摘要目的 通过比较自行研发的可弯曲椎体成形器与传统直形骨水泥注入器治疗骨质疏松性胸椎压缩骨折的疗效,观察可弯曲椎体成形器在椎体成形术治疗骨质疏松性胸椎压缩骨折中的应用效果. 方法 回顾性分析2016年6月至2017年1月西安交通大学附属红会医院脊柱外科收治的140例骨质疏松性胸椎压缩骨折患者的临床资料.患者男61例,女79例;年龄55 ～88岁,平均70.3岁,骨折椎体分布为T5～T12.根据治疗方法不同分为2组,A组患者(67例)接受可弯曲椎体成形器治疗,B组患者(73例)接受传统直形骨水泥注入器治疗.比较两组患者的手术时间、骨水泥注入量、骨水泥对侧分布率和骨水泥渗漏率,以及术后ld、术后l、2年的疼痛视觉模拟评分(VAS)、伤椎前缘高度比值和节段后凸cobb角.结果 两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.所有患者均获2年以上随访,平均26.7个月.A、B患者的手术时间[(28.1±4.2)、(26.3±3.2) min]和骨水泥渗漏率[34.3％ (23/67)、17.8％ (13/73)]比较差异均无统计学意义(P＞0.05).但A组的骨水泥注入量[(5.6±1.2)mL]和骨水泥对侧分布率(71.5％±l1.3％)均高于B组[(4.9±1.1)mL和65.7％±12.9％],术后1、2年A组的VAS评分[(2.8±0.7)、(3.0±0.9)分]和后凸cobb角(25.2°±5.2°、26.8°±5.5°)低于B组[(3.1±0.8)、(3.4±0.8)分和27.7°±4.9°、29.1°±1.6°],术后1、2年A组患者的伤椎前缘高度比值(39.2％±8.1％、37.1％±7.2％)高于B组(35.4％±7.8％、33.2％±8.4％),差异均有统计学意义(P＜0.05).术后ld两组患者间的VAS评分、伤椎前缘高度比值、后凸cobb角比较差异均无统计学意义(P＞0.05).结论 对于骨质疏松性胸椎压缩骨折,相比于传统直形骨水泥注入器,自行研发的可弯曲椎体成形器能获得更好的骨水泥椎体对侧分布,有效维持伤椎椎体高度,同时能达到更好的远期止痛效果.

abstractsObjective To compare the curative effects between our self-designed flexible vertebroplasty device and the conventional straight bone cement injector in the treatment of osteoporotic thoracic compression fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 140 patients with osteoporotic thoracic compression fracture who had been admitted to Department of Spine Surgery,Xi'an Honghui Hospital from June 2016 to January 2017.They were 61 males and 79 females,aged from 55 to 88 years (average,70.3 years).Their fractured vertebrae distributed from T5 to T12.Our self-designed flexible vertebroplasty device was used in 67 of them (group A) while the conventional straight bone cement injector in the other 73 patients (group B).The 2 groups were compared in terms of operative time,amount of bone cement injected,distribution ratio of bone cement on the contralateral side,bone cement leakage,and visual analogue scale (VAS),anterior height ratio of the fractured vertebra and kyphosis cobb angle at 1 d,1 and 2 years after operation.Results The 2 groups were comparable due to their insignificant differences in preoperative general data (P ＞ 0.05).All the patients were followed up for more than 2 years,with an average of 26.7 months.There were no significant differences between the 2 groups in operation time (28.1 ±4.2 min versus 26.3 ±3.2 min) or in bone cement leakage [34.3％ (23/67) versus 17.8％ (13/73)] (P ＞ 0.05).However,group A was significantly higher than group B in amount of bone cement injection (5.6 ± 1.2 mL versus 4.9 ± 1.1 mL) and in distribution ratio of bone cement on the contralateral side (71.5％ ± 11.3％ versus 65.7％ ± 12.9％),significantly lower than group B in VAS at 1 and 2 years after operation (2.8±0.7 and 3.0±0.9 versus 3.1 ±0.8 and 3.4±0.8) and in kyphosis cobb angle at 1and 2 years after operation (25.2°±5.2° and 26.8°±5.5° versus 27.7°±4.9° and 29.1°±1.6°),and significantly higher than group B in anterior height ratio of the fractured vertebra at 1 and 2 years after operation (39.2％ ± 8.1％ and 37.1％ ± 7.2％ versus 35.4％ ± 7.8％ and 33.2％ ± 8.4％) (all P ＜0.05).There were no significant differences between the 2 groups in VAS,anterior height ratio of the fractured vertebra or kyphosis cobb angle at one day after operation (P ＞ 0.05).Conclusions Compared with the conventional straight bone cement injector,our self-designed flexible vertebroplasty device can lead to better contralateral distribution of bone cement,more effective maintenance of the height of injured vertebra,and better long-term analgesic effect in the treatment of osteoporotic thoracic compression fractures.