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[1]羅科鋒,蔡凱文,盧斌,等.礦化膠原-聚甲基丙烯酸甲酯骨水泥經(jīng)皮椎體后凸成形術(shù)治療Ⅰ、Ⅱ期Kmmell病的臨床研究[J].中醫(yī)正骨,2018,30(06):4-14.
　LUO Kefeng,CAI Kaiwen,LU Bin,et al.A clinical study of percutaneous kyphoplasty with mineralized collagen-polymethylmethacrylate bone cement for treatment of phaseⅠandⅡKmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(06):4-14.
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礦化膠原-聚甲基丙烯酸甲酯骨水泥經(jīng)皮椎體后凸成形術(shù)治療 Ⅰ、Ⅱ期Kümmell病的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年06期
頁碼:
4-14
欄目:
kümmell病
出版日期:
2018-06-20

文章信息/Info

Title:
A clinical study of percutaneous kyphoplasty with mineralized collagen-polymethylmethacrylate bone cement for treatment of phaseⅠandⅡKümmell's diseases
作者:
羅科鋒; 蔡凱文; 盧斌; 岳兵; 陸繼業(yè); 蔣國強
寧波大學(xué)醫(yī)學(xué)院附屬醫(yī)院,浙江 寧波 315020
Author(s):
LUO Kefeng; CAI Kaiwen; LU Bin; YUE Bing; LU Jiye; JIANG Guoqiang
The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,Zhejiang,China
關(guān)鍵詞:
脊柱骨折;  骨質(zhì)疏松性骨折;  Kü; mmell病;  椎體后凸成形術(shù);  礦化膠原-聚甲基丙烯酸甲酯
Keywords:
spinal fractures;  osteoporotic fractures;  Kü; mmell's disease;  kyphoplasty;  mineralized collagen-polymethylmethacrylate
文獻(xiàn)標(biāo)志碼:
A
摘要:
目的:探討礦化膠原-聚甲基丙烯酸甲酯(mineralized collagen-polymethylmethacrylate,MC-PMMA)骨水泥經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)治療Ⅰ、Ⅱ期Kümmell病的臨床療效和安全性。方法:收集2015年1月至2017年1月在寧波大學(xué)醫(yī)學(xué)院附屬醫(yī)院住院治療的Ⅰ、Ⅱ期Kümmell病患者的病例資料進(jìn)行回顧性研究。符合要求的患者共23例,均行傷椎雙側(cè)PKP手術(shù),術(shù)中使用MC-PMMA者9例(MC-PMMA組)、使用PMMA者14例(PMMA組)。比較2組患者的手術(shù)時間、術(shù)中出血量、住院時間、疼痛視覺模擬量表(visual analogue scale,VAS)評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、傷椎前緣高度丟失率、傷椎后緣高度丟失率、脊柱后凸角矯正率、傷椎楔變角矯正率,以及治療和隨訪期間的并發(fā)癥發(fā)生情況。結(jié)果:①手術(shù)一般情況及并發(fā)癥。2組患者均順利完成手術(shù)。2組患者的手術(shù)時間、術(shù)中出血量及住院時間比較,組間差異均無統(tǒng)計學(xué)意義[(27.4±3.7)min,(27.0±4.5)min,t=0.248,P=0.807;(13.3±3.5)mL,(14.3±3.3)mL,t=-0.655,P=0.519;(8.1±1.1)d,(7.7±1.3)d,t=-0.780,P=0.444]。MC-PMMA組5例發(fā)生骨水泥滲漏,其中1例向椎體前緣滲漏、4例向椎間盤內(nèi)滲漏; PMMA組7例發(fā)生骨水泥滲漏,其中1例向椎體前緣滲漏、5例向椎間盤內(nèi)滲漏、1例向椎管內(nèi)少量滲漏但無神經(jīng)癥狀。MC-PMMA組2例發(fā)生椎體骨折,PMMA組3例發(fā)生椎體骨折,均經(jīng)非手術(shù)治療或PKP手術(shù)治療后改善或治愈。2組骨水泥滲漏和術(shù)后新發(fā)骨折率比較,組間差異均無統(tǒng)計學(xué)意義(P=1.000; P=1.000)②疼痛VAS評分。時間因素和分組因素不存在交互效應(yīng)(F=0.138,P=0.711)。2組患者疼痛VAS評分總體比較,差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=0.095,P=0.760); 手術(shù)前后不同時間點之間疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=302.813,P=0.000); 2組疼痛VAS評分隨時間均呈先降低后增加的趨勢,且2組的變化趨勢基本一致。③ODI。時間因素和分組因素不存在交互效應(yīng)(F=0.299,P=0.590)。2組患者ODI總體比較,差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=0.349,P=0.561); 手術(shù)前后不同時間點之間ODI的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=531.962,P=0.000); 2組ODI隨時間均呈先降低后增加的趨勢,且2組的變化趨勢基本一致。④傷椎前緣高度丟失率。時間因素與分組因素不存在交互效應(yīng)(F=2.881,P=0.074); 2組患者傷椎前緣高度丟失率總體比較,差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=0.853,P=0.366); 手術(shù)前后不同時間點之間傷椎前緣高度丟失率的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=27.068,P=0.000); 2組傷椎前緣高度丟失率隨時間變化均呈先降低后增高的趨勢,2組的變化趨勢基本一致。⑤傷椎后緣高度丟失率。時間因素與分組因素不存在交互效應(yīng)(F=2.488,P=0.102); 2組患者傷椎后緣高度丟失率總體比較,差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=3.871,P=0.062); 手術(shù)前后不同時間點之間傷椎后緣高度丟失率的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=20.016,P=0.000); 2組傷椎后緣高度丟失率隨時間變化均呈先降低后增高的趨勢,2組的變化趨勢基本一致。⑥脊柱后凸角矯正率。時間因素與分組因素存在交互效應(yīng)(F=18.089,P=0.000); 2組患者脊柱后凸角矯正率總體比較,差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=0.001,P=0.973); 術(shù)后不同時間點之間脊柱后凸角矯正率的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=52.825,P=0.000); 2組脊柱后凸角矯正率隨時間變化均呈降低趨勢,但2組的降低趨勢不完全一致; 術(shù)后即刻、術(shù)后3個月,2組脊柱后凸角矯正率的組間差異均無統(tǒng)計學(xué)意義(t=-1.867,P=0.076; t=-1.311,P=0.204); 術(shù)后1年,PMMA組的脊柱后凸角矯正率明顯低于MC-PMMA組(t=3.690,P=0.001)。⑦傷椎楔變角矯正率。時間因素與分組因素存在交互效應(yīng)(F=10.315,P=0.000); 2組患者傷椎楔變角矯正率總體比較,差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=0.016,P=0.901); 術(shù)后不同時間點之間傷椎楔變角矯正率的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=49.888,P=0.000); 2組傷椎楔變角矯正率隨時間變化均呈降低趨勢,2組的降低趨勢基本一致。結(jié)論:應(yīng)用MC-PMMA與應(yīng)用PMMA行PKP治療Ⅰ、Ⅱ期Kümmell病,均能迅速緩解疼痛癥狀、改善脊柱功能、恢復(fù)傷椎高度、糾正脊柱后凸畸形,而且具有較高的安全性; 但后期均會出現(xiàn)一定程度的傷椎高度丟失和脊柱后凸矯正度丟失,應(yīng)用MC-PMMA比應(yīng)用PMMA能更好地維持脊柱后凸矯正度。
