经皮椎体成形术后骨水泥椎间隙渗漏的临床疗效观察
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摘要
目的探究椎体成形术后发生椎间隙渗漏时对患者症状及椎间隙高度的影响。方法选取2016年2月～2017年5月收治的老年骨质疏松压缩性骨折并予以行椎体成形术(PVP)106例,其中发生椎间隙渗漏27例,未发生骨水泥渗漏79例,发生其他部位渗漏的病例未纳入研究。术后所有病例常规予以抗骨质疏松治疗,并于术后1d,术后1个月,术后3个月,术后1年予以行VAS评分及Oswestry功能障碍指数(ODI)评定,并于术后1年观察椎间隙渗漏的病例较术前椎间隙变化情况。结果术后1d、术后1个月、术后3个月、术后1年两组间患者VAS评分及ODI功能障碍指数较术前明显降低(P <0.05),术后1d、术后1个月,术后3个月,术后1年两组间VAS评分及ODI功能障碍指数比较,差异无统计学意义(P> 0.05),骨水泥椎间隙渗漏组术后1年椎间隙明显变窄,和术前比较差异有统计学意义(P <0.05)。结论椎体成形术出现椎间隙渗漏后,仍明显改善患者的疼痛症状,但是会造成远期椎间隙高度丢失,影响脊柱稳定性。
Objective To explore the effect of intervertebral space leakage after percutaneous vertebro-plasty on symptoms and intervertebral space height. Methods One hundred and six elderly patients with osteoporotic compression fractures who were treated and underwent percutaneous vertebro-plasty(PVP)from February 2016 to May 2017 were selected.Among them,27 cases had intervertebral space leakage,79 cases had no bone cement leakage,and the cases with leakage in other parts were not included in the study.All cases were treated with routineantiosteoporosis after operation.VAS score and Oswestry disability index were assessed on 1 day,1 month,3 months and 1 year after surgery.The changes in intervertebral space of cases with intervertebral space leakage were observed in 1 year after surgery. Results VAS score and Oswestry disability index of1 day,1 month,3 months and 1 year after surgery were significantly decreases than those before surgery(P < 0.05).There was no difference in VAS score and Oswestry disability index of 1 day,1 month,3 months and 1 year after surgery between two groups(P > 0.05).Intervertebral space of the intervertebral space leakage of bone cement group as significantly narrowed in 1 year after surgery,and the difference was statistically significant compared with that before surgery(P < 0.05). Conclusion Intervertebral space leakage after vertebro-plasty can still significantly improve pain symptoms of patients,but it will cause the loss of long-term intervertebral space and affect the stability of the spine.
Objective To explore the effect of intervertebral space leakage after percutaneous vertebro-plasty on symptoms and intervertebral space height. Methods One hundred and six elderly patients with osteoporotic compression fractures who were treated and underwent percutaneous vertebro-plasty(PVP)from February 2016 to May 2017 were selected.Among them,27 cases had intervertebral space leakage,79 cases had no bone cement leakage,and the cases with leakage in other parts were not included in the study.All cases were treated with routineantiosteoporosis after operation.VAS score and Oswestry disability index were assessed on 1 day,1 month,3 months and 1 year after surgery.The changes in intervertebral space of cases with intervertebral space leakage were observed in 1 year after surgery. Results VAS score and Oswestry disability index of1 day,1 month,3 months and 1 year after surgery were significantly decreases than those before surgery(P < 0.05).There was no difference in VAS score and Oswestry disability index of 1 day,1 month,3 months and 1 year after surgery between two groups(P > 0.05).Intervertebral space of the intervertebral space leakage of bone cement group as significantly narrowed in 1 year after surgery,and the difference was statistically significant compared with that before surgery(P < 0.05). Conclusion Intervertebral space leakage after vertebro-plasty can still significantly improve pain symptoms of patients,but it will cause the loss of long-term intervertebral space and affect the stability of the spine.
引文
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[26]Yan L,Jiang R,He B,et al.A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Spine,2014,39(26 Spec No.):B19-26.
[27]Sun H,Lu P-P,Liu Y-J,et al.Can Unilateral Kyphoplasty Replace Bilateral Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures?ASystematic Review and Meta-analysis[J].Pain Physician,2016,19(8):551-563.
