ObjectiveTo compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients’ symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.ResultsThe injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups (t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups (χ2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation (P<0.05), and there were significant differences among the postoperative time points (P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group (P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up (P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups (P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant (χ2=4.105, P=0.043; χ2=4.661, P=0.031).ConclusionBone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.
目的 探討軀體感覺誘發電位（SEP）在頸脊髓損傷術前、術中監測的意義。 方法 納入2010年1月－2012年4月治療的241例頸脊髓損傷患者，術前按美國脊柱脊髓損傷協會（ASIA）評分并分級，確定損傷平面。術前與術中SEP監測，分析不同損傷分級以及不同損傷平面術前的波幅及潛伏期的差異，術中SEP監測以波幅下降＞50%和或潛伏期延長＞10%為預警標準。 結果 各損傷分級組術前SEP監測：A級組SEP波消失，呈一直線，而B、C、D、E級組均測出SEP波形，根據是否可測出SEP波形，可將A級與B、C、D、E及組區別。B、C、D級組之間波幅和潛伏期均無統計學意義（P＞0.05）。E級組較B、C、D級組波幅增高、潛伏期縮短，差異有統計學意義（P＜0.05）；不完全性頸脊髓損傷組內不同損傷平面組之間波幅和潛伏期差異均無統計學意義（P＞0.05）。術中SEP對脊髓功能損傷監測的靈敏度83.3%、特異度98.7%。其中術中：SEP陽性8例，真陽性5例，4例術者處理后波幅及潛伏期回復至正常范圍，術后無新的神經功能損傷，另1例術者采取各種處理后波幅及潛伏期無恢復，術后神經功能損傷較術前加重；假陽性3例，1例麻醉師給予升高血壓后波形恢復至正常，另2例經麻醉師調整麻醉深度后波形恢復正常，此3例術后無新的神經功能損傷。SEP陰性233例，真陰性232例，術后無新的神經功能損傷；假陰性1例，患者術中、術后波形未見異常，術后運動功能損傷程度較術前加重。 結論 ① SEP能準確評估完全性和不完性頸脊髓損傷，但對不完全性頸脊髓損傷的損傷程度不能作出準確評估、也不能區分頸脊髓損傷的損傷平面；② 術中SEP監測能較好地反映頸脊髓功能完整性，對減少頸脊髓損傷術中發生醫源性頸脊髓損傷風險具有重要意義。