老年人脊柱脆性骨折PVP术后再发骨折再次PVP术后治疗效果研究  

Therapeutic efficacy of second percutaneous vertebroplasty for the treatment of refractures after first percutaneous vertebroplasty in aged patients with osteoporotic vertebral fractures

作　　者：李光胜[1] 边立忠[1] 王宏[1] 刘稳[1] 李洪德[1] 姜锡静 

机构地区：[1]齐都医院骨外科,山东淄博255400

出　　处：《中国骨质疏松杂志》2013年第9期967-969,共3页Chinese Journal of Osteoporosis

摘　　要：目的探讨老年人脊柱脆性骨折椎体成型（PVP）术后患者再发椎体骨折的临床特点及治疗策略。方法回顾分析2005年4月-2012年3月行老年人脊柱脆性骨折经皮PVP共361例，其中再发椎体骨折27例31椎体，再次采用闭合复位、PVP治疗，并行抗骨质疏松治疗。比较术前、术后24h及术后6个月时疼痛视觉模拟评分（VAS）、脊柱伤椎前缘压缩比值及矢状位Cobb角。结果本组病人术后24h腰痛消失或明显减轻，VAS术前（8．15±0．76）分，术后24h（1．64±0．45）分，术后6个月为（1．25±0．31）分（P〈0．01）；术后脊柱伤椎前缘压缩比值、Cobb角分别为术前（30．7±5．16）％、24．72°±4．1°，术后24h为（84．2±5．03）％、8．7°±2．6°，术后6个月为（82．9±4．65）％、9．1°±2．3°，术后后凸畸形矫正，较术前有统计学显著性差异（尸〈0．01）；随访6个月至24个月（平均10个月），随访期间未出现再次骨折。结论老年人骨质疏松性椎体压缩骨折PVP后效果较好，但未进行有效抗骨质疏松症治疗，仍有部分骨折复发。在进行抗骨质疏松症治疗后，无再发椎体骨折。骨折后再次行PVP，仍可有效缓解疼痛，配合抗骨质疏松治疗，可获得较为满意的临床效果。Objective To investigate the clinieal features and treatment of refraetures after pereutaneous vertebroplasty （PVP） in aged patients with osteoporotie vertebral fractures. Methods The clinical data of 361 aged patients with osteoporotie vertebral fractures, who received pereutaneous vertebroplasty in our hospital from April 2005 to March 2012, were retrospectively analyzed. Among them, 27 patients with 31 vertebrae had refractures. They were retreated with closed reduction and second pereutaneous vertebroplasty. And they received anti-osteoporosis treatment. Visual analogue scale （VAS） , the front compression ratio of injured vertebrae, and the Cobb angle were measured and compared with before the operation, the first day, and 6 months after the operation. Results Low back pain disappeared or relieved obviously after 24 hours. VAS has reduced from a mean preoperative score of 8.15±0.76 to 1.64±0. 45 （24 hours after the operation） and 1.25±0.31 （6 months after the operation） （P 〈 0.01 ）. The front compression ratio of injured vertebrae and the Cobb angle before the operation was （30. 7±5. 16）% and 24.72°±4. 1°, respectively. At the 1st day and the 6th month after the operation, the value was （84.2±5.03）% and 8.7°±2.6°; （82.9±4.65）% and 9. 1°±2.3°, respectively. The correction of kyphosis postoperative was significant different to that before the treatment （P 〈 0. 01 ）. The follow-up period ranged from 6 to 24 months, with an average of 10 months. No relapse of vertebral fractures was observed. Conclusion The effeet of PVP on aged patients with osteoporotic vertebral compression fractures is good. But without effective treatment of anti-osteoporosis, some refractures occurred. After anti-osteoporosis treatment, no relapse of vertebral fractures is observed. The second PVP can also relive pain effeetively. Combined with anti-osteoporosis treatment, satisfying effect can be achieved.

关 键 词：骨质疏松 椎体骨折 PVP 再发骨折 老年人 

分 类 号：R681.5[医药卫生—骨科学] R683.2[医药卫生—外科学]