经皮椎体成形术/经皮椎体后凸成形术治疗超高龄患者椎体压缩骨折的疗效和安全性初步研究  

Safety and effectiveness of vertebroplasty/kyphoplasty in treatment of vertebral compression fracture in super-aged patients

作　　者：邝冠明 高庆鹏 杨震宇 吴建斌 朱锋 郑召民[3] 黄德民[2] 张文智[2] KUANG Guanming;GAO Qingpeng;YANG Zhenyu;WU Jianbin;ZHU Feng;ZHENG Zhaomin;Tak Man Wong;Kenneth MC Cheung(Department of Orthopaedics,The University of Hong Kong-Shenzhen Hospital,Shenzhen 518053,Guangdong;Department of Orthopaedics and Traumatology,The University of Hong Kong,Hong Kong Special Administrative Region 999077;Department of Spine Surgery,The First Afiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]香港大学深圳医院骨科,广东深圳518053 [2]香港大学矫形及创伤外科学系,香港特别行政区999077 [3]中山大学附属第一医院脊柱外科,广州510080

出　　处：《中华骨与关节外科杂志》2020年第12期982-986,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:超高龄患者椎体压缩骨折一直是骨科治疗及快速康复的难点。目前尚没有研究表明经皮椎体成形术(PVP)/经皮椎体后凸成形术(PKP)治疗该特殊年龄段患者的临床疗效和安全性。目的:初步探讨PVP/PKP治疗超高龄患者椎体压缩骨折的疗效和安全性。方法:回顾性分析2018年1月至2019年7月我院治疗的16例年龄≥85岁患者的临床资料,其中男2例,女14例,年龄85~96岁,平均(87.9±2.9)岁。通过疼痛数字分级法(NRS)及功能障碍指数(ODI)对患者术前1 d、术后1 d和随访时的疼痛症状和日常功能情况进行评价;通过阅读术后的影像学资料判断是否有骨水泥渗漏。结果:所有患者术后随访3~12个月,平均(7.5±4.2)个月。患者手术时间42~100 min,平均(63.2±16.9)min。骨水泥注射量(3.6±0.8)ml/椎。术后1 d患者腰背痛明显缓解。NRS评分及ODI均较术前明显改善(NRS:8.5±0.7 vs.3.4±0.8,P<0.01;ODI:72.8±3.4 vs.37.9±8.9,P<0.01)。末次随访患者均无明显腰背痛,日常生活基本自理。术后随访2例出现邻椎骨折,其中1例术后6个月L3处骨折,予保守治疗,另外1例术后3个月T9处骨折,予PKP治疗,2例患者经治疗后症状缓解,恢复日常生活自理能力。结论:对超高龄患者的骨质疏松性椎体压缩骨折,在患者全身状况允许的前提下,及早行PVP/PKP有助于患者改善疼痛症状、尽快恢复生活自理,符合现代加速康复外科(ERAS)理念。Background:It is not easy for a super-aged patient with vertebral compression fracture(VCF)to have early rehabilitation due to the comorbidities.However,few study has shown the safety and efficacy of percutaneous vertebroplasty(PVP)/percutaneous kyphoplasty(PKP)in the treatment of VCF in super-aged patients.Objective:To investigate the safety and effectiveness of PVP/PKP in the treatment of vertebral compression fracture in super-aged patients.Methods:A total of 16 VCF patients who were treated with PVP/PKP from January 2018 to July 2019 were retrospectively analyzed including 14 females and 2 males with the mean age of(87.9±2.9)years(range:85-96 years).Numerical rating scale(NRS)and Oswestry disability index(ODI)were used preoperatively and postoperatively to assess the pain relief and functional improvement.The post-operative X-ray or CT images were studied to evaluate whether any cement leakage.Results:The patients were followed for 3-12 months with the mean of(7.5±4.2)months.The operation time ranged from 42 to 100 min,with(63.2±16.9)min on average.The injected cement volume was(3.6±0.8)ml per vertebrae.The patients reported significantly improvement in low back pain on post-operative day 1.NRS(8.5±0.7 vs.3.4±0.8,P<0.01)and ODI(72.8±3.4 vs 37.9±8.9,P<0.01)were improved significantly as compared with preoperative status.At the final follow up,all patients reported no obvious low back pain and to retrieve basic self-care in daily life.Two patients had adjacent vertebral fractures including one at L3 at postoperative 6 months treated conservatively and the other at T9 at postoperative 3 months treated by PKP,who had symptoms relieved and restored the ability to take care of themself in daily life.Conclusions:Early PVP/PKP is helpful to relieve pain and restore the ability to take care of oneself in daily life for super-aged patients with VCF if their general condition permitted,which is in line with the concept of enhanced recovery after surgery.

关 键 词：骨质疏松 椎体压缩骨折 椎体成型术 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]