[28]Cheng X,Long H-Q,Xu J-H,et al.Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):a systematic review and meta-analysis[J].European Spine Journal:Official Publication of the European Spine Society,the European Spinal Deformity Society,and the European Section of the Cervical Spine Research Society,2016,25(11):3439-3449.
[29]Chen X,Guo W,Li Q,et al.Is Unilateral Percutaneous Kyphoplasty Superior to Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures?Evidence from a Systematic Review of Discordant Meta-Analyses[J].Pain Physician,2018,21(4):327-336.
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[31]Xiang G-H,Tong M-J,Lou C,et al.The role of unilateral balloon kyphoplasty for the treatment of patients with OVCFS:A Systematic Review and Meta-Analysis[J].Pain Physician,2018,21(3):209-218.
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[33]Chang W,Zhang X,Jiao N,et al.Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures:A meta-analysis[J].Medicine,2017,96(17):e6738.
[34]Feng H,Huang P,Zhang X,et al.Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures:A systematic review and meta-analysis of RCTs[J].Journal of Orthopaedic Research:Official Publication of the Orthopaedic Research Society,2015,33(11):1713-1723.
[35]Hoppe S,Wangler S,Aghayev E,et al.Reduction of cement leakage by sequential PMMA application in a vertebroplasty model[J].European Spine Journal:Official Publication of the European Spine Society,the European Spinal Deformity Society,and the European Section of the Cervical Spine Research Society,2016,25(11):3450-3455.
[2]Kwon HM,Lee SP,Baek JW,et al.Appropriate cement volume in vertebroplasty:a multivariate analysis with short-term follow-up[J].Korean Journal of Neurotrauma,2016,12(2):128-134.
[3]Graham J,Ahn C,Hai N,et al.Effect of bone density on vertebral strength and stiffness after percutaneous vertebroplasty[J].Spine,2007,32(18):E505-511.
[4]Liebschner MA,Rosenberg WS,Keaveny TM,et al.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J].Spine,2001,26(14):1547-1554.
[5]Ryu KS,Park CK,Kim MC,et al.Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures[J].Journal of Neurosurgery,2002,96(1 Suppl):56-61.
[6]Kim J-M,Shin DA,Byun D-H,et al.Effect of bone cement volume and stiffness on occurrences of adjacent vertebral fractures after vertebroplasty[J].Journal of Korean Neurosurgical Society,2012,52(5):435-440.
[7]Kim JE,Choi SS,Lee MK,et al.Failed Percutaneous Vertebroplasty Due to Insufficient Correction of Intravertebral Instability in Kummell’s Disease:A Case Report[J].Pain Practice:The Official Journal of World Institute of Pain,2017,17(8):1109-1114.
[8]Alenezi S,Jerban S,Elkoun S,et al.Importance of the PMMA viscoelastic rheology on the reduction of the leakage risk during osteoporotic bone augmentation:A numerical leakage model through a porous media[J].Journal of the Mechanical Behavior of Biomedical Materials,2017,65:29-41.
[9]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?[J].Dose-Response:APublication of International Hormesis Society,2016,14(4):1559325816682867.
[10]Baroud G,Vant C,Wilcox R,et al.Long-term effects of vertebroplasty:adjacent vertebral fractures[J].Journal of Long-Term Effects of Medical Implants,2006,16(4):265-280.
[11]Phillips FM,Todd WF,Lieberman I,et al.An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty[J].Spine,2002,27(19):2173-2179.
[12]Schmidt R,Cakir B,Mattes T,et al.Cement leakage during vertebroplasty:an underestimated problem?[J].European Spine Journal:Official Publication of the European Spine Society,the European Spinal Deformity Society,and the European Section of the Cervical Spine Research Society,2005,14(5):466-473.
[13]He X,Li H,Meng Y,et al.Percutaneous Kyphoplasty Evaluated by Cement Volume and Distribution:An Analysis of Clinical Data[J].Pain Physician,2016,19(7):495-506.
[14]Hulme PA,Krebs J,Ferguson SJ,et al.Vertebroplasty and kyphoplasty:a systematic review of 69 clinical studies[J].Spine,2006,31(17):1983-2001.
[15]Nieuwenhuijse MJ,Van AR,Dijkstra DS,et al.Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures:identification of risk factors[J].The Spine Journal:Official Journal of the North American Spine Society,2011,11(9):839-848.
