椎体成形术治疗重度胸椎骨质疏松性椎体压缩骨折  

Vertebroplasty in the Treatment of Severe Collapsed Thoracic Osteoporotic Vertebral Compression Fractures

作　　者：王亚斌[1] 骆文兴[1] 刘勇[1] 张云庆[1] Wang Yabin;Luo Wenxing;Liu Yong;Zhang Yunqing(Department of Orthopaedics,Jiangyin People's Hospital,Jiangyin Jiangsu 214400,China)

机构地区：[1]江阴市人民医院骨科

出　　处：《中国继续医学教育》2019年第36期101-104,共4页China Continuing Medical Education

摘　　要：目的探讨应用高粘度骨水泥行椎体成形术(percutaneous vertebroplasty,PVP)治疗重度塌陷的胸椎骨质疏松性椎体压缩性骨折(osteoporosis vertebral compression fractures,OVCF)的疗效和安全性。方法回顾性分析2014年6月-2015年12月间27例采用高粘度骨水泥行PVP治疗重度塌陷的胸椎OVCF患者资料。在术前、术后2天及术后6个月时采用疼痛视觉模拟评分(visual analogue scale,VAS)评估疼痛程度;Oswsetry功能障碍指数(oswsetry disability index,ODI)评估患者日常生活功能;X线摄片测量伤椎高度及局部后凸角。观察术中及术后并发症。结果 27例患者中23例患者获得6个月以上随访。患者术后腰背部疼痛迅速缓解,VAS评分术前(8.39±1.07)分,术后2天时(2.04±0.47)分,P <0.05。术后6个月时(1.60±0.49)分,P <0.05。ODI评分术前为(70.08±8.79)%,术后2天时(27.52±5.30)%,P <0.05,术后6个月时为(26.69±5.26)%,P <0.05。椎体高度及局部后凸角术前与术后、术前与末次随访比较有统计学差异(P <0.05)。所有患者术后均出现血管损伤、脊髓及神经根损伤、感染、肺栓寒等并发症。有6例患者出现骨水泥渗漏(4例椎体侧方或前方渗漏,1例椎间隙渗漏,1例血管渗漏,无椎管内渗漏),但均无临床症状。结论患有疼痛的胸椎SOVCF的患者可以应用高粘度骨水泥行PVP。患者手术后能得到显著的疼痛缓解和功能改善。虽然技术上要求更高,但高粘度骨水泥行PVP在技术上是安全可行的。Objective To evaluate the clinical effects of percutaneous vertebroplasty(PVP) with high-viscosity bone cement in treatment of severe collapsed thoracic osteoporotic vertebral compression fracture(OVCF). Methods Twenty-seven patients with severe collapsed thoracic OVCF were treated by PVP with high-viscosity bone cement between June 2014 and December 2015.Visual analog scale(VSA) and Oswestry Disability Index(ODI) were used for clinical assessment. Vertebral height loss and segmental kyphotic angle were measured radiographically at preoperative;and 2-day, and 6-month postoperative time points. Procedure-related and postoperative complications were recorded. Results Twenty-three of the 27 patients were followed up for more than 6 months. Back pain was efectively relieved after operation in all cases. The VAS score was(8.39±1.07) points preoperatively,(2.04±0.47) points(P < 0.05) 2 days postoperatively, and(1.60±0.49) points(P < 0.05) at 6 months postoperatively. The ODI score was(70.08±8.79) points preoperatively,(27.52±5.30) points(P < 0.05) 2 days postoperatively, and(26.69±5.26) points(P < 0.05) at 6 months postoperatively. Vertebral height and local kyphosis angle were statistically different between preoperative and postoperative as well as preoperative and last follow-up(P < 0.05). No severe adverse events were observed, including vascular injury, spinal cord and nerve root injury, surgical incision infection, and pulmonary thrombosis. Bone cement leakage was detected in 6 patients, but did not cause clinical symptoms. Four patients were found with cement leakage in paravertebral soft tissues, 1 patients in intervertebral spaces, and 1 patients in prevertebral veins. Conclusions Patients with painful thoracic SOVCFs can be treated with, and benefit from PVP with high-viscosity bone cement and they can achieve significant pain relief and functional improvement after surgery. Although technically more demanding, PVP with high viscosity bone cement is technically safe and feasible.

关 键 词：骨质疏松症 骨质疏松性椎体压缩性骨折 严重 椎体成形术 骨水泥 并发症 

分 类 号：R605[医药卫生—外科学]