Abstract:
Objective:To explore the clinical curative effects and the safety of percutaneous kyphoplasty(PKP)with mineralized collagen-polymethylmethacrylate(MC-PMMA)bone cement for treatment of phaseⅠandⅡKümmell's diseases.Methods:The medical records of patients with phaseⅠandⅡKümmell's diseases who were treated in the Affiliated Hospital of Medical School of Ningbo University from January 2015 to January 2017 were collected and retrospectively studied.Twenty-three patients enrolled in the study were treated with bilateral PKP on injured vertebra using MC-PMMA(9)and PMMA(14)respectively.The operative time,intraoperative blood loss,hospital stay,pain visual analogue scale(VAS)scores,Oswestry disability index(ODI),loss rate of injured vertebrae anterior border height,loss rate of injured vertebrae posterior border height,correction rate of spinal kyphotic angle,correction rate of angle of wedge shaped injured vertebrae and complications during treatment period and follow-up period were compared between the 2 groups.Results:The surgeries were finished successfully in all patients.There was no statistical difference in operative time,intraoperative blood loss and hospital stay between the 2 groups(27.4+/-3.7 vs 27.0+/-4.5 min,t=0.248,P=0.807; 13.3+/-3.5 vs 14.3+/-3.3 mL,t=-0.655,P=0.519; 8.1+/-1.1 vs 7.7+/-1.3 days,t=-0.780,P=0.444).The bone cements leaked out of anterior border of vertebral body(1)and leaked into intervertebral disc(4)in MC-PMMA group.The bone cements leaked out of anterior border of vertebral body(1)and leaked into intervertebral disc(5)and vertebral canal without nerve symptoms(1)in PMMA group.Meanwhile,the vertebral fractures were found in MC-PMMA group(2)and PMMA group(3),and all patients were improved or cured after non-surgical treatment or PKP surgery.There was no statistical difference in the rates of bone cement leakage and postoperative new fracture between the 2 groups(P=1.000; P=1.000).There was no interaction between time factor and group factor in pain VAS scores(F=0.138,P=0.711).There was no statistical difference in pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=0.095,P=0.760).There was statistical difference in the pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=302.813,P=0.000).The pain VAS scores presented a time-dependent trend of decreasing firstly and increasing subsequently in both of the 2 groups,and the 2 groups were basically consistent with each other in the variation tendency of pain VAS scores.There was no interaction between time factor and group factor in ODI(F=0.299,P=0.590).There was no statistical difference in ODI between the 2 groups in general,in other words,there was no group effect(F=0.349,P=0.561).There was statistical difference in ODI between different timepoints before and after the surgery,in other words,there was time effect(F=531.962,P=0.000).The ODI presented a time-dependent trend of decreasing firstly and increasing subsequently in both of the 2 groups,and the 2 groups were basically consistent with each other in the variation tendency of ODI.There was no interaction between time factor and group factor in the loss rate of injured vertebrae anterior border height(F=2.881,P=0.074).There was no statistical difference in the loss rate of injured vertebrae anterior border height between the 2 groups in general,in other