Objective To summarize the efficacy and complications of high viscosity bone cement percutaneous vertebroplasty (PVP) in the treatment of osteoporotic spine fractures in elderly patients, and to compare it with low viscosity bone cement percutaneous kyphoplasty (PKP). Method Treatment of senile osteoporotic vertebral fracture with high viscosity bone cement PVP and low viscosity bone cement. Case selection criteria: 1 to 3 vertebral fractures, course of less than 1 month, no spinal cord or nerve compression symptoms, CT showed no fracture into the spinal canal. High viscosity PVP were injected into bilateral high viscosity bone cement 3-5 ml, low viscosity bone cement PKP by bilateral pedicle injection of low viscosity bone cement 3-6 ml. Result The mean operative time (about 15.1±2.7 min) was significantly shorter in 165 patients with osteoporotic vertebral compression fractures than in those with low viscosity bone cement (about 28.3±4.6 min). The difference of the results was significant (P<0.05). The postoperative pain was relieved in both groups. The mean pain relief was 3.0±1.4 days after PVP in high viscosity cement group and The mean pain relief was 3.1±1.7 days after PKP in low viscosity cement group. There was no statistically significant difference (P>0.05). Compared with preoperative, VAS score and ODI were significantly improved (P<0.05) in the two groups after operation and at the last follow-up. There was no significant difference in VAS score and ODI between two groups (preoperative, postoperative and last follow-up) (P>0.05). There was significant difference in the leakage rate of bone cement between the two groups (P<0.05). There was no significant difference between the two groups in the rate of bone cement Intervertebral disc leakage and paraspinal leakage (P>0.05). There was no significant difference in the incidence of upper and lower endplate with high viscosity cement and low viscosity bone cement (P>0.05). Compared with low viscosity bone cement, the incidence of the high viscosity bone cement to the side of the distribution is lower. The difference was statistically significant (P<0.05). At the last follow-up, there were 5 cases of adjacent vertebral fractures, 3 cases of high viscosity cement group (2.9%) and 2cases of low viscosity cement group (3.3%). There was no statistically significant difference (P>0.05). After an average of 1 year and 6 months follow-up, no kyphosis increased, Cobb angle increased, etc., and we did not find bedsore, venous thrombosis, hypostatic pneumonia and other complications. Conclusion High viscosity PVP and low viscosity bone cement PKP for the treatment of osteoporotic spine fracture of the elderly with minimally invasive, analgesic effect can be early down to the ground, and other unique advantages. Compared with low viscosity bone cement, the surgery time of high viscosity bone cement PVP was significantly shorter. High viscosity cement leakage occurred significantly reduced the possibility of venous leakage, thereby reducing the possibility of pulmonary embolism caused by cement. So high viscosity bone cement has higher security.%目的 总结采用高黏度骨水泥经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗老年骨质疏松性脊柱压缩骨折的疗效及并发症,并与低黏度骨水泥经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)进行比较.方法 纳入2013年10月至2015年9月在本院采用高黏度骨水泥PVP(105例,112个椎体)与低黏度骨水泥PKP(60例,65个椎体)治疗的老年骨质疏松性脊柱压缩骨折患者.病例选择标准:1~3个椎体骨折,病程1个月以内,无脊髓或神经压迫症状,CT显示无骨折块突入椎管内.高黏度骨水泥PVP组经双侧椎弓根注入高黏度骨水泥3~5ml,低黏度骨水泥PKP组经双侧椎弓根注入低黏度骨水泥3~6ml.评估并比较两组术后骨水泥分布情况及渗漏情况,手术前后腰痛变化、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及并发症发生情况.结果 高黏度骨水泥PVP组平均手术时间为(15.1±2.7)分钟,低黏度骨水泥PKP组平均手术时间为(28.3±4.6)分钟,组间比较差异有显著性(P<0.05).两组患者术后疼痛均明显缓解,高黏度骨水泥PVP组术后平均(3.0±1.4)天后疼痛完全缓解,低黏度骨水泥PKP组术后平均(3.1±1.7)天后疼痛完全缓解,组间比较差异无显著性(P>0.05).两组患者术后及末次随访时的VAS评分和ODI均较术前显著改善(P<0.05).术前、术后及末次随访时VAS评分和ODI两组间比较差异均无显著性(P>0.05).高黏度骨水泥PVP组骨水泥静脉渗漏率(17.8%)明显低于低黏度骨水泥PKP组(48.4%),组间比较差异有显著性(P<0.05),而椎间盘渗漏率(均为16.1%)和椎旁渗漏率(分别为23.2%、24.1%)组间比较差异均无显著性(P>0.05).两组骨水泥同时接触上下终板的发生率差异无显著性(P>0.05),但高黏度骨水泥偏向一侧分布的发生率较低,组间比较差异有显著性(P<0.05).末次随访时,共有5例患者发生邻近椎体骨折,其中高黏度骨水泥PVP组3例(2.9%),低黏度骨水泥PKP组2例(3.3%),组间比较差异无显著性(P>0.05).经平均1年6个月的随访,两组均无脊柱后凸增大、Cobb角加大等情况发生,未发现褥疮、下肢静脉血栓等并发症.结论 高黏度骨水泥PVP及低黏度骨水泥PKP治疗老年骨质疏松性脊柱压缩骨折具有创伤小、止痛效果好、可早期下地等优势,且高黏度骨水泥PVP手术时间明显较短,发生骨水泥静脉渗漏的可能性较低,降低了骨水泥导致肺栓塞的风险,手术安全性较高.
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