Effect comparison of vertebroplasty with bone cement of different viscosity for the treatment of vertebral osteonecrosis
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摘要:目的 探讨采用高黏度骨水泥或低黏度骨水泥椎体成形术治疗椎体骨坏死患者的临床效果及并发症发生情况。方法 将32例椎体骨坏死患者随机分为高黏度组15例及低黏度组17例, 记录术中透视次数、手术时间及骨水泥注射量，手术前后采用视觉模拟评分法(VAS)评分评估腰背部疼痛，功能障碍指数(ODI)评分评估腰背部功能，简明健康状况调查量表(SF-36)评分评估生活质量，影像学测量伤椎椎体相对高度(%)、伤椎后凸畸形角度，同时观察骨水泥渗漏及临近节段椎体骨折等并发症发生情况。结果 2组患者均手术顺利，完成至少12个月随访; 2组患者一般情况、术中透视次数、手术时间及骨水泥注射量比较，差异无统计学意义(P>0.05); 与手术前比较, 2组患者手术后VAS评分及ODI评分显著降低, SF-36评分显著提高，伤椎椎体前缘高度(%)及伤椎椎体中部高度(%)显著改善，后凸畸形角度显著改善(P < 0.05), 但2组间同一时点及组内术后不同时点无显著差异(P>0.05); 术后X线检查发现骨水泥渗漏情况为高黏度组5个椎体(33.3%), 均为椎间盘内渗漏，低黏度组10个椎体(58.8%), 其中8个椎间盘内渗漏、2个为椎旁渗漏，2组渗漏率有显著差异(P < 0.05)。结论 采用椎体成形术治疗椎体骨坏死可达到满意的临床效果，而应用高黏度骨水泥行椎体成形术可显著降低术后骨水泥渗漏率，提升手术安全性。Abstract:Objective To compare the clinical outcomes of high- and low-viscosity cement percutaneous vertebroplasty (PVP) for the treatment of vertebral osteonecrosis and its complications.Methods Thirty-two patients suffering from osteoporotic vertebral osteonecrosis were randomly assigned into high-viscosity group(n=15) and low-viscosity group(n=17). Intraoperative X-ray times, operative time and volume of bone cement injection were recorded. Visual analogue scale (VAS), Oswestry disability index (ODI) scores, 36-Item Short Form Health Survey(SF-36), and radiographic measurement were performed to assess waist-back pain, waist-back function and life quality, relative height of injured vertebrae(%) and its kyphotic angle, respectively. Incidence of complications such as bone cement leakage and vertebral fractures in adjacent segments were observed.Results The patients in both groups had smooth operation and completed follow-up for at least 12 months. There was no significant difference in the general data, intraoperative X-ray times, operation time and volume of bone cement injection between the two groups (P>0.05). Significant improvement on the VAS, ODI scores, SF-36 score, vertebral height (%) and kyphosis Cobb′s angle were noted in each group compared with treatment before. However, there were no significant differences in the same postoperative time between the 2 groups and at varied time points intra-group(P>0.05). Postoperative X-ray assessment identified cement leakage occurred in 5 vertebrae(33.3%) in high viscosity group, and all of them were intraspinal leakage, while high-viscosity cement group had 10 vertebrae leakage(58.8%), among which 8 was intraspinal leakage, 2 was vertebral side leakage. There were significant differences between the two groups in cement leakage rate(P < 0.05).Conclusion PVP used in osteoporotic vertebral osteonecrosis has better clinical efficacy, which can significantly relieve back pain, improve lower back function and quality of life. Furthermore, high-viscosity cement can reduce the cement leakage rate and greatly enhance operative safety.
