[1]白杰 陈荣彬△ 李勇.骨水泥弥散类型与胸腰段椎体成形术后早期术椎塌陷的相关性研究[J].中国中医骨伤科杂志,2020,28(06):26-31.
　BAI Jie CHEN Rongbin LI Yong.Study on the Relationship between the Types of CementDiffusion and the Collapse of Early PostoperativeVertebrae after Thoracolumbar Vertebroplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2020,28(06):26-31.
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骨水泥弥散类型与胸腰段椎体成形术后早期术椎塌陷的相关性研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年06期
页码:
26-31
栏目:
临床研究
出版日期:
2020-06-10

文章信息/Info

Title:
Study on the Relationship between the Types of CementDiffusion and the Collapse of Early PostoperativeVertebrae after Thoracolumbar Vertebroplasty
文章编号:
1005-0205(2020)06-0026-06
作者:
白杰1 陈荣彬1△ 李勇2
1广州中医药大学第二临床医学院(广州,510410)2广东省中医院珠海医院
Author(s):
BAI Jie1 CHEN Rongbin1△ LI Yong2
1The Second School of Clinical Medicine,Guangzhou University of Traditional Chinese Medicine,Guangzhou 510410,China; 2Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine,Zhuhai 519015,Guangdong China.
关键词:
骨水泥弥散类型;  椎体成形术;  再塌陷;  胸腰段
Keywords:
diffuse types of bone cement;  vertebroplasty;  recollapse;  thoracolumbar
分类号:
R681.5
文献标志码:
A
摘要:
目的:观察胸腰段椎体成形术(PVP)后三种骨水泥弥散类型对老年骨质疏松性压缩性骨折(OVCF)的临床疗效及早期术椎塌陷的影响。方法:对2017年1月至2018年12月采用PVP治疗OVCF(T11～L2)90例病例进行比较研究,其中男13例,平均年龄(73.85±8.16)岁,女77例,(70.58±7.06)岁。术后常规摄胸腰段正侧位DR片,通过Photoshop图形处理软件分别计算术椎骨水泥弥散颗粒区和团块区面积,将弥散颗粒区面积与团块区面积的比值定义为k值,k<50%为团块型,50%≤k≤100%为混合型,k>100%为弥散型,根据k值分为弥散组(28例)、团块组(31例)、混合组(31例),定义随访时X线侧位片术椎高度较术后椎体高度下降4 mm为术椎塌陷,通过观察比较三组的视觉模拟(VAS)评分,术前、术后及随访时椎体高度、Cobb角、椎体压缩率等指标,进行统计分析。结果:所有患者均获得随访,随访时间为1～11个月,平均(2.61±2.06)个月。弥散型、团块型及混合型三种弥散类型构成k值分别为154.88±58.87,29.57±13.48和73.30±16.70,差异有统计学意义(P<0.05)。术后及随访时VAS评分及JOA评分各组间比较差异无统计学意义(P>0.05)。术后随访时出现术椎塌陷:弥散组9例(32.1%),团块组12例(39%),混合组1例(3%)。随访时椎体压缩率、Cobb角及椎体高度三组比较差异有统计学意义(P<0.05)。结论:胸腰段PVP术后三种骨水泥弥散类型均可获得良好的治疗效果,骨水泥呈团块型分布是造成术后术椎塌陷的因素之一。
Abstract:
Objective:To observe the clinical efficacy and the impact on the early operated-vertebrae collapses from three diffuse types of bone cement after thoracolumbar percutaneous vertebroplasty(PVP)in treating geriatric osteoporotic vertebral compression fracture(OVCF).Methods:Retrospectively study 90 cases of OVCF(T11～L2)treated with PVP from January 2017 to December 2018.They were 13 males with average age(73.85±8.16)years and 77 females with average age(70.58±7.06)years.Post-surgery standard frontal and lateral DR X-ray films were put into the graphic handling software Photoshop.Areas of the diffuse-granule region and the bulk region were calculated and defined k as the ratio of the area of the diffuse-granule region to that of the bulk region.k<50% was defined as the bulk type,50%≤k≤100% was defined as the mixed type,and k>100% was defined as the diffuse type.According to the values of k,there were 28 diffuse-type cases,31 bulk-type cases and 31 mixed-type cases.Decrease of 4 mm in the height of the operated vertebra was defined as collapse of operated vertebra.Visual Analog Score(VAS scoring),the heights of the operated vertebrae before and after the surgery,Cobb angle and compression rate of the vertebrae were documented and compared in this 3 groups.Results:All patients were followed up ranged from 1 to 11 months with average(2.61±2.06)months.The k vales of the diffuse-type,bulk-type and mixed-type were 154.88±58.87,29.57±13.48 and 73.30±16.70 respectively,and the differences were statistically significant(P<0.05).The between-group difference in VAS scoring of the post-surgery group and follow-up group was not statistically(P>0.05).In terms of the vertebral collapse,9 cases(32.1%)in the diffuse-type group,12 cases(39%)in the bulk-type group and 1 case(3%)in the mixed-type group were found.Statistically significant differences among 3 groups were found in terms of the vertebral compression rate during follow-up,Cobb angle,and vertebra’s height(P<0.05).Conclusion:The diffuse bone cement types after the thoracolumbar PVP can acquire good therapeutic results,while bone cement with bulk-type distribution is one of the factors contributing to the post-surgery vertebral collapse.

