):75.
[4]Waterloo S,Ahmed LA,Center JR,et al.Prevalence of vertebral fractures in women and men in the population-based Troms? Study.BMC Musculoskelet Disord.2012;13(1):3.
[5]Kim DY,Lee YK,Ha YC,et al.Mortality after vertebral fracture in Korea:Analysis of the national claim registry.Bone.2011;48(7):1859-1865.
[6]马洪,李文蛟,冯伟临,等.西双版纳老年人骨质疏松性骨折流行病学初步调查[J].中国骨与关节杂志,2009,8(5):263-265.
[7]赵刚,胡侦明,劳汉昌,等.昆明地区部分老年人群骨质疏松性骨折发病率初步调查和分析[J].中国骨质疏松杂志,2007,13(4):257-259.
[8]Jaremko JL,Siminoski K,Firth GB,et al.Common normal variants of pediatric vertebral development that mimic fractures:a pictorial review from a national longitudinal bone health study.Pediatr Radiol.2015;45(4):593-605.
[9]Siminoski K,Lee KC,Jen H,et al.Anatomical distribution of vertebral fractures:comparison of pediatric and adult spines.Osteoporos Int.2012;23(7):1999-2008.
[10]Chen AT,Cohen DB,Skolasky RL.Impact of nonoperative treatment,vertebroplasty,and kyphoplasty on survival and morbidity after vertebral compression fracture in the medicare population.Spine J.2012;12(9):1729-1736.
[11]Svedbom A,Alvares L,Cooper C,et al.Balloon kyphoplasty compared to vertebroplasty and nonsurgical;management in patients hospitalised with acute osteoporotic vertebral;compression fracture:a UK cost-effectiveness analysis.Osteoporos Int.2013;24(1):355-367.
[12]高志祥,李淳,李磊,等.PVP、PKP、骨填充网袋治疗胸腰段骨质疏松性椎体压缩性骨折的疗效分析[J].实用骨科杂志,2017,23(8):680-683.
[13]Yu W,Jiang X,Liang,et al.Intravertebral Vacuum Cleft and Its Varied Locations within Osteoporotic Vertebral Compression Fractures:Effect on Therapeutic Efficacy.Pain Physician.2017;20(6):E979.
[14]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5):413-443.
[15]龚遂良,陈宝,范顺武,等.椎体内裂隙样变对经皮椎体后凸成形术疗效的影响[J].中华骨科杂志,2014,34(1):6-12.
[16]Wu AM,Lin ZK,Ni WF,et al.The existence of intravertebral cleft impact on outcomes of nonacute osteoporotic vertebral compression fractures patients treated by percutaneous kyphoplasty:a comparative study.J Spinal Disord Tech.2014;27(3):E88.
[17]刘冬斌,李辉,程志安,等.经皮椎体成形术联合鲑鱼降钙素治疗骨质疏松椎体压缩性骨折的临床观察[J].中国骨质疏松杂志,2012,18(1):36-39.
[18]Fan J,Shen Y,Zhang N,et al.Evaluation of surgical outcome of Jack vertebral dilator kyphoplasty for osteoporotic vertebral compression fracture-clinical experience of 218 cases.J Orthop Surg Res.2016;11(1):56.
[19]李楠,何达,张贵林,等.PVP与PKP治疗伴椎体内裂隙样变的骨质疏松性椎体压缩骨折疗效对比观察[J].山东医药,2015,55(4):1-4.
[20]吴爱悯,倪文飞,池永龙.椎体内裂隙征的形成机理、影像学特征及手术治疗[J].脊柱外科杂志,2012,10(1):56-59.
[21]Kim YC,Kim YH,Ha KY.Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine.Spine J.2014;14(4):659-666.
[22]Sarli M,Pérez Manghi FC,Gallo R,et al.The vacuum cleft sign:an uncommon radiological sign.Osteoporos Int.2005;16(10):1210-1214.
[23]余伟波,梁德,江晓兵,等.经皮治疗有无裂隙骨质疏松椎体压缩骨折骨水泥分布及渗漏率比较[J].广东医学,2016,37(24):3678-3682.
[24]Bang JI,Jin JI,Ghanem N,et al.Quality improvement of transgenic cloned bovine embryos using an aggregation method:Effects on cell number,cell ratio,embryo perimeter,mitochondrial distribution,and gene expression profile.Theriogenology.2015;84(4):509-523.