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Keywords:
- vertebral osteonecrosis /
- vertebroplasty /
- bone cement /
- viscosity /
- leakage
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表 1 2组患者一般资料比较(x±s)
组别 n 男性 女性 年龄/岁 椎体数/个 发病时间/d 手术时间/min 术中透视/次 骨水泥使用量/mL 高黏度组 15 5 10 70.0±6.6 17 48.0±74.3 35.1±15.2 21.2±9.5 6.7±1.4 低黏度组 17 6 11 70.3±6.9 20 50.9±57.0 42.4±13.3 27.0±8.4 6.7±1.5 
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表 2 2组患者VAS、ODI评分及SF-36评分比较(x±s)
分 指标 高黏度组(n=15) 低黏度组(n=17) 术前 术后3 d 术后1年 术前 术后3 d 术后1年 VAS评分 8.0±1.0 2.1±0.8* 1.8±0.9* 7.9±1.1 2.1±0.9* 2.0±0.8* ODI评分 71.7±8.8 21.1±3.9* 18.9±3.4* 72.0±8.6 20.2±4.5* 17.4±3.2* SF-36 PCS 24.9±7.1 43.7±7.4* 42.9±5.8* 22.6±5.2 40.5±5.2* 41.3±6.3* SF-36 MCS 36.0±6.7 44.6±7.1* 43.4±5.6* 32.0±9.2 41.4±5.2* 39.6±4.8* VAS: 视觉模拟评分法; ODI: 功能障碍指数; SF-36 PCS: 简明健康状况调查量表-躯体健康; SF-36 MCS: 简明健康状况调查量表-精神健康。与术前比较, *P < 0.05。
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表 3 2组患者手术前后椎体高度变化、后凸畸形角度及骨水泥渗漏情况比较(x±s)
指标 高黏度组(n=15) 低黏度组(n=17) 术前 术后3 d 术后1年 术前 术后3 d 术后1年 椎体前缘高度/% 63.0±8.7 78.4±7.5* 73.0±7.2* 59.5±15.0 81.1±9.0* 75.0±10.1* 椎体中部高度/% 72.5±8.8 81.6±6.2* 77.6±6.3* 65.3±15.6 82.5±7.9* 79.9±8.4* 后凸畸形角度/° 13.3±6.0 5.4±3.2* 6.7±3.4* 12.9±4.6 6.0±2.9* 7.3±3.2* 与术前比较, *P < 0.05。
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[1] D′Oria S, Delvecchio C, Dibenedetto M, et al. Case report of Kummell's disease with delayed onset myelopathy and the literature review[J]. Eur J Orthop Surg Traumatol, 2018, 28(2): 309-316. doi: 10.1007/s00590-017-2039-0
[2] Kümmell H. Die rarefizierende Ostitis der Wirbelkorper[J]. Deutsche Med, 1985, 21(1): 180-181.
[3] Zha L L, Tong P J, Xia L W, et al. Diagnostic analysis of the radiologic characteristics in osteoporotic Kiinmmel's disease[J]. Zhongguo gu shang, 2016, 29(5): 460-463. http://www.cqvip.com/QK/97146X/201605/669161204.html
[4] Hur W, Choi S S, Lee M, et al. Spontaneous vertebral reduction during the procedure of kyphoplasty in a patient with kummell's disease[J]. Korean J Pain, 2011, 24(4): 231-234. doi: 10.3344/kjp.2011.24.4.231
[5] Matzaroglou C, Georgiou C S, Panagopoulos A, et al. Kümmell's disease: clarifying the mechanisms and patients′inclusion criteria[J]. Open Orthop J, 2014, 8: 288-297. doi: 10.2174/1874325001408010288
[6] Liu F J, Chen Z Z, Lou C, et al. Anterior reconstruction versus posterior osteotomy in treating Kümmell's disease with neurological deficits: A systematic review[J]. Acta Orthop Traumatol Turc, 2018, 52(4): 283-288. doi: 10.1016/j.aott.2018.05.002
[7] 黄吉军, 冯新民, 杨建东, 等. 内固定联合椎体成形治疗Ⅲ型Kummell病疗效观察[J]. 实用骨科杂志, 2016, 22(3): 198-200, 224. https://www.cnki.com.cn/Article/CJFDTOTAL-SGKZ201603003.htm [8] Yang H L, Pan J, Wang G L. A review of osteoporotic vertebral fracture nonunion management[J]. Spine, 2014, 39(26): B4-B6. http://www.ncbi.nlm.nih.gov/pubmed/25504096
