椎体成形术操作技巧探讨  

The Exploration of Operating Skills of Vertebralplasty

作　　者：黄卫国[1] 易军飞[1] 白瑞飞[1] 陈通 

机构地区：[1]广西柳州市柳铁中心医院骨科,广西柳州545007

出　　处：《临床医学工程》2011年第7期1002-1004,共3页Clinical Medicine & Engineering

摘　　要：目的评价椎体成形术治疗老年骨质疏松椎体压缩性骨折的临床疗效,探讨和总结手术操作技巧。方法回顾性分析经皮穿刺椎体成形术治疗87例137个骨质疏松椎体压缩性骨折;男32例,女55例,年龄52～91岁,平均73岁;椎体骨折部位T3～L5;单个椎体54例,多个椎体33例,其中双椎21例,三椎8例,四椎3例,五椎1例;全部经单侧椎弓根穿刺,骨水泥稀薄期注射,骨水泥注射量为3～7.5ml,胸椎3ml以上,腰椎4.5ml以上,平均4.8ml;多椎体者均一次手术完成;术后复查X-ray观察骨水泥充盈渗透情况;临床疗效采用VAS评分和ODI评分。结果所有患者随访6个月以上(6～30个月),平均随访13.2个月,VAS评分由术前8.7(8.7±0.9)到术后第2天1.6(1.6±0.7)和最终随访时的1.7(1.7±0.5)(P<0.001)。Oswestry评分由术前61(61±4.8)到术后第2天20(20±2.7)和最终随访时的21(21±3.1)(P<0.01)。所有患者胸腰背疼痛明显缓解,其中58例疼痛完全消失;1例术中出现骨水泥单体中毒症状,28例出现不同程度骨水泥渗漏,但无1例出现临床症状。137个椎体中骨水泥渗透达到和超过中线119个,占86.9%。结论椎体成形术是治疗老年骨质疏松椎体压缩性骨折的有效方法;骨水泥稀薄期注射能够获得良好的渗透效果和足够的治疗剂量;不强调穿刺针尖到达椎体中线以免引起穿刺损伤;在局麻药限量范围内,一次可完成3个以上椎体成形;严格正规的操作技术是预防骨水泥渗漏最重要的方法。Objective To eveluate the clinical effect of vertebralplasty in the treatment of vertebral compression of osteoporosis in aged patients and discuss operating skill of vertebralplasty.Methods To retrospectively study the 87 patients with 137 vertebraes（21 cases of two vertebraes,8 cases of three vertebraes,3 cases of four vertebraes and one case of five vertebraes） suffered from osteoportic compres-sion fracture and treated with percutaneous vertebralplasty from May 2008 to June 2010.The patients included 32 males and 55 females aged from 52 to 91 years with a mean of 73 years;all the patients were given unilateral transpedicular puncture,bone cement was injected at thin dense time and the volume was from 3 ~ 7.5 ml with an average of 4.8 ml;all those multiple vertebral compression fracture were com-pleted at one time.The postoperative X-ray was carried out to study bone cement filling in the vertebraes;the results were considered care-fully by the visual analogue scale（VAS） and the oswestry disability index（ODI）.Results All the patients were followed up for at least 6 months（6 ~ 30 months） with an average of 13.2 months.VAS decreased from 8.7（8.7 ± 0.9） before operation to 1.6（1.6 ± 0.7） and 1.7（1.7 ± 0.5）（P 0.001） in the second day after operation and the final follow-up respectively.ODI decreased from 61（61 ± 4.8） before operation to 20（20 ± 2.7） and 21（21 ± 3.1）（P 0.01） in the second day after operation and the final follow-up respectively.All the patients had marked to complete pain relief after operation;one patient had the poisoning symptom of bone cement,bone cement leakage happened in 28 patients,but no severe complication occurred.119 cases of bone cement penetration were reached to or more than the center line,accounting for 86.9%.Conclusion Vertebralplasty provides significant pain relief in the treatment of osteoporosis vertebrae compression fracture;bone cement injection at thin dense time gets satisfactory penetration and sufficient dose.The inje

关 键 词：椎体成形术 骨质疏松 压缩性骨折 

分 类 号：R683[医药卫生—骨科学]