弯角椎体成形术治疗骨质疏松性椎体压缩骨折的效果评估

doi:10.3760/cma.j.cn441417-20240506-09001

摘要/Abstract

摘要：

目的　探讨骨质疏松性椎体压缩骨折（OVCF）患者经过弯角椎体成形术（PCVP）治疗后血清基质金属蛋白酶抑制因子-1（TIMP-1）、基质金属蛋白酶-3（MMP-3）、瘦素（leptin）水平变化及临床获益。方法　本研究按随机、前瞻性、单中心临床研究方法设计。选取2020年10月至2023年1月在西安市第五医院接受治疗的OVCF患者108例，按随机数字表法分为A组和B组，每组54例。A组男、女各30、24例；年龄45～71（67.87±3.65）岁；致伤原因：搬提重物、交通事故、滑倒摔伤各18、13、23例；骨折至手术时间0.5～3.0（1.76±0.54）d。B组男、女各28、26例；年龄45～72（68.02±3.70）岁；致伤原因：搬提重物、交通事故、滑倒摔伤各21、11、22例；骨折至手术时间0.7～3.0（1.79±0.58）d。A组行单侧经皮椎体成形术（PVP），B组行PCVP。两组术后均随访6个月。比较两组随访6个月后骨水泥填充效果，手术相关指标，术前、随访6个月后伤椎前缘高度、伤椎Cobb角、腰椎活动能力，术前、术后7 d MMP-3、TIMP-1、leptin水平，并发症。采用χ2检验、t检验进行统计学分析。结果　随访6个月后，B组骨水泥填充优良率高于A组［94.44%（51/54）比81.48%（44/54）］，差异有统计学意义（P<0.05）。B组手术时间、住院时间短于A组［（21.65±2.54）min比（33.65±3.43）min、（8.54±2.54）d比（12.54±6.43）d］，透视次数、骨水泥用量少于A组［（13.54±1.98）次比（21.43±2.03）次、（23.65±0.32）ml比（31.65±2.54）ml］，B组骨水泥有效弥散倍数高于A组（1.87±0.06比0.99±0.04），差异均有统计学意义（均P<0.05）。与术前比较，随访6个月后两组伤椎前缘高度均升高，且B组高于A组［（95.65±3.43）%比（92.12±2.43）%］；两组Oswestry功能障碍指数（ODI）及伤椎Cobb角均降低，且B组低于A组［（15.43±4.32）分比（19.87±4.98）分、（12.76±2.31）°比（14.98±2.89）°］，差异均有统计学意义（均P<0.05）。与术前比较，术后7 d两组血清MMP-3、leptin水平均降低，且B组血清MMP-3水平低于A组［（21.76±1.65）mmol/L比（24.65±1.87）mmol/L］；两组血清TIMP-1水平均升高，且B组高于A组［（144.76±16.54）μg/L比（136.65±17.02）μg/L］，差异均有统计学意义（均P<0.05）。B组随访期间并发症发生率低于A组［5.56%（3/54）比18.52%（10/54）］，差异有统计学意义（P<0.05）。结论　相比于单侧PVP，PCVP有手术时间短、骨水泥用量少等优点，可减少透视次数，提高骨水泥填充效果，调节OVCF患者血清MMP-3、TIMP-1水平，促进患者伤椎前缘高度、伤椎Cobb角及腰椎功能恢复，进而缩短患者住院时间，且安全性较高。

关键词:

骨质疏松性椎体压缩骨折, 弯角椎体成形术, 单侧经皮椎体成形术

Abstract:

