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[1]楊晶晶,王威,何承建,等.骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體成形術(shù)中骨水泥椎間盤滲漏對(duì)手術(shù)療效的影響…[J].中醫(yī)正骨,2022,34(01):15-21.
　YANG Jingjing,WANG Wei,HE Chengjian,et al.Effects of intradiscal bone cement leakage on the clinical outcome of percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(01):15-21.
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骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體成形術(shù)中骨水泥椎間盤滲漏對(duì)手術(shù)療效的影響…()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年01期
頁碼:
15-21
欄目:
臨床研究
出版日期:
2022-01-20

文章信息/Info

Title:
Effects of intradiscal bone cement leakage on the clinical outcome of percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fracture
作者:
楊晶晶; 王威; 何承建; 張志文; 文峰
(湖北省中醫(yī)院,湖北 武漢 430061)
Author(s):
YANG Jingjing; WANG Wei; HE Chengjian; ZHANG Zhiwen; WEN Feng
Hubei Provincial Hospital of TCM,Wuhan 430061,Hubei,China
關(guān)鍵詞:
骨質(zhì)疏松性骨折;  骨折; 壓縮性;  椎體成形術(shù);  手術(shù)中并發(fā)癥;  手術(shù)后并發(fā)癥;  骨水泥滲漏
Keywords:
osteoporotic fractures;  fractures; compression;  vertebroplasty;  intraoperative complications;  postoperative complications;  bone cement leakage
摘要:
目的:觀察骨質(zhì)疏松性椎體壓縮骨折(osteoporotic vertebral compression fracture,OVCF)經(jīng)皮椎體成形術(shù)(percutaneous vertebroplasty,PVP)中骨水泥椎間盤滲漏對(duì)手術(shù)療效的影響。方法:回顧性分析2016年1月至2019年1月采用PVP治療的162例OVCF患者的病例資料,其中30例出現(xiàn)骨水泥椎間盤滲漏(滲漏組)、132例未出現(xiàn)骨水泥滲漏(無滲漏組)。比較2組患者的傷椎疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、Cobb角、椎間盤高度及鄰近椎體骨折發(fā)生率。結(jié)果:滲漏組隨訪時(shí)間19～32個(gè)月,中位數(shù)26個(gè)月。無滲漏組隨訪時(shí)間17～33個(gè)月,中位數(shù)25個(gè)月。①傷椎疼痛VAS評(píng)分。時(shí)間因素與分組因素存在交互效應(yīng)(F=3.571,P=0.039)。2組患者傷椎疼痛VAS評(píng)分總體比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=2.875,P=0.092)。手術(shù)前后不同時(shí)間點(diǎn)傷椎疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=792.352,P=0.000)。2組患者的傷椎疼痛VAS評(píng)分隨時(shí)間變化均呈下降趨勢(shì),但2組的下降趨勢(shì)不完全一致。術(shù)前、術(shù)后1 d,2組患者傷椎疼痛VAS評(píng)分的組間差異均無統(tǒng)計(jì)學(xué)意義[(7.21±1.32)分,(7.15±1.41)分,t=-0.227,P=0.821;(2.81±0.59)分,(2.89±0.83)分,t=0.508,P=0.612]; 末次隨訪時(shí),滲漏組傷椎疼痛VAS評(píng)分低于無滲漏組[(1.58±0.64)分,(2.23±0.84)分,t=4.734,P=0.000]。②ODI。時(shí)間因素與分組因素不存在交互效應(yīng)(F=1.283,P=0.279)。2組患者ODI總體比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.007,P=0.935)。手術(shù)前后不同時(shí)間點(diǎn)ODI的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=662.717,P=0.000)。2組患者的ODI隨時(shí)間變化均呈下降趨勢(shì),且2組的下降趨勢(shì)完全一致[滲漏組:(41.29±5.74)%,(22.75±5.97)%,(11.46±5.24)%,F=192.697,P=0.000; 無滲漏組:(42.51±5.19)%,(21.27±6.37)%,(11.56±5.71)%,F=941.928,P=0.000]。③傷椎Cobb角。時(shí)間因素與分組因素不存在交互效應(yīng)(F=0.157,P=0.773)。2組患者傷椎Cobb角總體比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.890,P=0.347)。手術(shù)前后不同時(shí)間點(diǎn)傷椎Cobb角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=633.877,P=0.000)。2組患者的傷椎Cobb角隨時(shí)間變化均呈減小趨勢(shì),且2組的減小趨勢(shì)完全一致(24.07°±4.15°,13.64°±1.48°,13.54°±1.49°,F=184.863,P=0.000; 24.70°±4.36°,13.91°±1.94°,13.86°±1.86°,F=886.434,P=0.000)。④傷椎椎間盤高度。時(shí)間因素與分組因素存在交互效應(yīng)(F=94.251,P=0.000)。2組患者傷椎椎間盤高度總體比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.189,P=0.277)。手術(shù)前后不同時(shí)間點(diǎn)傷椎椎間盤高度的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=786.319,P=0.000)。