[16]Wahlquist TC,Lee JJ,Brunfeldt A,et al.Biomechanical Analysis of Intervertebral Cement Extravasation in Vertebral Motion Segments[J].Orthopedics,2017,40(2):e300-e304.
[17]Shen M,Niu J,Zhou H,et al.Adjacent disc height reduction and clinical outcome after intradiscal cement leakage[J].International Journal of Spine Surgery,2016,10:34.
[18]Zhao H,Ni C-F,Huang J,et al.Effects of bone cement on intervertebral disc degeneration[J].Experimental and Therapeutic Medicine,2014,7(4):963-969.
[19]Lin EP,Ekholm S,Hiwatashi A,et al.Vertebroplasty:cement leakage into the disc increases the risk of new fracture of adjacent vertebral body[J].AJNR.American Journal of Neuroradiology,2004,25(2):175-180.
[20]Nieuwenhuijse MJ,Bollen L,Van AR,et al.Optimal intravertebral cement volume in percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures[J].Spine,2012,37(20):1747-1755.
[21]Mai HT,Le GM,Tran BX.Adherence to antiretroviral therapy among HIV/AIDS patients in the context of early treatment initiation in Vietnam[J].Patient Prefer Adherence,2018,12.
[22]Wei H,Tang H,Zhang T.Preliminary efficacy of interspinal distraction fusion which is a new technique for lumbar disc herniation[J].Int Orthop,2018,23.
[23]倪才方,赵辉,陈珑,等.两种骨水泥渗漏对椎间盘影响的实验研究[J].中华骨科杂志,2007,27(4):263-267.
[24]Yang L-Y,Wang X-L,Zhou L,et al.A systematic review and meta-analysis of randomized controlled trials of unilateral versus bilateral kyphoplasty for osteoporotic vertebral compression fractures[J].Pain Physician,2013,16(4):277-290.
[25]Yang S,Chen C,Wang H,et al.A systematic review of unilateral versus bilateral percutaneous vertebroplasty/percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J].Acta Orthopaedica Et Traumatologica Turcica,2017,51(4):290-297.
[26]Yan L,Jiang R,He B,et al.A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Spine,2014,39(26 Spec No.):B19-26.
[27]Sun H,Lu P-P,Liu Y-J,et al.Can Unilateral Kyphoplasty Replace Bilateral Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures?ASystematic Review and Meta-analysis[J].Pain Physician,2016,19(8):551-563.
[28]Cheng X,Long H-Q,Xu J-H,et al.Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):a systematic review and meta-analysis[J].European Spine Journal:Official Publication of the European Spine Society,the European Spinal Deformity Society,and the European Section of the Cervical Spine Research Society,2016,25(11):3439-3449.
[29]Chen X,Guo W,Li Q,et al.Is Unilateral Percutaneous Kyphoplasty Superior to Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures?Evidence from a Systematic Review of Discordant Meta-Analyses[J].Pain Physician,2018,21(4):327-336.
[30]Yan L,He B,Guo H,et al.The prospective selfcontrolled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Osteoporosis international:a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA,2016,27(5):1849-1855.
[31]Xiang G-H,Tong M-J,Lou C,et al.The role of unilateral balloon kyphoplasty for the treatment of patients with OVCFS:A Systematic Review and Meta-Analysis[J].Pain Physician,2018,21(3):209-218.
[32]Tan G,Li F,Zhou D,et al.Unilateral versus bilateral percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures:A systematic review of overlapping meta-analyses[J].Medicine,2018,97(33):e11968.
[33]Chang W,Zhang X,Jiao N,et al.Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures:A meta-analysis[J].Medicine,2017,96(17):e6738.
[34]Feng H,Huang P,Zhang X,et al.Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures:A systematic review and meta-analysis of RCTs[J].Journal of Orthopaedic Research:Official Publication of the Orthopaedic Research Society,2015,33(11):1713-1723.
[35]Hoppe S,Wangler S,Aghayev E,et al.Reduction of cement leakage by sequential PMMA application in a vertebroplasty model[J].European Spine Journal:Official Publication of the European Spine Society,the European Spinal Deformity Society,and the European Section of the Cervical Spine Research Society,2016,25(11):3450-3455.