椎体强化术后骨水泥移位的治疗分析  

Treatment of cement dislodgement after vertebral augmentation

作　　者：张林林[1] 干旻峰[1] 史金辉[1] 杨鹏[1] 杨少锋[1] 朱默[2] 陶云霞[1] 杨惠林[1] Zhang Linlin;Gan Minfeng;Shi Jinhui;Yang Peng;Yang Shaofeng;Zhu Mo;Tao Yunxia;Yang Huilin(Department of Orthopaedics,The First Affiliated Hospital of Soochow University,Suzhou 215031,China;Department of Medical Imaging,The First Affiliated Hospital of Soochow University,Suzhou 215031,China)

机构地区：[1]苏州大学附属第一医院骨科,苏州215031 [2]苏州大学附属第一医院影像科,苏州215031

出　　处：《中华创伤骨科杂志》2023年第1期19-24,共6页Chinese Journal of Orthopaedic Trauma

基　　金：苏州市科技发展计划(SLJ2022016);江苏省卫健委老年健康项目(LK2021017)。

摘　　要：目的分析骨质疏松性椎体骨折椎体强化术后骨水泥移位的治疗和疗效。方法回顾性分析2013年7月至2022年7月苏州大学附属第一医院骨科收治的13例骨水泥移位患者资料。男4例,女9例;年龄(76.5±8.6)岁;骨密度T值-3.3±0.6。依据CT和MRI影像学特征,可分为4个类型:骨水泥原位松动4例,骨水泥松动前移6例,骨水泥前移伴椎体骨块后移2例,骨水泥后移1例;其中采用经皮椎体成形术治疗3例,钉棒固定椎板切除联合后外侧减压植骨融合7例,保守治疗3例。手术治疗患者通过比较术前、术后1周、1个月、末次随访时的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、后凸畸形cobb角及观察神经损伤Frankel分级变化评估疗效,保守治疗患者观察症状评估疗效。结果13例患者治疗后随访时间7(5,12)个月。10例手术患者术后1周、1个月、末次随访时的VAS评分[5.0(4.0,5.0)分、3.0(2.0,3.0)分、3.0(2.0,3.0)分]均较术前[8.5(8.0,9.0)分]显著改善,术后1个月、末次随访时较术后1周也显著改善,差异均有统计学意义(P<0.05),而末次随访时与术后1个月比较差异无统计学意义(P>0.05);10例手术患者术后1周、1个月、末次随访时的ODI(50.6%±4.2%、37.8%±4.5%、29.3%±5.6%)均较术前(93.2%±3.6%)显著持续改善,两两比较差异均有统计学意义(P<0.05);10例手术患者术后1周、1个月、末次随访时cobb角[10.0(9.0,11.0)°、9.0(9.0,11.0)°、10.0(9.0,12.0)°]均较术前[12.5(11.0,14.0)°]显著改善,差异均有统计学意义(P<0.05),术后各时间点间比较差异均无统计学意义(P>0.05);6例神经损伤患者术后神经恢复Frankel分级有显著改善。3例保守治疗患者,1例治愈,1例随访无变化,1例症状进一步加重。结论手术治疗可显著改善椎体强化术后骨水泥移位患者的疼痛、脊柱功能障碍及神经损伤症状。Objective To analyze the clinical efficacy of treatment of cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures.Methods A retrospective study was conducted to analyze the data of 13 patients who had been treated at Department of Orthopaedics,The First Affiliated Hospital of Soochow University for cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures from July 2013 to July 2022.There were 4 males and 9 females,with an average age of(76.5±8.6)years and a T value of bone mineral density of-3.3±0.6.By the CT and MRI features of cement dislodgement,their conditions fell in 4 types:cement loosening in situ(4 cases),anterior cement moving(6 cases),anterior cement moving with posterior bone mass moving(2 cases),and posterior cement moving(1 case).They were treated by percutaneous vertebroplasty(3 cases),pedicle screw fixation combined with bone graft fusion and decompression(7 cases),and conservative therapy(3 cases).The curative effects for surgical patients were evaluated by comparing their visual analogue scale(VAS),Oswestry dysfunction index(ODI)and cobb angle of kyphosis at preoperation,1 week and 1 month postoperation,and the last follow-up,and Frankel grading for nerve injury as well.The curative effects for patients undergoing conservative treatment were evaluated by observing their symptoms.Results This cohort was followed up for 7(5,12)months after treatment.The VAS scores[5.0(4.0,5.0)points,3.0(2.0,3.0)points,and 3.0(2.0,3.0)points]in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value[8.5(8.0,9.0)points](P<0.05);the VAS scores at 1 month postoperation and the last follow-up were also significantly improved compared with that at 1 week postoperation(P<0.05),but there was no significant difference between the last follow-up and 1 month postoperation(P>0.05).The ODIs(50.6%±4.2%,37.8%±4.5%,and 29.3%±5.6%)in the 10 surgical patients at 1 week and 1 m

关 键 词：骨质疏松 压缩性骨折 骨水泥成形术 骨水泥移位 

分 类 号：R687.3[医药卫生—骨科学]