Effects of bone cement dispersion on clinical curative effect in patients with osteoporotic vertebral compression fracture after percutaneous vertebroplasty

doi:10.3760/cma.j.cn441417-20241122-17013

Abstract

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

摘要：

目的　探究不同骨水泥分布类型对经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗骨质疏松性椎体压缩性骨折（osteoporotic vertebral compressibility fractures，OVCF）疗效的影响。方法　本文为回顾性研究。选取2022年7月至2024年1月梅州市中医医院收治的198例采用PVP治疗的OVCF患者资料，基于椎体解剖学特征，根据影像学骨水泥扩散分布特征分为Ⅰ型（87例）、Ⅱ型（17例）、Ⅲ型（70例）、Ⅳ型（24例）。Ⅰ型男26例，女61例，年龄（69.80±7.64）岁，骨密度T值-2.50±1.01；Ⅱ型男6例，女11例，年龄（70.10±8.03）岁，骨密度T值-2.45±0.98；Ⅲ型男21例，女49例，年龄（69.80±7.95）岁，骨密度T值-2.61±1.23；Ⅳ型男7例，女17例，年龄（69.10±8.04）岁，骨密度T值-2.70±1.16。术前、术后1 d、术后3个月时，采用视觉模拟评分法（VAS）评估疼痛程度，采用Oswestry功能障碍指数（ODI）评估腰椎功能，并通过Image-J软件测量患椎面积与骨水泥面积的比值，计算骨水泥弥散效果。统计学方法采用χ²检验、单因素方差分析。结果　治疗前、术后1 d、术后3个月，Ⅰ型患者的VAS评分和ODI评分分别为（7.68±1.01、2.93±1.12、1.80±0.78）分和（38.13±2.80、21.11±2.37、15.74±2.86）分，Ⅱ型患者分别为（7.75±0.99、2.76±0.98、1.76±0.81）分和（38.00±3.10、20.24±2.40、15.94±3.01）分，Ⅲ型患者分别为（7.53±1.31、2.67±1.17、1.83±0.69）分和（37.56±2.92、20.06±2.70、15.61±3.16）分；Ⅳ型患者分别为（7.88±1.12、2.96±1.05、2.29±0.76）分和（37.88±2.79、21.04±2.81、19.58±2.96）分；组内比较，4组治疗前、术后1 d、术后3个月VAS、ODI评分差异均有统计学意义（均P<0.05）；组间比较，Ⅳ型患者术后3个月的VAS、ODI评分均高于其余3型，差异均有统计学意义（均P<0.05）。Ⅰ型患者正、侧位X射线片骨水泥弥散比值分别为（0.93±0.16、0.94±0.14）%，均优于Ⅱ型［（0.82±0.12、0.82±0.08）%］、Ⅲ型［（0.84±0.06、0.81±0.12）%］、Ⅳ型［（0.80±0.06、0.79±0.05）%］，差异均有统计学意义（均P<0.05）。Ⅳ型骨水泥灌注量、手术时间、C臂机曝光次数分别为（5.07±0.27）ml、（35.18±3.71）min、（16.50±2.12）次，均优于Ⅰ型［（6.14±0.36）ml、（43.62±3.13）min、（25.76±1.34）次］、Ⅱ型［（5.12±0.43）ml、（42.38±3.03）min、（26.53±1.28）次］、Ⅲ型［（5.10±0.29）ml、（43.31±2.93）min、（25.81±1.37）次］，差异均有统计学意义（均P<0.05）。4组不良反应发生率差异无统计学意义（χ²=2.949，P=0.400）。结论　OVCF患者应用PVP治疗，能够显著缓解疼痛，改善腰椎功能，骨水泥在椎体内分布广泛且灌注均匀时效果更佳。

关键词:

压缩性骨折, 骨质疏松, 经皮椎体成形术, 骨水泥弥散

Zhang Hao, Yao Zhensong, Guo Jianbang, Lai Weihua, Yue Wenfeng.

Effects of bone cement dispersion on clinical curative effect in patients with osteoporotic vertebral compression fracture after percutaneous vertebroplasty [J]. International Medicine and Health Guidance News, 2025, 31(17): 2885-2890.

张浩姚珍松郭建邦赖维华岳文锋.

经皮椎体成形术骨水泥弥散分布对骨质疏松性椎体压缩性骨折患者疗效的影响 [J]. 国际医药卫生导报, 2025, 31(17): 2885-2890.

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