经皮球囊扩张椎体后凸成形术治疗骨质疏松性多节段胸腰椎骨折的效果  

Effect of percutaneous kyphoplasty for treatment of multiple osteoporotic vertebral compression fractures

作　　者：靳占奎[1] 徐翠香[2] 吴学元[1] 董向辉[1] 常彦海[1] 孙正明[1] 陈明[1] 凌鸣[1] JIN Zhankui;XU Cuixiang;WU Xueyuan;DONG Xianghui;CHANG Yanhai;SUN Zhengming;CHEN Ming;LING Ming(Department of Orthopaedics,Shaanxi Provincial People′s Hospital,Shaanxi Province,Xi′an 710068,China;Center of Shaanxi Provincial Clinical Laboratory,Shaanxi Province,Xi′an 710068,China)

机构地区：[1]陕西省人民医院骨科,陕西西安710068 [2]陕西省临床检验中心,陕西西安710068

出　　处：《中国医药导报》2018年第21期55-59,共5页China Medical Herald

基　　金：陕西省重点研发计划项目(2017 KW-051)

摘　　要：目的观察经皮球囊扩张椎体后凸成形术(PKP)治疗老年骨质疏松性多节段胸腰椎骨折的临床效果。方法回顾性分析2011年4月~2016年1月陕西省人民医院收治的46例接受PKP治疗的多节段老年骨质疏松性椎体骨折患者的临床资料。观察术前、术后3 d及末次随访时的视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)评分、椎体高度和伤椎Cobb角,评价影响术后疗效的因素。结果 46例患者113节病变椎体行PKP治疗,骨水泥注射量平均为(4.05±1.20)m L,出现骨水泥渗漏为11椎,其中神经压迫症状1例,7例患者发生了新发相邻椎体压缩性骨折。术后3 d、末次随访的VAS评分、ODI评分与术前比较,差异有高度统计学意义(P<0.01),术后3 d椎体前缘、椎体中线高度显著高于手术前,术后末次随访椎体前缘、椎体中线高度均高于术后3 d,差异有高度统计学意义(P<0.01),术后3 d伤椎Cobb角显著低于术前,术后末次随访伤椎Cobb角高于术后3 d,差异有高度统计学意义(P<0.01)。多因素分析发现骨密度、伤椎个数、相邻椎体骨折是影响手术疗效的相关因素(P<0.05)。结论 PKP是治疗多节段老年骨质疏松性胸腰椎骨折安全、有效的方法 ,能即刻减少疼痛、提高生活质量。Objective To observe the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic multiple segmental thoracolumbar fractures in the elderly.Methods The clinical data of 46 patients with multi-segment senile osteoporotic vertebral fracture treated by PKP from April 2011 to January 2016 in Shaanxi Provincial People′s Hospital were retrospectively analyzed.Visual analogue scale(VAS),Oswestry disability index(ODI)score,vertebral body height,and vertebral Cobb angle were observed preoperatively at 3 days postoperatively and at the last follow-up,and the factors that affect postoperative efficacy were evaluated.Results PKP was performed on 113 vertebral lesions in 46 patients.The average cement injection volume was(4.05±1.20)mL.There was 11 vertebral cement leakages,including 1 nerve compression symptom and 7 cases were new-onset adjacent vertebral compressions fractures.The VAS scores,ODI scores at preoperative 3 d,the last follow-up and were compared,the differences were statistically significant(P<0.01).The height of anterior vertebral body and vertebral body at the postoperative 3 d was significantly higher than before operation,and the height of the last follow-up was lower than the postoperative 3 d,the differences were statistically significant(P<0.01).The Cobb angle at the postoperative 3 d was significantly lower than before opertation,and the Cobb angle of the last follow-up was higher than the postoperative 3 d,the differences were statistically significant(P<0.01).Multivariate analysis found that bone density,the number of injured vertebrae,and adjacent vertebral fractures were related factors affecting surgical outcomes(P<0.05).Conclusion PKP is a safe and effective method for the treatment of multi-segment senile osteoporotic thoracolumbar fractures.It can instantly reduce pain and improve quality of life.

关 键 词：多椎体骨折 骨质疏松 椎体成形术 骨水泥 

分 类 号：R683.2[医药卫生—骨科学]