经皮椎体成形术治疗老年人骨质疏松性椎体压缩骨折  

The Efficacy Evaluation of the Percutaneous Vertebroplasty for the Aged Patients with the Osteoporotic Compression Fracture

作　　者：胡永胜[1] 沙吾提江[1] 田慧中[1] 黄卫民[1] 张玉坤[1] 周纲[1] 高小亮[1] 

机构地区：[1]新疆医科大学第六附属医院脊柱外科,新疆乌鲁木齐830002

出　　处：《实用骨科杂志》2011年第6期486-489,共4页Journal of Practical Orthopaedics

摘　　要：目的评价经皮椎体成形术治疗老年人骨质疏松性椎体压缩骨折的治疗效果并分析原因。方法回顾性分析2005年1月至2009年1月治疗老年骨质疏松性椎体压缩骨折共89例，其中男性43例，女性46例，年龄65～83岁，平均73．3岁。病程1～26d，平均4．3d。手术在局麻下进行，采用经皮、椎弓根向椎体内穿针，在C型臂x线机监视下，向椎体内注射聚甲基丙烯酸甲酯骨水泥。治疗分为两组：单个椎体骨折A组48例，多个椎体骨折B组（两个椎体骨折38例，3个椎体骨折3例）41例。术前所有患者均有腰背部疼痛及功能障碍症状，两组患者年龄、性别、病程、术前疼痛视觉模拟评分（visual analogue scale，VAS）和功能障碍评分（oswestry disability index，ODI）差异无统计学意义，术后比较VAS及0DI变化评价疗效。结果所有患者均穿刺成功，注射骨水泥2～6mL，平均3．2mL。7例骨水泥渗漏至前方或侧方，5例少量骨水泥渗漏至椎管内静脉丛，3例骨水泥椎间盘内漏，均无不适症状，1例术后出现心绞痛转科治疗后好转。全部病例随防6～23个月，平均14．3个月。A组和B组术后3d、术后3个月、末次随访时VAS及ODI评分与术前比较，差异均有统计学意义（P〈0．01），A组和B组之间术后3d、术后3个月、末次随访时VAs评分及0DI评分比较，差异有统计学意义（P〈0．05）。结论经皮椎体成形术能够有效缓解骨质疏松性椎体压缩骨折引起的疼痛及功能障碍症状，可以增加椎体的强度，是一种操作简单、安全、有效的微创治疗方法。尤其是单个椎体骨折者，可以获得比较满意的临床疗效，对多个椎体骨折者需要增加其他辅助治疗措施。Objective To evaluate the efficacy of the percutaneous vertebroplasty for the aged patients with the osteoporotie compression fracture and analysis of its reasons. Methods A retrospective study was carried out for 89 patiets with the osteoporotic compressin fracture from January 2005 to January 2009.43 were males and 46 were females. The average age of the patiets was 73.3 years old with the range of 44 to 71 years. Average course of disease was 4.3 days with range of lto 26 days. The operation was undertaken in local anesthesia. The PMMA （polymethly-methacrylate, PMMA） has been injected into the vertebral body under monitoring in the whole operation. The patients were divided 2 treatment group as A was the single vertebra fracture with 48 cases and B was multiple vertebra fracture with 41 cases （Amoung them 38 cases with 2 vertebra fracture and 3 were 3 vertebra fracture）. Before the surgery,all cases had the symptoms as lower back pain and local disability,and there were not reached statistical significant difference between the two group about their age,gender,course of disease,VAS（Visual analog scale） and ODI （oswestry disability index）. After operation,the the treatment efficacy between the 2 gorups has been compared with VAS and ODI. Results Operations in all patients were completed smoothly. The amount of bone cement （PMMA）were 3.2 mL in average（2-6 mL）. There were 7 patients with less cement leakge at the anterior or lateral vertebral edge, 5 patients at the venous plexus of vertebral canal and 3 patients at the vertebral disc,but no clinical symptoms occured. The mean duration of follow-up time was 14.3months（6-23 months）. The VAS and ODI has the statistical significant difference between preoperation with 3 days, 3months postoperation and the last follow-up time both in A and B Groups. （P〈0. 01）. Also there were statistical significant difference between A and b groups at 3 days, 3 months postoperation and the last follow-up time（P〈0, 05）. Conclusion The Pereutane

关 键 词：椎体成形术 聚甲基丙烯酸甲酯 骨质疏松症 

分 类 号：R683.2[医药卫生—骨科学]