Objective　To investigate the changes of serum matrix metalloproteinase inhibitory factor-1 (TIMP-1), matrix metalloproteinase-3 (MMP-3), and leptin levels and clinical benefits in patients with osteoporotic vertebral compression fractures (OVCF) treated with percutaneous corner vertebroplasty (PCVP). Methods　The study was designed using a randomized, prospective, single-center clinical study method. A total of 108 patients with OVCF who received treatment in Xi'an Fifth Hospital from October 2020 to January 2023 were selected and were divided into group A and group B according to the random number table method, with 54 patients in each group. There were 30 males and 24 females in group A, aged 45-71 (67.87±3.65) years, injury causes: 18 cases of lifting heavy objects, 13 cases of traffic accidents, and 23 cases of slips and falls; the time from fracture to operation was 0.5-3.0 (1.76±0.54) d. There were 28 males and 26 females in group B, aged 45-72 (68.02±3.70) years, injury causes: 21 cases of lifting heavy objects, 11 cases of traffic accidents, and 22 cases of slips and falls; the time from fracture to operation was 0.7-3.0 (1.79±0.58) d. Group A received unilateral percutaneous vertebroplasty (PVP), while group B received PCVP. Both groups were followed up for 6 months after surgery. The bone cement filling effect after 6 months of follow-up, surgical related indicators, anterior vertebral height, Cobb angle of injured vertebra, and lumbar mobility before and after 6 months of follow-up, levels of MMP-3, TIMP-1, and leptin before and 7 d after surgery, and complications were compared between the two groups. χ² test and t test were used for statistical analysis. Results　After 6 months of follow-up, the excellent and good rate of bone cement filling in group B was higher than that in group A [94.44% (51/54) vs. 81.48% (44/54)], with a statistically significant difference (P<0.05). The operation time and hospital stay of group B were shorter than those of group A [(21.65±2.54) min vs. (33.65±3.43) min, (8.54±2.54) d vs. (12.54±6.43) d], the number of fluoroscopy times and bone cement dosage were less than those in group A [(13.54±1.98) times vs. (21.43±2.03) times, (23.65±0.32) ml vs. (31.65±2.54) ml], and the effective diffusion ratio of bone cement in group B was higher than that in group A (1.87±0.06 vs. 0.99±0.04), with statistically significant differences (all P<0.05). After 6 months of follow-up, the anterior vertebral height was increased in both groups, and that in group B was higher than that in group A [(95.65±3.43)% vs. (92.12±2.43)%], the Oswestry Disability Index (ODI) and Cobb angle of injured vertebra were decreased in both groups, and those in group B were lower than those in group A [(15.43±4.32) min vs. (19.87±4.98) min, (12.76±2.31)° vs. (14.98±2.89)°], with statistically significant differences (all P<0.05). Compared with preoperative levels, serum MMP-3 and leptin levels were decreased in both groups 7 d after surgery, and the serum MMP-3 level in group B was lower than that in group A [(21.76±1.65) mmol/L vs. (24.65±1.87) mmol/L]; serum TIMP-1 level was increased in both groups, and that in group B was higher than that in group A [(144.76±16.54) μg/L vs. (136.65±17.02) μg/L], with statistically significant differences (all P<0.05). The incidence of complications in group B was lower than that in group A during follow-up [5.56% (3/54) vs. 18.52% (10/54)], with a statistically significant difference (P<0.05). Conclusion　Compared with unilateral PVP, PCVP had advantages such as shorter surgical time and less amount of bone cement used, which can reduce the number of fluoroscopy times, improve the filling effect of bone cement, further regulate the levels of serum MMP-3 and TIMP-1 in patients with OVCF, promote the recovery of the anterior edge height, Cobb angle of the injured vertebra, and lumbar function, and shorten the hospital stay, with high safety

Key words:

Osteoporotic vertebral compression fractures, Percutaneous corner vertebroplasty, Unilateral percutaneous vertebroplasty

张桂彬邓亚军陈新庆曹萌徐剡.

弯角椎体成形术治疗骨质疏松性椎体压缩骨折的效果评估 [J]. 国际医药卫生导报, 2025, 31(9): 1410-1415.

Zhang Guibin, Deng Yajun, Chen Xinqing, Cao Meng, Xu Yan.

Evaluation of the effect of percutaneous corner vertebroplasty in the treatment of osteoporotic vertebral compression fractures [J]. International Medicine and Health Guidance News, 2025, 31(9): 1410-1415.

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