2組患者的傷椎椎間盤高度隨時(shí)間變化均呈下降趨勢(shì),但2組的下降趨勢(shì)不完全一致。術(shù)前、術(shù)后1 d,2組患者傷椎椎間盤高度的組間差異均無統(tǒng)計(jì)學(xué)意義[(7.01±1.49)mm,(6.92±1.30)mm,t=-0.320,P=0.750;(6.91±1.44)mm,(6.96±1.29)mm,t=0.172,P=0.864]; 末次隨訪時(shí),滲漏組傷椎椎間盤高度低于無滲漏組[(5.17±1.46)mm,(6.06±1.25)mm,t=3.450,P=0.001]。⑤鄰近椎體骨折發(fā)生率。末次隨訪時(shí),滲漏組8例出現(xiàn)鄰近椎體骨折,其中胸段2例、胸腰段4例、腰段2例; 無滲漏組25例出現(xiàn)鄰近椎體骨折,其中胸段6例、胸腰段14例、腰段5例。2組患者鄰近椎體骨折發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.900,P=0.343)。結(jié)論:OVCF患者PVP治療后出現(xiàn)骨水泥椎間盤滲漏,不影響傷椎的Cobb角及活動(dòng)功能恢復(fù)、不會(huì)增加鄰近椎體骨折的風(fēng)險(xiǎn),反而可以在短期內(nèi)緩解疼痛癥狀,但遠(yuǎn)期可能加速椎間盤退變。
Abstract:
Objective:To observe the effects of intradiscal bone cement leakage on the clinical outcome of percutaneous vertebroplasty (PVP)in treatment of osteoporotic vertebral compression fracture(OVCF).Methods:The medical records of 162 patients who underwent PVP for OVCF from January 2016 to January 2019 were analyzed retrospectively.The intradiscal bone cement leakage was found in 30 patients(leakage group)and unfound in 132 patients(non-leakage group).The injured vertebrae pain visual analogue scale(VAS)score,Oswestry disability index(ODI),Cobb angle,intervertebral disc(IVD)height and incidence rate of adjacent vertebral fracture(AVF)were compared between the 2 groups.Results:The patients in leakage group were followed up for 19-32 months with a median of 26 months,and the ones in non-leakage group for 17-33 months with a median of 25 months.①There was interaction between time factor and group factor in injured vertebrae pain VAS scores(F=3.571,P=0.039).There was no statistical difference in injured vertebrae pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=2.875,P=0.092).There was statistical difference in injured vertebrae pain VAS scores between different timepoints before and after the PVP,in other words,there was time effect(F=792.352,P=0.000).The injured vertebrae pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in injured vertebrae pain VAS scores between the 2 groups before the PVP and at 1 day after the PVP(7.21±1.32 vs 7.15±1.41 points,t=-0.227,P=0.821; 2.81±0.59 vs 2.89±0.83 points,t=0.508,P=0.612).The injured vertebrae pain VAS scores were lower in leakage group compared to non-leakage group at the last follow-up(1.58±0.64 vs 2.23±0.84 points,t=4.734,P=0.000).②There was no interaction between time factor and group factor in injured vertebrae ODI(F=1.283,P=0.279).There was no statistical difference in injured vertebrae ODI between the 2 groups in general,in other words,there was no group effect(F=0.007,P=0.935).There was statistical difference in injured vertebrae ODI between different timepoints before and after the PVP,in other words,there was time effect(F=662.717,P=0.000).The injured vertebrae ODI presented a time-dependent decreasing trend in the 2 groups,and the 2 groups were completely consistent with each other in the variation tendency(leakage group:41.29±5.74,22.75±5.97,11.46±5.24%,F=192.697,P=0.000; non-leakage group:42.51±5.19,21.27±6.37,11.56±5.71%,F=941.928,P=0.000)...

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通訊作者:王威 E-mail:[email protected]
更新日期/Last Update: 1900-01-01