words,there was no group effect(F=0.853,P=0.366).There was statistical difference in the loss rate of injured vertebrae anterior border height between different timepoints before and after the surgery,in other words,there was time effect(F=27.068,P=0.000).The loss rate of injured vertebrae anterior border height presented a time-dependent trend of decreasing firstly and increasing subsequently in both of the 2 groups,and the 2 groups were basically consistent with each other in the variation tendency of loss rate of injured vertebrae anterior border height.There was no interaction between time factor and group factor in the loss rate of injured vertebrae posterior border height(F=2.488,P=0.102).There was no statistical difference in the loss rate of injured vertebrae posterior border height between the 2 groups in general,in other words,there was no group effect(F=3.871,P=0.062).There was statistical difference in the loss rate of injured vertebrae posterior border height between different timepoints before and after the surgery,in other words,there was time effect(F=20.016,P=0.000).The loss rate of injured vertebrae posterior border height presented a time-dependent trend of decreasing firstly and increasing subsequently in both of the 2 groups,and the 2 groups were basically consistent with each other in the variation tendency of loss rate of injured vertebrae posterior border height.There was interaction between time factor and group factor in the correction rate of spinal kyphotic angle(F=18.089,P=0.000).There was no statistical difference in the correction rate of spinal kyphotic angle between the 2 groups in general,in other words,there was no group effect(F=0.001,P=0.973).There was statistical difference in the correction rate of spinal kyphotic angle between different timepoints after the surgery,in other words,there was time effect(F=52.825,P=0.000).The correction rate of spinal kyphotic angle presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of correction rate of spinal kyphotic angle.There were no statistical difference in the correction rate of spinal kyphotic angle between the 2 groups immediately postoperatively and at 3 months after the surgery(t=-1.867,P=0.076; t=-1.311,P=0.204).The correction rate of spinal kyphotic angle was obviously lower in PMMA group compared to MC-PMMA group at 1 year after the surgery(t=3.690,P=0.001).There was interaction between time factor and group factor in the correction rate of angle of wedge shaped injured vertebrae(F=10.315,P=0.000).There was no statistical difference in the correction rate of angle of wedge shaped injured vertebrae between the 2 groups in general,in other words,there was no group effect(F=0.016,P=0.901).There was statistical difference in the correction rate of angle of wedge shaped injured vertebrae between different timepoints after the surgery,in other words,there was time effect(F=49.888,P=0.000).The correction rate of angle of wedge shaped injured vertebrae presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were basically consistent with each other in the decreasing trend of correction rate of angle of wedge shaped injured vertebrae.Conclusion:PKP with MC-PMMA or PMMA can rapidly alleviate pain symptoms,improve spinal function,restore injured vertebrae height and correct kyphotic deformity in treatment of phaseⅠandⅡKümmell's diseases,and both of them have high safety.However,injured vertebra height and kyphotic correction rate can loss to a certain degree in later stage,and MC-PMMA surpasses PMMA in maintaining kyphotic correction rate.

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備注/Memo

備注/Memo:
基金項目:浙江省自然科學(xué)基金項目(LY17H060001) 通訊作者:蔣國強 E-mail:[email protected]
更新日期/Last Update: 2018-10-30