关键词:

压缩性骨折, 骨质疏松, 经皮椎体成形术, 骨水泥弥散

Abstract:

Objective　To explore the correlation between different cement distribution types and the efficacy of percutaneous vertebroplasty (PVP) in treating osteoporotic vertebral compressibility fractures (OVCF). Methods　This study is a retrospective analysis. A total of 198 patients with OVCF treated with PVP at Meizhou Traditional Chinese Medicine Hospital from July 2022 to January 2024 were selected. Based on the anatomical characteristics of the vertebrae and the imaging features of cement diffusion, patients were divided into four groups: type Ⅰ (87 cases), type Ⅱ (17 cases), type Ⅲ (70 cases), and type Ⅳ (24 cases). In type Ⅰ, there were 26 males and 61 females, aged (69.80±7.64) years old and a bone mineral density T-score of -2.50±1.01; in type Ⅱ, there were 6 males and 11 females, aged (70.10±8.03) years old and a T-score of -2.45±0.98; in type Ⅲ, there were 21 males and 49 females, aged (69.80±7.95) years and a T-score of -2.61±1.23; in type Ⅳ, there were 7 males and 17 females, with an average age of (69.10±8.04) years old and a T-score of -2.70±1.16. Preoperative pain levels were assessed using the Visual Analog Scale (VAS) at baseline, 1 day postoperatively, and 3 months postoperatively. The Oswestry Disability Index (ODI) was used to evaluate lumbar function, and the ratio of the affected vertebral area to the cement area was measured using Image-J software to calculate the cement diffusion effect. Statistical analyses were conducted using the χ² test and one-way ANOVA. Results　Before treatment, 1 day postoperatively, and 3 months postoperatively, the VAS scores and ODI scores for type Ⅰ patients were (7.68±1.01, 2.93±1.12, 1.80±0.78) points and (38.13±2.80, 21.11±2.37, 15.74±2.86) points, respectively. For type Ⅱ patients, the scores were (7.75±0.99, 2.76±0.98, 1.76±0.81) points and (38.00±3.10, 20.24±2.40, 15.94±3.01) points, respectively. For type Ⅲpatients, the scores were (7.53±1.31, 2.67±1.17, 1.83±0.69) points and (37.56±2.92, 20.06±2.70, 15.61±3.16) points, respectively. For type Ⅳ patients, the scores were (7.88±1.12, 2.96±1.05, 2.29±0.76) points and (37.88±2.79, 21.04±2.81, 19.58±2.96) points, respectively. Within-group comparisons showed significant differences in VAS and ODI scores among all groups before treatment, 1 day postoperatively, and 3 months postoperatively (all P<0.05). Between-group comparisons indicated that type Ⅳ patients had significantly higher VAS and ODI scores at 3 months postoperatively compared to the other three types (all P<0.05). The cement diffusion ratios on anteroposterior and lateral X-rays for type Ⅰ patients were (0.93±0.16, 0.94±0.14)%, which were better than those of type Ⅱ [(0.82±0.12, 0.82±0.08)%], type Ⅲ[(0.84±0.06, 0.81±0.12)%], and type Ⅳ [(0.80±0.06, 0.79±0.05)%], showing statistically significant differences (all P<0.05). The volume of cement infusion, operative time, and C-arm exposure counts for type Ⅳ were (5.07±0.27) ml, (35.18±3.71) min, and (16.50±2.12) times, respectively, which were better than those for type Ⅰ [(6.14±0.36) ml, (43.62±3.13) min, (25.76±1.34) times], type Ⅱ [(5.12±0.43) ml, (42.38±3.03) min, (26.53±1.28) times], and type Ⅲ [(5.10±0.29) ml, (43.31±2.93) min, (25.81±1.37) times], with statistically significant differences (all P<0.05). There were no statistically significant differences in the incidence of adverse reactions among the four groups (χ²=2.949, P=0.400). Conclusion　PVP can significantly relieve pain and improve lumbar function in OVCF patients. The wide distribution and uniform perfusion of bone cement in vertebra has better effect.

Key words:

Compression fracture, Osteoporosis, Percutaneous vertebroplasty, Bone cement dispersion