经皮椎体后凸成形术治疗老年人骨质疏松性脊柱压缩骨折的疗效分析  

Clinical outcomes of percutaneous kyphoplasty under local anesthesia for osteoporotic vertebral compression fractures

作　　者：方秀统[1] 于方[1] 付胜良[1] 陈国强[1] 袁晓明[1] 李洪川[1] 张林[1] 俞猛[1] 姚琦[1] 艾笛[1] 沈煜[2] 吴斌[3] 

机构地区：[1]首都医科大学附属北京世纪坛医院骨科,100038 [2]首都医科大学宣武医院骨科 [3]吉林省珲春市医院骨科

出　　处：《中华医学杂志》2013年第33期2654-2658,共5页National Medical Journal of China

摘　　要：目的分析经皮椎体后凸成形术治疗老年人骨质疏松性脊柱压缩骨折的手术疗效。方法2008年8月至2009年11月对76例（87个骨折椎体）随访2年以上资料完整的老年人骨质疏松性脊柱压缩骨折患者进行回顾性分析（平均随访时间2．1年），根据患者不同年龄段分为3组：60～69岁（A组），70～79岁（B组），80～91岁（C组），分析术前患者骨密度（BMD，双能量X线吸收测定法）、术前X线骨折椎体和MRI是否一致、术中手术时间、术前和术后视觉模拟评分（VAS）、Oswestry功能障碍指数、骨折椎体高度、术中术后并发症及患者的住院费用分析。结果患者骨密度随着年龄增加而降低，各年龄组之间比较差异有统计学意义（P〈0．05）；本组资料中9个骨质疏松压缩性骨折不能在X线片上诊断，在MRI影像诊断明确；术中每个椎体后凸成型术平均时间为28min；本组患者术前VAS疼痛评分、Oswestry功能障碍指数随着年龄的增加而增加，但A组与B组比较差异无统计学意义，A组、B组与C组比较差异有统计学意义，术后VAS疼痛评分（8．0±1．2）分比（2．6±1．0）分、Oswestry功能障碍指数（82．3±5．6）比（33．9±4．7）与术前比较均明显改善，P〈0．05；A组、B组和C组骨折椎体高度、椎体节段矢状面Cobb角与术前比较均较术前明显改善（17．1±5．1）比（-3．8±0．7），P〈0．05；术后结果与2年后最后随访[2．2分，（26．1±3．6）]比较差异无统计学意义；术中透视下监测有5例出现无症状骨水泥渗漏，1例患者出现骨水泥渗透到椎间盘，2例渗透到椎体旁外，2例渗透到椎旁静脉；术后1例患者17个月后出现相邻椎体的骨折，并行椎体成形术；患者从住院到出院平均费用为33778元。结论椎体后凸成形术治疗老年骨质疏松压缩性骨折是简单、安全、有效的，能迅速完全或部分缓解患者的疼痛及Objective To analyze the clinical outcomes of percutaneous kyphoplasty under local anesthesia for osteoporotic vertebral compression fractures. Methods In this study, 76 elderly patients with osteoporotic vertebral compression fractures undergoing percutaneous kyphoplasty were followed up for 2 - 3.1 years. They were divided into 3 groups according to different ages ：60 -69 yrs （A group） , 70 -79 yrs （B group） and 80 -91 yrs （C group）. Pre- and post-operative and last follow-up evaluations were conducted. And the parameters of bone mineral density （ BMD ） , kyphotic angle, change of visual analog scale （VAS）, Oswestry disability index, average vertebral body height, complications and costs of hospitalization were recorded and analyzed. Results BMD decreased with advancing age and had statistical significance between three groups （ P 〈 0. 05 ）. Three thoracic spine fractures and 6 lumbar spine fractures could not be detected with digital radiography and were observed only on magnetic resonance imaging （MRI）. The pre-operative levels of visual analogue scale and Oswestry disability index increased in all groups. No statistical significance existed between A and B groups. But there was statistical significance between A or B and C groups （ P 〈 0. 05 ）. Pre- and post-operative assessments showed that statistically significant improvements were found in visual analogue scale and Oswestry disability index in all groups （P 〈0. 05）. And statistically significant improvements were found for the pre- and post-operative kyphotic angles and vertebral body heights in A, C group and B groups （ P 〈 0. 05 ）. The sites for symptomatic leakage of cement included paravertebal vein （ n = 2 ）, intervertebral disc （ n = 1 ） and paravertebral space （ n = 2 ）. Adjacent vertebral fracture occurred in 1 patient at 17 months and underwent percutaneous kyphoplasty. The mean operative duration was 28 minutes per vertebrae and the mean cost of hospitalization at RMB yuan 33 778. Co

关 键 词：脊柱后凸 老年人 骨质疏松 骨折 

分 类 号：R687.3[医药卫生—骨科学]