参考文献/References:

[1] YU W B,JIANG X B,LIANG D,et al.Risk factors and score for recollapse of the augmented vertebrae after percutaneous vertebroplasty in osteoporoticvertebral compression fractures[J].Osteoporos Int,2019,30(2):423-430.
[2] LEE S K,LEE S H,YOON S P,et al.Quality of life comparison between vertebroplasty and kyphoplasty in patients with osteoporotic vertebral fractures[J].Asian Spine J,2014,8(6):799-803.
[3] DRAMPALOS E,NIKOLOPOULOS K,BALTAS C,et al.Vertebral fracture assessment:current research status and application in patients with kyphoplasty[J].World J Orthop,2015,6(9):680-687.
[4] BUCHBINDER R,JOHNSTON R V,RISCHIN K J,et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J].The Cochrane Database of Systematic Reviews,2018,11:CD006349.
[5] HE D,LOU C,YU W,et al.Cement distribution patterns are associated with recompression in cemented vertebrae after percutaneous vertebroplasty:a retrospective study[J].World Neurosurg,2018,120:1-7.
[6] 吴钊钿,陈荣彬,李勇,等.骨水泥弥散类型与椎体强化术后再发术椎塌陷的相关性分析[J].中国医药导报,2018,15(27):62-65.
[7] STEVENSON M,GOMERSALL T,LLOYD JONES M,et al. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures:a systematic review and cost-effectiveness analysis [J]. Health Technol Assess,2014,18(17): 1-290.
[8] TSOUMAKIDOU G,TOOC W,KOCH G,et al.CIRSE guidelines on percutaneous vertebral augmentation[J]. Cardiovasc Intervent Radiol,2017,40(3): 331-342.
[9] NIU J,ZHOU H,MENG Q,et al.Factors affecting recompres-sion of augmented vertebrae after successful percutaneous bal-loonkyphoplasty:a retrospective analysis[J].Acta Radiol,2015,56(11):1380-1387.
[10] YU W,LIANG D,YAO Z,et al.Risk factors for recollapse of the augmented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral fractures with intravertebral vacuum cleft [J].Medicine,2017,96(2):e5675.
[11] KIM Y Y,RHYU K W.Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebralcompression fracture[J].Eur Spine J,2010,19(11):1907-1912.
[12] LI X,LU Y,LIN X.Refracture of osteoporotic vertebral body after treatment by balloon kyphoplasty:three cases report [J].Medicine,2017,96(49):e8961.
[13] HA K Y,KIM K W,KIM Y H,et al.Revision surgery after ver-tebroplasty or kyphoplasty[J].Clin Orthop Surg,2010,2(4):203-208.
[14] HWEE WENG D H,JUN H T,CHUEN S T,et al.Subsequent vertebral fractures post cement augmentation of the thoracolumbar spine:does it correlate with level-specific bone mineral density scores[J].Spine,2015,40(24):1903-1909.
[15] LI Y X,GUO D Q,ZHANG S C,et al.Risk factor analysis for recollapse of cemented vertebrae after percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)[J].Int Orthop,2018(1):1-9.
[16] IMAI K,OHNISHI I,YAMAMOTO S,et al.In vivo assessment of lumbar vertebral strength in elderly women using computed tomographybased nonlinear finite element model[J].Spine,2008,33(1):27-32.
[17] CHEN H,SHOUMUR A S,EMUR A S,et al.Regional variations of vertebral trabecular bone microstructure with age and gender [J].Osteoporos Int, 2008,19(10):1473-1483.
[18] 赵永生,李强,历强,等.骨水泥弥散类型对治疗骨质疏松性椎体压缩骨折的影响[J].中国骨伤,2017,30(5):446-452.
[19] 何奇龙,陈荣彬,李勇.骨水泥的弥散情况对经皮椎体成形的疗效影响[J].中国中医骨伤科杂志,2018,26(6):51-55.
[20] 张煜,张绍东.椎体成形术后手术椎体再塌陷的危险因素[J].中国脊柱脊髓杂志,2016,26(5):459-462.
[21] 蓝涛,陈扬,杨欣建.椎体成形术后再骨折研究进展[J].中国脊柱脊髓杂志,2015,25(2):179-182.
[22] KIM M J,LINDSEY D P,HANNIBAL M,et al.Vertebroplasty versus kyphoplasty:biomechanical behavior under repetitive loading conditions[J].Spine(Phila Pa 1976),2006,31(18):2079-2084.
[23] LEE J H,LEE D O,LEE J H,et al.Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture [J].Spine J,2014,14(10):2281-2289.
[24] LIANG D,YE L,JIANG X,et al.Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures:a three-dimensional fi-nite element analysis [J].J Surg Res,2015,195(1):246-256.

备注/Memo

备注/Memo:
(收稿日期:2019-12-18)基金项目:广东省医学科学技术研究基金(A2018165)广东省中医药管理局(20194010)△通信作者 E-mail:469843897@qq.com
更新日期/Last Update: 2020-06-10