经皮椎体成形术治疗不伴神经症状的骨质疏松性椎体爆裂骨折  

Percutaneous Vertebroplasty for the Treatment of the Osteoporosis Vertebral Burst Fractures without Neurological Impairment

作　　者：沈洪弟 崔烨平 魏志祥[1] 田纪伟[2] 

机构地区：[1]昆山市第三人民医院骨科,江苏昆山215300 [2]上海交通大学附属第一人民医院脊柱外科,上海200080

出　　处：《实用骨科杂志》2014年第1期11-13,共3页Journal of Practical Orthopaedics

摘　　要：目的探讨经皮椎体成形术（percutaneousvertebroplasty，PVP）治疗不伴神经症状的骨质疏松性椎体爆裂骨折的临床效果。方法回顾性分析2006年9月至2012年6月间我院治疗的25例不伴神经症状的骨质疏松性椎体爆裂骨折患者的临床资料，男9例，女16例；年龄65～82岁，平均73．5岁。损伤节段在T10-L3之间，共36个节段。所有患者均伴有5％～20％的椎管占位。分别于术前和术后1周、1、6、12个月，采用视觉模拟疼痛评分（visualaria—loguescores，VAS）和Oswestq功能障碍指数（oswestrydisabilityindex，ODI）评估患者的临床效果；通过侧位x线片测量患者椎体中线高度和矢状位Cobb角；通过轴位CT测量椎管占位程度，对患者的骨水泥渗漏、感染等并发症情况进行记录。结果9例（25％）椎体发生骨水泥渗漏，但均未出现相关临床症状。无感染、神经损伤、肺栓塞等病例出现。在VAS评分、ODI评分以及椎体中线高度、矢状位Cobb角、椎管占位程度测量评估方面，患者术前与术后各个时间点比较，术后评估结果显著优于术前，差异均有统计学意义（P〈0．05）。结论对于椎管占位5％一20％的无神经功能损害的骨质疏松性椎体爆裂骨折患者而言，PVP技术是一种安全、有效的治疗方法，且不增加病椎椎管占位程度加重的风险。Objective To investigate the clinical efficacy of percutaneous vertebroplasty （PVP） in the treatment of osteo- porosis vertebral burst fractures without neurological impairment. Methods The clinical data of osteoporosis vertebral burst fractures in 25 patients were analyzed retrospectively from September 2006 to June 2012. There were 9 males and 14 females with the mean age of 73.5 range from 65 to 82 years old including 35 level from T10 to L2,with all patients had 5 to 20% ca- nal encroachment. The pain level of each patient was assessed before operation and 1 week, 1,6,12 months after the operation using visual analogue scale （VAS） and Oswestry disability index （ODI）. The middle line vertebral body height and local sag- ittal Cobb＇ s angle were also measured. Degree of canal encroachment was measured in the axial CT scan. Cement leakage,in- fections and other complications were recorded. Results Bone cement leakage took place in 9 eases （25 % ）. None of the 9 cases had clinical symptom. There was no infection, nerve injury, pulmonary embolism. Postoperative average VAS, Oswestry disability index （ODI）, the local sagittal Cobb＇ s angle and spinal canal encroachment at each postoperative time point signifi- cantly less than the preoperative （P 〈 0.05 ）. The mean midline vertebral height at each postoperative time point significantly greater than the preoperative （P 〈 O. 05）. Conclusion We safely performed vertebroplasty in patients with 5 to 20c~ preoper- ative canal encroachment. Therefore, vertebroplasty might be a safe treatment option for osteoporosis vertebral burst fractures with no neurological deficit. There is no the risk of aggravation of spinal canal encroachment.

关 键 词：椎体成形术 脊髓损伤 骨质疏松性骨折 后凸 椎管占位 

分 类 号：R683.2[医药卫生—骨科学]