闭合复位及撬拨法在椎体成形术中的应用  

Closed reduction and levering manipulation in vertebroplasty

作　　者：高梁斌[1] 陈嘉裕[1] 张亮[1] 张志[1] 

机构地区：[1]广州医学院第三附属医院骨外科,510150

出　　处：《中华创伤骨科杂志》2009年第9期837-840,共4页Chinese Journal of Orthopaedic Trauma

基　　金：广州市医药卫生资助项目（穗卫科[2004]21号）

摘　　要：目的探讨闭合复位及撬拨法在椎体成形术治疗骨质疏松性压缩骨折中椎体高度的恢复及后凸畸形矫正的效果。方法2005年1月至2007年6月应用闭合复位及椎体成形术中经椎弓根用穿刺针撬拨塌陷的椎体终板治疗38例骨质疏松性压缩骨折患者，手术前后用视觉模拟评分及Oswestry功能障碍指数的变化来评价患者疼痛缓解和功能改善情况，参照Lee等方法观测病椎的高度和后凸畸形的改变以及骨水泥在椎体内的分布。结果术后随访6～24个月，平均13．4个月。视觉模拟评分从术前平均（8．6±2．3）分降至术后平均（3．8±2．6）分，差异有统计学意义（P〈0．05）；Oswestry功能障碍指数指数从术前平均64．8％降至术后平均48．7％，差异有统计学意义（P〈0．05）。椎体前、中、后壁高度平均增加5．8mm、6．6mm、1．0mm，椎体后凸畸形矫正平均9．7。，椎体高度前、中、后壁恢复率平均为54．6％、58．1％、46．5％，手术前后差异均有统计学意义（P〈0．05）。结论闭合复位结合椎体成形术中撬拨法是治疗骨质疏松性压缩骨折的有效方法。Objective To discuss the effects of closed reduction and levering manipulation on vertebral height restoration and kyphosis correction in vertebroplasty for osteoporotic compression fractures. Methods From January 2005 to June 2007, a total of 38 patients with osteoporotic vertebral compression fractures were treated with vertebroplasty. In closed reduction, a transfixion pin was used to lever the collapsed vertebral endplate through the pedicle. Before and after surgery, pain relief and functional improvement were evaluated using a visual analogue scale （VAS） and the Oswestry＇ s disability index （ODI）. Changes in vertebral height and kyphotic angle and distribution of bone cement in the vertebral body were observed by Lee＇s method. Results All patients were followed up for 6 to 24 （average, 13.4） months. The average VSA scores were reduced from preoperative 8.6 ± 2.3 to postoperative 3.8 ± 2.6. The average ODI scores reduced from preoperative 64.8% to postoperative 48.7%. The differences were of statistical significance. The average increase in vertebral body height was 5.8 mm anteriorly, 6.6 mm centrally, and 1.0 mm posteriorly. The mean reduction in the kyphosis angle was 9.7 degrees. The percentages of restoration of vertebral height were 54. 6% at the anterior border, 58. 1% at the center, and 46.5% at the posterior border. The differences were of statistical significance between preoperation and postoperation. Conclusion Closed reduction and levering manipulation is effective in vertebroplasty for osteoporotic vertebral compression fractures.

关 键 词：骨质疏松 脊柱骨折 椎体成形术 闭合复位 

分 类 号：R686[医药卫生—骨科学]