摘要
背景:采用经皮穿刺椎体后凸成形治疗骨质疏松性椎体压缩骨折中,填充材料的选择成为影响手术效果的重要因素。目的:探讨聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)、自固化磷酸钙骨水泥(calciumphosphate cement,CPC)与含有重组人骨形态发生蛋白2(recombinant human bone morphogenetic protein-2,rhBMP-2磷酸钙骨水泥治疗胸腰椎骨质疏松性骨折的疗效。方法:纳入120例胸腰椎骨质疏松性压缩骨折患者,均进行经皮椎体后凸成形治疗,随机分3组,在治疗过程中分别填充聚甲基丙烯酸甲酯骨水泥(PMMA对照组)、自固化磷酸钙骨水泥(CPC观察组)及含有人骨形态发生蛋白2的磷酸钙骨水泥(rhB MP-2/CPC观察组),每种材料40例。治疗后7 d,评估各组临床疗效;治疗前及治疗后3个月,评估止痛药使用情况;治疗前及治疗后3,6个月,评估伤椎骨密度;治疗后1年,统计新发骨折情况。结果与结论:(1)3组治疗总有效率达到97.5%,组间临床疗效比较无差异(P> 0.05);(2)3组治疗后7 d的疼痛均较治疗前改善(P <0.05),CPC观察组、rhB MP-2/CPC观察组改善情况优于PMMA对照组(P <0.05),CPC观察组、rhBMP-2/CPC观察组改善情况无差异(P> 0.05);(3)3组治疗后7 d的活动功能恢复情况均较治疗前改善(P <0.05),CPC观察组、rhBMP-2/CPC观察组改善程度优于PMMA对照组(P <0.05);(4)3组治疗后7 d的伤椎前中柱椎体高度、后凸Cobb角均较治疗前有所改善(P <0.05),3组间改善程度比较无差异(P> 0.05);(5)治疗后3个月,3组患者均脱离了止痛药物;(6)治疗后6个月,PMMA对照组与CPC观察组骨密度与治疗前比较无差异(P> 0.05),rhBMP-2/CPC观察组骨密度较治疗前明显增加(P <0.05);(7)治疗后1年,CPC观察组、rhB MP-2/CPC观察组新发骨折情况低于PMMA对照组(P<0.05),CPC观察组、rh BMP-2/CPC观察组新发骨折情况比较无差异(P> 0.05);(8)结果表明,PMMA、CPC与rhB MP-2/CPC治疗骨质疏松性椎体压缩骨折临床疗效均较好,CPC与rhBMP-2/CPC改善疼痛的速度和远期支撑效果更好,可减少新发骨折发生风险,同时rh BMP-2/CPC能够增加椎体骨密度。
BACKGROUND:In the treatment of osteoporotic vertebral compression fractures with percutaneous kyphoplasty,the choice of filling material has become an important factor for the surgical outcome.OBJECTIVE:To investigate the effects of polymethyl methacrylate(PMMA),calcium phosphate cement(CPC)and CPC with recombinant human bone morphogenetic protein-2(rhBMP-2/CPC)in the treatment of osteoporotic vertebral compression fractures.METHODS:One hundred and twenty patients with osteoporotic thoracolumbar compression fractures undergoing percutaneous kyphoplasty were included,and were randomly divided into three groups,PMMA,CPC and rhBMP-2/CPC groups(n=40per group).After7days of treatment,the clinical efficacy of each group was evaluated.The use of analgesics was evaluated before and3months after treatment.Bone mineral density was assessed before treatment and3and6months after treatment.At1year after treatment,the incidence of new fractures was counted.RESULTS AND CONCLUSION:The total effective rate of the three groups was97.5%,and there was no significant difference in the clinical efficacy among groups(P>0.05).The visual analogue scale scores in each group after7-day treatment were all improved compared with the baseline(P<0.05).The improvement in the CPC and rhBMP-2/CPC groups was significantly better than that in the PMMA group(P<0.05).There was no difference in the improvement between CPC and rhBMP-2/CPC groups(P>0.05).The recovery of motor function in the three groups at7days after treatment was significantly better than the baseline(P<0.05).The improvement degree in the CPC and rhBMP-2/CPC groups was significantly better than that in the PMMA group(P<0.05).The height of the injured anterior and middle vertebral column and the Cobb angle of kyphosis in each group at7days after treatment were significantly improved compared with the baseline(P<0.05).There was no significant difference in the degree of improvement among groups(P>0.05).At3months after treatment,the patients in all groups were separated from the analgesic drugs.At6months after treatment,the bone mineral density in the PMMA and CPC groups showed no significant difference compared with the baseline(P>0.05).The bone mineral density in the rhBMP-2/CPC group was significantly increased compared with the baseline(P<0.05).After1year of treatment,the incidence of new fractures in the CPC and rhBMP-2/CPC groups was significantly lower than that in the PMMA group(P<0.05),and there was no difference between CPC and rhBMP-2/CPC groups(P>0.05).These results suggest that the clinical efficacy of PMMA,CPC and rhBMP-2/CPC in the treatment of osteoporotic vertebral compression fractures is satisfactory.CPC and rhBMP-2/CPC can accelerate pain relief and hold long-term support effect,reduce the incidence of new fractures,and meanwhile,rhBMP-2/CPC can increase the vertebral mineral density.
作者
王雪峰
尚希福
Wang Xuefeng;Shang Xifu(Department of Orthopedics, the Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001,Anhui Province, China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第6期863-869,共7页
Chinese Journal of Tissue Engineering Research