[9] 王根林, 杨惠林, 姜为民, 等. 球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折后骨坏死[J]. 中华外科杂志, 2010, 48(8): 593-596. doi: 10.3760/cma.j.issn.0529-5815.2010.08.010 [10] Ding J, Zhang Q, Zhu J F, et al. Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures[J]. Eur Spine J, 2016, 25(11): 3411-3417. doi: 10.1007/s00586-015-3923-0
[11] Rothermich M A, Buchowski J M, Bumpass D B, et al. Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection[J]. Clin Orthop Relat Res, 2014, 472(5): 1652-1657. doi: 10.1007/s11999-014-3506-0
[12] D′Oria S, Delvecchio C, Dibenedetto M, et al. Case report of Kummell′s disease with delayed onset myelopathy and the literature review[J]. Eur J Orthop Surg Traumatol, 2018, 28(2): 309-316. doi: 10.1007/s00590-017-2039-0
[13] Wu C C, Lin M H, Yang S H, et al. Surgical removal of extravasated epidural and neuroforaminal polymethylmethacrylate after percutaneous vertebroplasty in the thoracic spine[J]. Eur Spine J, 2007, 16(Suppl 3): 326-331. http://europepmc.org/articles/PMC2148084
[14] 陈涛, 杨建东, 张亮, 等. 骨质疏松性胸腰椎骨折椎体强化术后发生邻近椎体骨折的危险因素分析[J]. 骨科, 2017, 8(3): 190-193, 199. doi: 10.3969/j.issn.1674-8573.2017.03.007 [15] Zhang L, Wang J C, Feng X M, et al. A comparison of high viscosity bone cement and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures[J]. Clin Neurol Neurosurg, 2015, 129: 10-16. doi: 10.1016/j.clineuro.2014.11.018
[16] Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage[J]. Spine, 2006, 31(22): 2562-2568. doi: 10.1097/01.brs.0000240695.58651.62
[17] 张亮, 王静成, 冯新民, 等. 高粘度骨水泥椎体成形术与普通粘度椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的效果比较[J]. 中国老年学杂志, 2017, 37(18): 4601-4603. doi: 10.3969/j.issn.1005-9202.2017.18.080 [18] 张亮, 王静成, 冯新民, 等. 不同黏度骨水泥椎体成形术治疗重度骨质疏松性骨折的疗效研究[J]. 实用骨科杂志, 2016, 22(7): 577-581. https://www.cnki.com.cn/Article/CJFDTOTAL-SGKZ201607001.htm [19] 张亮, 王静成, 冯新民, 等. 高黏度骨水泥用于重度骨质疏松性胸腰椎骨折治疗[J]. 实用骨科杂志, 2015, 21(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-SGKZ201501001.htm [20] 张亮, 王静成, 冯新民, 等. 唑来膦酸在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用[J]. 实用医学杂志, 2015, 31(2): 283-285. doi: 10.3969/j.issn.1006-5725.2015.02.041 [21] Ma R, Chow R, Shen F H. Kummell′s disease: delayed post-traumatic osteonecrosis of the vertebral body[J]. Eur Spine J, 2010, 19(7): 1065-1070. doi: 10.1007/s00586-009-1205-4
[22] Pappou I P, Papadopoulos E C, Swanson A N, et al. Osteoporotic vertebral fractures and collapse with intravertebral vacuum sign (Kümmel′s disease)[J]. Orthopedics, 2008, 31(1): 61-66. doi: 10.3928/01477447-20080101-35
[23] 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. doi: 10.3760/cma.j.issn.0253-2352.2014.01.002 [24] Libicher M, Appelt A, Berger I, et al. The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study[J]. Eur Radiol, 2007, 17(9): 2248-2252. doi: 10.1007/s00330-007-0684-0
[25] Kim D Y, Lee S H, Jang J S, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability[J]. J Neurosurg, 2004, 100(1): 24-31. doi: 10.3171/jns.2004.100.1.0024
[26] Lim J, Choi S W, Youm J Y, et al. Posttraumatic delayed vertebral collapse: kummell's disease[J]. J Korean Neurosurg Soc, 2018, 61(1): 1-9. doi: 10.3340/jkns.2017.0505.010
