交叉单侧穿刺椎体成形术在多节段老年骨质疏松椎体压缩性骨折中的应用  

The application of cross unilateral vertebroplasty in multiple segmental osteoporotic vertebral compression fractures in the elderly

作　　者：陈继良[1] 许庆山[1] 王旭[1] CHEN Ji-liang;XU Qing-shan;FANG Xu(Department of Orthopeadics,Ningde Fujian Hospital orthopedic branch,Affiliated to Fujian Medical University,Fuan 355000,China)

机构地区：[1]福建医科大学附属宁德市闽东医院骨科分院骨三科,福建福安355000

出　　处：《吉林医学》2018年第7期1209-1212,共4页Jilin Medical Journal

摘　　要：目的:探讨经皮椎体成形术中采用交叉单侧穿刺注射骨水泥在多节段老年骨质疏松椎体压缩骨折的临床疗效。方法:采用交叉单侧穿刺椎体成形术治疗多节段骨质疏松性椎体压缩性骨折36例93个病椎。术前分析患者影像学资料,结合患者症状、体征,明确责任椎及数量,其中2个椎体压缩性骨折21例,3个椎体压缩性骨折10例,4个椎体压缩性骨折4例,5个椎体压缩性骨折1例。采用模拟视觉评分(VAS)及Oswesty功能障碍指数(ODI)评价术后疼痛缓解及日常活动功能恢复情况。记录手术时间及并发症情况,并在X线片上分别测量术前、术后椎体前缘高度及Cobb后凸角的纠正程度。结果:所有患者均顺利完成手术,手术时间为22~72 min,平均14.1 min/椎。发生骨水泥渗漏6例8椎,其中2椎为椎管内出现少量渗漏,6椎为发生椎旁渗漏,均无明显临床症状。1例患者1年内出现再发相邻椎体压缩性骨折。患者术后1天及术后6个月VAS评分分别为(2.31±0.79)分、(2.19±0.67)分,与术前(8.42±0.97)分比较,差异均有统计学意义(P<0.01);患者术后1天及术后6个月ODI指数分别为(20.67±1.97)%、(19.94±2.11)%,与术前(41.58±3.47)%比较,差异均有统计学意义(P<0.01);患者术后1天及术后6个月椎体前缘高度分别为(17.27±2.06)mm、(17.09±2.12)mm,与术前(9.83±1.99)mm比较,差异均有统计学意义(P<0.01);患者术后1天及术后6个月Cobb后凸角分别为(16.130±2.120)°、(16.490±2.250)°,与术前(27.810±2.920)°比较,差异均有统计学意义(P<0.01)。结论 :采用交叉单侧穿刺注射骨水泥椎体成形术治疗多节段骨质疏松椎体压缩性骨折手术时间短、创伤小、治疗费用低、疼痛缓解率高,功能改善明显,安全、有效。Objective To explore the therapeutic efficacy of unilateral crossover channels approach in percutaneous vertebroplasty（ PVP） for osteoporosis vertebral compression fracture of multi-vertebral in elderly patients. Method 36 patients with multi-segment osteoporotic vertebral compression fractures underwent unilateral crossover transpedicular vertebroplasty,a total of96 vertebrae were involved. The imaging information was analyzed before operation,the injured vetebra and the number were identified according to the symptoms and signs. There were 36 patients who were operated for two segments（ 21 cases）,three segments（ 10 cases）,four segments（ 4 cases）,five segments（ 1 cases）. The pain relief and functional recovery of daily life was evaluated by visual analogue sale（ VAS） and oswestry disability Index（ ODI）. The operation time and complications were recorded. The anterior height of the vertebrae body and Cobb＇ s angle were measured preoperatively and postoperatively on the X ray film. Results All procedure were uneventful. The operation time was 14. 1 min/vertebra in average,from 22 to 72 min. During the procedure,there were 2 cases with intraspinal leakage and 6 case with paraspinal leakage,which led to no obvious clinical symptoms at all. One patients had new symptomatic vertebral fracture during follow-up in one year. The VAS score was decreased from（ 8. 42 ± 0. 97） preoperatively to（ 2. 31 ± 0. 79） day 1 and to（ 2. 19 ± 0. 67） months 6 postoperatively; The ODI score was decreased from（ 41. 58 ± 3. 47） % preoperatively to（ 20. 67 ± 1. 97） % day 1 and to（ 19. 94 ± 2. 11） % months 6 postoperatively; the anterior vertebral height was increased from（ 9. 83 ± 1. 99） mm preoperatively to（ 17. 27 ± 2. 06） mm day 1 and（ 17. 09 ±2. 12） mm months 6 postoperatively; and the Cobb＇s angle was improved from（ 27. 810 ± 2. 920） ° preoperatively to（ 16. 130 ±2. 120） ° day 1 and（ 16. 490 ± 2. 250） ° months 6 postoperatively. There were si

关 键 词：经皮椎体成形术 骨折 骨质疏松 多节段 

分 类 号：R687.3[医药卫生—骨科学]