经皮椎体成形术后非手术椎体新发骨折的临床分析  

Clinical Analysis of Subsequent Non-operative Vertebral Compressible Fracture after Percutaneous Vertebroplasty

作　　者：徐德兴[1] 陈昌礼[1] 陈硕[1] 

机构地区：[1]都江堰市医疗中心骨科,四川都江堰611830

出　　处：《华西医学》2015年第7期1217-1221,共5页West China Medical Journal

摘　　要：目的分析骨质疏松椎体压缩性骨折行椎体成形术后非手术椎体骨折再次行椎体成形术的疗效及临床特点。方法 2008年1月-2013年5月,因骨质疏松椎体压缩性骨折接受椎体成形术的患者共277例(331椎)。术后新发骨折需要手术治疗者42例。将其分为邻近椎体新发骨折组(A组)19例,非邻近椎体新发骨折组(B组)23例。比较首次及再次椎体成形术后患者疼痛强度及功能改善,比较A组与B组一般资料、新发骨折的时间、骨水泥注入量、骨水泥渗漏情况及手术相关并发症。结果首次与再次椎体成形术后1 d疼痛视觉模拟评分改善率分别为(64.6±12.6)%及(67.4±12.8)%,差异无统计学意义(P>0.05);改良Oswestry失能指数评分改善率分别为(60.6±13.3)%及(62.6±12.9)%,差异无统计学意义(P>0.05)。首次行椎体成形术与新发椎体压缩骨折的时间间隔:A组(62.4±45.5)d,B组(203.7±77.6)d,差异有统计学意义(P<0.05)。A组与B组在一般资料、骨水泥注入量及渗漏情况等方面差异均无统计学意义(P>0.05)。5例患者再次椎体成形术后发生脊柱旁骨水泥渗漏,其中1例在术后3个月发现邻近椎体压缩骨折。所有患者再次椎体成形术后均未发生手术相关并发症。结论再次椎体成形术治疗新发椎体压缩骨折对患者疼痛及功能改善与首次手术疗效相当;邻近椎体新发骨折多在首次椎体成形术后早期发生。Objective To explore the therapeutic effects and clinical characteristics of repeated percutaneous vertebroplasty（PVP） on subsequent non-operative osteoporotic vertebral compressible fractures（OVCF） after initial PVP for OVCF.Methods From January 2008 to May 2013,277 patients（ 331 vertebral bodies） with OVCF who were regularly followed up had underwent PVP.Among the 277 patients,the second treatment group included 42 patients who developed subsequent OVCF,which were retreated by PVP.And they were divided into adjacent new OVCF group（group A,19 patients） and non-adjacent new OVCF group（group B,23 patients）.Analgesic effects and functional improvements were compared between the initial and second treatment.The interval of new OVCF after initial surgery,complications,and other clinical characteristics including age,gender,history of trauma,the amount of injected polymethylmethacrylate（PMMA） and PMMA leakage were compared between group A and B.Results The improvement rates of visual analogue scale scores were（ 64.6 ± 12.6）% in the initial treatment group and（ 67.4 ± 12.8）% in the second treatment group（ P 〉0.05）.The improvement rates of Oswestry Disability Index（ODI） were（ 60.6 ± 13.3）% in the initial treatment group and（ 62.6 ± 12.9）% in the second treatment group（ P 〉0.05）.The interval of incidence of subsequent new OVCF after the initial treatment were（ 62.4 ± 45.5） days in group A and（ 203.7 ± 77.6） days in group B,respectively（ P 〈0.05）.There were no significant differences in age,gender,history of trauma,the amount of injected PMMA and PMMA leakage between group A and group B（ P 〈0.05）.No surgery-related complications occurred after the second treatment except asymptomatic cement leakage in 5 patients,one of whom suffered from adjacent OVCF 3 months after the operation.Conclusions The therapeutic effect of repeated PVP for new OVCF on alleviating the pain and improving the function is just as the effect of the initial operation.Ad

关 键 词：骨质疏松症 椎体压缩骨折 再骨折 椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]