[27] He D W, Yu W Y, Chen Z Z, et al. Pathogenesis of the intravertebral vacuum of Kümmell's disease[J]. Exp Ther Med, 2016, 12(2): 879-882. doi: 10.3892/etm.2016.3369
[28] Chen L, Dong R B, Gu Y, et al. Comparison between balloon kyphoplasty and short segmental fixation combined with vertebroplasty in the treatment of kümmell's disease[J]. Pain Physician, 2015, 18(4): 373-381. http://europepmc.org/abstract/MED/26218941
[29] Maldague B E, Noel H M, Malghem J J. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse[J]. Radiology, 1978, 129(1): 23-29. doi: 10.1148/129.1.23
[30] Grohs J G, Matzner M, Trieb K, et al. Treatment of intravertebral pseudarthroses by balloon kyphoplasty[J]. J Spinal Disord Tech, 2006, 19(8): 560-565. doi: 10.1097/01.bsd.0000211232.91340.6b
[31] 王远政, 田晓滨, 李波, 等. 高粘度骨水泥与低粘度骨水泥经皮椎体成形术治疗严重骨质疏松性椎体压缩性骨折的前瞻性比较研究[J]. 中华创伤骨科杂志, 2017, 19(1): 54-60. doi: 10.3760/cma.j.issn.1671-7600.2017.01.009 [32] 唐冲, 吴四军, 刘正, 等. 高粘度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效分析[J]. 中国脊柱脊髓杂志, 2017, 27(8): 720-726. doi: 10.3969/j.issn.1004-406X.2017.08.08 [33] 冯新民, 王静成, 张亮, 等. 高黏度骨水泥在修复骨质疏松性胸腰椎骨折中的应用[J]. 中国组织工程研究, 2014, 18(30): 4757-4763. doi: 10.3969/j.issn.2095-4344.2014.30.001 [34] Hulme P A, Krebs J, Ferguson S J, et al. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies[J]. Spine, 2006, 31(17): 1983-2001. doi: 10.1097/01.brs.0000229254.89952.6b
[35] Aparisi F. Vertebroplasty and kyphoplasty in vertebral osteoporotic fractures[J]. Semin Musculoskelet Radiol, 2016, 20(4): 382-391. doi: 10.1055/s-0036-1592431
[36] Ha K Y, Lee J S, Kim K W, et al. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts[J]. J Bone Joint Surg Br, 2006, 88(5): 629-633. http://www.ncbi.nlm.nih.gov/pubmed/16645109
[37] Xie W X, Jin D X, Ma H, et al. Cement leakage in percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: analysis of risk factors[J]. Clin Spine Surg, 2016, 29(4): E171-E176. doi: 10.1097/BSD.0000000000000229
[38] 杨惠林, 王根林, 姜为民, 等. 分次灌注骨水泥技术治疗Kümmell病[J]. 脊柱外科杂志, 2012, 10(1): 22-24. doi: 10.3969/j.issn.1672-2957.2012.01.007 [39] Nieuwenhuijse M J, Muijs S P, van Erkel A R, et al. A clinical comparative study on low versus medium viscosity polymethylmetacrylate bone cement in percutaneous vertebroplasty: viscosity associated with cement leakage[J]. Spine, 2010, 35(20): E1037-E1044. doi: 10.1097/BRS.0b013e3181ddd262
[40] Anselmetti G C, Zoarski G, Manca A, et al. Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures[J]. Cardiovasc Intervent Radiol, 2008, 31(5): 937-947. doi: 10.1007/s00270-008-9324-6
[41] 张亮, 王静成, 冯新民, 等. 高粘度骨水泥椎体成形术与普通粘度椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的效果比较[J]. 中国老年学杂志, 2017, 37(18): 4601-4603. doi: 10.3969/j.issn.1005-9202.2017.18.080 [42] Zhang L, Wang J C, Feng X M, et al. A comparison of high viscosity bone cement and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures[J]. Clin Neurol Neurosurg, 2015, 129: 10-16. doi: 10.1016/j.clineuro.2014.11.018
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