[25]Zou D,Zhang K,Ren Y.Therapeutic effects of PKP on chronic painful osteoporotic vertebral compression fractures with or without intravertebral cleft.Int J Clin Exp Med.2015;8(9):15780-15786.
[26]余伟波,梁德,江晓兵,等.经皮椎体成形术和经皮椎体后凸成形术治疗伴椎体内真空裂隙的骨质疏松椎体压缩骨折比较研究[J].中国修复重建外科杂志,2016,30(9):1104-1110.
[27]高林,闫亮,郝定均,等.椎体内裂隙对经皮椎体后凸成形术疗效的影响[J].实用骨科杂志,2016,22(6):481-485.
[28]Wiggins MC,Sehizadeh M,Pilgram TK,et al.Importance of intravertebral fracture clefts in vertebroplasty outcome.AJR Am J Roentgenol.2007;188(3):634-640.
[29]Ha KY,Lee JS,Kim KW,et al.Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts.J Bone Joint Surg Br.2006;88(5):629.
[30]李石岩,钮俊杰,宋达玮,等.椎体后凸成形术治疗骨质疏松性椎体骨折伴或不伴裂隙征的对比研究[J].浙江临床医学,2014,16(6):843-845.
[31]Wang G,Yang H,Chen K.Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty.Bone.2010;92(11):1553.
[32]Fu Z,Hu X,Wu Y,et al.Is There a Dose-Response Relationship of Cement Volume With Cement Leakage and Pain Relief After Vertebroplasty.Dose Response.2016;14(4):1559325816682867.
[33]宋仁谦,周英杰,赵刚,等.高黏度骨水泥经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松压缩骨折的临床疗效观察[J].中国矫形外科杂志,2016,24(8):692-696.
[34]Kolmeder S,Lion A,Landgraf R,et al.Thermophysical properties and material modelling of acrylic bone cements used in vertebroplasty.J Therm Anal Calorim.2011;105(2):705-718.
[2]Jun DS,An BK,Yu CH,et al.Practical use of bone scan in patients with an osteoporotic vertebral compression fracture.JKorean Med Sci.2015;30(2):194-198.
[3]Darko P,Igor B.Diagnostics and treatment of osteoporotic vertebral fractures.Reumatizam.2014;61(2):75.
[4]Waterloo S,Ahmed LA,Center JR,et al.Prevalence of vertebral fractures in women and men in the population-based Troms? Study.BMC Musculoskelet Disord.2012;13(1):3.
[5]Kim DY,Lee YK,Ha YC,et al.Mortality after vertebral fracture in Korea:Analysis of the national claim registry.Bone.2011;48(7):1859-1865.
[6]马洪,李文蛟,冯伟临,等.西双版纳老年人骨质疏松性骨折流行病学初步调查[J].中国骨与关节杂志,2009,8(5):263-265.
[7]赵刚,胡侦明,劳汉昌,等.昆明地区部分老年人群骨质疏松性骨折发病率初步调查和分析[J].中国骨质疏松杂志,2007,13(4):257-259.
[8]Jaremko JL,Siminoski K,Firth GB,et al.Common normal variants of pediatric vertebral development that mimic fractures:a pictorial review from a national longitudinal bone health study.Pediatr Radiol.2015;45(4):593-605.
[9]Siminoski K,Lee KC,Jen H,et al.Anatomical distribution of vertebral fractures:comparison of pediatric and adult spines.Osteoporos Int.2012;23(7):1999-2008.
[10]Chen AT,Cohen DB,Skolasky RL.Impact of nonoperative treatment,vertebroplasty,and kyphoplasty on survival and morbidity after vertebral compression fracture in the medicare population.Spine J.2012;12(9):1729-1736.
[11]Svedbom A,Alvares L,Cooper C,et al.Balloon kyphoplasty compared to vertebroplasty and nonsurgical;management in patients hospitalised with acute osteoporotic vertebral;compression fracture:a UK cost-effectiveness analysis.Osteoporos Int.2013;24(1):355-367.
[12]高志祥,李淳,李磊,等.PVP、PKP、骨填充网袋治疗胸腰段骨质疏松性椎体压缩性骨折的疗效分析[J].实用骨科杂志,2017,23(8):680-683.
