骨填充网袋灌注骨水泥修复椎体压缩骨折:可降低骨水泥椎体外渗漏率

摘要

背景：利用骨填充网袋包裹骨水泥，可使少量骨水泥通过网眼渗入到骨小梁间隙，形成微观绞锁，达到加固椎体的目的，但尚未见骨填充网袋治疗骨质疏松性椎体压缩骨折的报道。　　目的：比较应用骨填充网袋与经皮椎体成形和经皮椎体后凸成形治疗骨质疏松性椎体楔形压缩骨折的临床疗效。　　方法：将90例单椎体骨质疏松性楔形压缩骨折患者随机分为3组，分别应用骨填充网袋、经皮椎体成形和经皮椎体后凸成形灌注聚甲基丙烯酸甲酯骨水泥Ⅱ型，统计并比较3组的骨水泥类型、椎体抬升、骨水泥渗漏率、目测类比评分、Oswestry功能障碍指数和Cobb角。　　结果与结论：所有患者均顺利完成手术，穿刺成功率为100%。经皮椎体成形组骨水泥外溢2例，经皮椎体后凸成形组骨水泥外溢1例。3组治疗后3 d的椎体抬升、目测类比评分、Oswestry功能障碍指数和Cobb角均较治疗前改善(P <0.05)；经皮椎体后凸成形组与骨填充网袋组抬升椎体和矫正后凸畸形的效果优于经皮椎体成形组(P<0.05)，前两组组间比较差异无显著性意义(P >0.05)；3种方法缓解疼痛和恢复行动的效果无差异。表明应用骨填充网袋灌注聚甲基丙烯酸甲酯骨水泥治疗骨质疏松性椎体压缩骨折，在改善疼痛、抬升伤椎高度、矫正后凸畸形等方面具有满意效果，并可降低骨水泥椎体外渗漏率。%BACKGROUND:By using the bone filing mesh container, a smal amount of bone cement can be penetrated to the trabecular space to form a microscopic twist, thereby strengthening the vertebral body. But there is no report about bone filing mesh container for treatment of osteoporotic vertebral compression fractures. OBJECTIVE:To compare the vertebral uplift and cement leakage of bone filing mesh container, percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of wedge-shaped osteoporotic vertebral compression fractures. METHODS:Ninety patients with wedge-shaped osteoporotic vertebral compression fractures were randomly divided into three groups. Polymethylmethyl acrylic bone cement type II was perfused into these three groups by bone filing mesh container, percutaneous vertebroplasty and percutaneous kyphoplasty, respectively. Bone cement type, vertebral uplift, leakage rate, visual analogue scale score, Oswestry disability index and Cobb’s angle were calculated and compared among the three groups. RESULTS AND CONCLUSION:The operation was successful in al patients. The success rate of puncture was 100%. There were 2 cases of bone cement leakage for percutaneous vertebroplasty and one case for percutaneous kyphoplasty. The vertebral uplift, visual analog scale score, Oswestry disability index and Cobb’s angle were improved significantly in the three groups after treatment (P < 0.05). Percutaneous kyphoplasty and bone filing mesh container were superior to percutaneous vertebroplasty on the aspect of vertebral uplift and kyphosis correction (P < 0.05), but there was no significant difference between the former two groups (P > 0.05). No difference in pain relief and action recovery was found among the three groups. These findings demonstrate that the bone filing mesh container with polymethylmethyl acrylic bone cement for treatment of osteoporotic vertebral compression fractures can have a promising result in relieving the pain, lifting the injured vertebral height, and the correction of kyphosis, which can also reduce the leakage rate of bone cement.