聚甲基丙烯酸甲酯与可吸收骨水泥治疗骨质疏松椎体压缩骨折的临床疗效对照研究

发布时间：2018-03-01 10:46

本文关键词： 骨质疏松骨折压缩性椎体成形术骨水泥　出处：《北京大学学报(医学版)》2017年02期 　论文类型：期刊论文

【摘要】：目的:回顾性分析骨质疏松椎体压缩骨折患者在行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)中使用聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)与GeneX~汶骨水泥的治疗结果差异,为PKP手术椎体填充材料的选择提供参考。方法:回顾性分析2012年6月至2013年6月北京大学第三医院收治的89例骨质疏松椎体压缩骨折患者,于术后1个月、3个月、6个月、1年行问卷、X线片及CT检查随访,通过椎体高度恢复率、椎体Cobb角恢复率、计算机软件辅助CT数据分析、视觉模拟评分(visual analogue scale,VAS)减少情况、Oswestry评分以及并发症评估患者术后恢复情况。结果采用SPSS 18.0统计软件分析。结果:两组间椎体高度恢复率、椎体Cobb角恢复率、椎体体积恢复率在术后3个月、6个月、1年差异有统计学意义(P0.05),GeneX~汶组的椎体高度、Cobb角、椎体体积丢失多于PMMA组。PMMA组发生骨水泥渗漏者3例,邻近椎体再骨折1例,GeneX~汶组发生骨水泥渗漏2例,均无神经症状,均无致死性并发症。结论:GeneX~汶骨水泥对于患者术后疼痛的缓解效果与PMMA相当,作为椎体成形材料近期维持椎体高度良好,可以迅速提高椎体的强度和刚度,且其并发症少,但术后中、远期对椎体高度的维持并不十分满意,故骨质疏松压缩骨折患者可使用GeneX~汶骨水泥作为椎体填充材料,而对于术前椎体压缩程度重且伴有严重骨质疏松患者,可使用PMMA骨水泥作为椎体填充材料,并应避免术后早期负重,更佳的生物可替代材料仍然需要进一步寻找和研究。
[Abstract]:Objective: to retrospectively analyze the results of percutaneous kyphoplastyplasty (PKP) and polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral compression fracture. Methods: from June 2012 to June 2013, 89 patients with osteoporotic vertebral compression fracture treated in Peking University third Hospital were retrospectively analyzed. At 1 month, 3 months, 6 months and 1 year after operation, the patients were followed up by questionnaire X ray and CT examination. The recovery rate of vertebral body height, the recovery rate of vertebral body Cobb angle and the analysis of CT data were analyzed by computer software. Visual analogue score was used to evaluate the postoperative recovery of patients. Results: the recovery rate of vertebral body height and the recovery rate of Cobb angle between the two groups were analyzed by SPSS 18.0 statistical software. The recovery rate of vertebral volume at 3 months, 6 months, and 1 year after operation was significantly different between the two groups. There were 3 cases of bone cement leakage in the PMMA group, and the vertebral body volume loss was more than that in the PMMA group, and there was a significant difference between the two groups in terms of the height of the vertebral body and the Cobb angle in the GeneX- Wen group. There were 2 cases of bone cement leakage in the adjacent vertebral refracture group. There were no neurological symptoms and no fatal complications. Conclusion the effect of GeneX- Wengu cement on postoperative pain relief is similar to that of PMMA. As a material of vertebroplasty, the height of vertebral body can be maintained well in the near future, and the strength and stiffness of vertebral body can be improved rapidly, and its complications are few. However, in the long term after operation, the maintenance of height of vertebral body is not very satisfactory. Therefore, bone cement can be used as filling material in patients with osteoporotic compression fracture, while PMMA bone cement can be used as filling material for patients with severe vertebral compression and severe osteoporosis before operation. Early loading should be avoided, and better biomaterials still need to be looked for and studied.
【作者单位】：北京大学第三医院骨科;
【基金】：国家自然科学基金(81470101)资助~~
【分类号】：R687.3;R580

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