[13]Yu W,Jiang X,Liang,et al.Intravertebral Vacuum Cleft and Its Varied Locations within Osteoporotic Vertebral Compression Fractures:Effect on Therapeutic Efficacy.Pain Physician.2017;20(6):E979.
[14]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5):413-443.
[15]龚遂良,陈宝,范顺武,等.椎体内裂隙样变对经皮椎体后凸成形术疗效的影响[J].中华骨科杂志,2014,34(1):6-12.
[16]Wu AM,Lin ZK,Ni WF,et al.The existence of intravertebral cleft impact on outcomes of nonacute osteoporotic vertebral compression fractures patients treated by percutaneous kyphoplasty:a comparative study.J Spinal Disord Tech.2014;27(3):E88.
[17]刘冬斌,李辉,程志安,等.经皮椎体成形术联合鲑鱼降钙素治疗骨质疏松椎体压缩性骨折的临床观察[J].中国骨质疏松杂志,2012,18(1):36-39.
[18]Fan J,Shen Y,Zhang N,et al.Evaluation of surgical outcome of Jack vertebral dilator kyphoplasty for osteoporotic vertebral compression fracture-clinical experience of 218 cases.J Orthop Surg Res.2016;11(1):56.
[19]李楠,何达,张贵林,等.PVP与PKP治疗伴椎体内裂隙样变的骨质疏松性椎体压缩骨折疗效对比观察[J].山东医药,2015,55(4):1-4.
[20]吴爱悯,倪文飞,池永龙.椎体内裂隙征的形成机理、影像学特征及手术治疗[J].脊柱外科杂志,2012,10(1):56-59.
[21]Kim YC,Kim YH,Ha KY.Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine.Spine J.2014;14(4):659-666.
[22]Sarli M,Pérez Manghi FC,Gallo R,et al.The vacuum cleft sign:an uncommon radiological sign.Osteoporos Int.2005;16(10):1210-1214.
[23]余伟波,梁德,江晓兵,等.经皮治疗有无裂隙骨质疏松椎体压缩骨折骨水泥分布及渗漏率比较[J].广东医学,2016,37(24):3678-3682.
[24]Bang JI,Jin JI,Ghanem N,et al.Quality improvement of transgenic cloned bovine embryos using an aggregation method:Effects on cell number,cell ratio,embryo perimeter,mitochondrial distribution,and gene expression profile.Theriogenology.2015;84(4):509-523.
[25]Zou D,Zhang K,Ren Y.Therapeutic effects of PKP on chronic painful osteoporotic vertebral compression fractures with or without intravertebral cleft.Int J Clin Exp Med.2015;8(9):15780-15786.
[26]余伟波,梁德,江晓兵,等.经皮椎体成形术和经皮椎体后凸成形术治疗伴椎体内真空裂隙的骨质疏松椎体压缩骨折比较研究[J].中国修复重建外科杂志,2016,30(9):1104-1110.
[27]高林,闫亮,郝定均,等.椎体内裂隙对经皮椎体后凸成形术疗效的影响[J].实用骨科杂志,2016,22(6):481-485.
[28]Wiggins MC,Sehizadeh M,Pilgram TK,et al.Importance of intravertebral fracture clefts in vertebroplasty outcome.AJR Am J Roentgenol.2007;188(3):634-640.
[29]Ha KY,Lee JS,Kim KW,et al.Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts.J Bone Joint Surg Br.2006;88(5):629.
[30]李石岩,钮俊杰,宋达玮,等.椎体后凸成形术治疗骨质疏松性椎体骨折伴或不伴裂隙征的对比研究[J].浙江临床医学,2014,16(6):843-845.
[31]Wang G,Yang H,Chen K.Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty.Bone.2010;92(11):1553.
[32]Fu Z,Hu X,Wu Y,et al.Is There a Dose-Response Relationship of Cement Volume With Cement Leakage and Pain Relief After Vertebroplasty.Dose Response.2016;14(4):1559325816682867.
[33]宋仁谦,周英杰,赵刚,等.高黏度骨水泥经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松压缩骨折的临床疗效观察[J].中国矫形外科杂志,2016,24(8):692-696.
[34]Kolmeder S,Lion A,Landgraf R,et al.Thermophysical properties and material modelling of acrylic bone cements used in vertebroplasty.J Therm Anal Calorim.2011;105(2):705-718.