机构地区:[1]西安交通大学附属红会医院脊柱外科,西安710054
出 处:《中华创伤杂志》2024年第6期516-521,共6页Chinese Journal of Trauma
基 金:国家自然科学基金重点项目(81830077)。
摘 要:目的探讨二次靶向穿刺经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCF)椎体强化术后伤椎再骨折的疗效。方法采用回顾性病例系列研究分析2019年1月至2022年1月西安交通大学附属红会医院收治的25例OVCF椎体强化术后伤椎再骨折患者的临床资料,其中男10例,女15例;年龄62~86岁[(73.8±5.2)岁]。骨折节段:T101例,T112例,T1210例,L110例,L22例。均采用二次靶向穿刺PVP治疗。记录手术时间、骨水泥注入量;比较术前和术后1 d、6个月及末次随访时腰背视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎体指数(VBI)及椎体后凸角(KA);末次随访时采用Odom标准评估患者手术效果;观察术中骨水泥渗漏情况和随访期间的新发椎体骨折情况。结果患者均获随访23~59个月[(36.8±7.6)个月]。手术时间为35~60 min[(42.6±5.2)min],骨水泥注入量为3~5 ml[(3.6±0.8)ml]。术后1 d、6个月及末次随访时腰背VAS分别为3.1(2.0,4.0)分、1.7(1.0,2.0)分、0.6(0.0,1.0)分,均低于术前的7.6(7.0,9.0)分(P<0.01),并随随访时间延长进一步降低(P<0.01)。术后1 d、6个月及末次随访时ODI分别为(49.5±5.9)%、(28.5±4.6)%、(19.2±4.8)%,均低于术前的(78.8±6.8)%(P<0.01),并随随访时间延长进一步降低(P<0.01)。术后1 d、6个月及末次随访时VBI分别为(76.6±4.5)%、(76.3±4.0)%、(76.1±3.8)%,均高于术前的(58.9±5.8)%(P<0.01),术后1 d、6个月及末次随访时差异均无统计学意义(P>0.05)。术后1 d、6个月及末次随访时KA分别为(12.4±2.7)°、(12.6±2.5)°、(12.8±2.9)°,均低于术前的(20.8±3.6)°(P<0.01),术后1 d、6个月及末次随访时差异均无统计学意义(P>0.05)。末次随访时Odom标准评定结果:优20例,良5例,优良率为100%。术中3例(12%)发生无症状性骨水泥渗漏,其中2例渗漏至椎间隙,1例渗漏至椎旁。随访期间,未发生邻近椎体或其他椎体骨折。结论对于OVCF椎体强化术后伤椎再骨折患者,二次靶向穿Objective To explore the efficacy of secondary targeted percutaneous vertebroplasty(PVP)for the treatment of refracture of injured vertebrae after vertebral augmentation for osteoporotic vertebral compression fracture(OVCF).Methods A retrospective case series study was performed on the clinical data of 25 patients with refracture of injured vertebrae after vertebral augmentation for OVCF admitted to Honghui Hospital,Xi′an Jiaotong University from January 2019 to January 2022,including 10 males and 15 females,aged 62-86 years[(73.8±5.2)years].The fractured segments involved T10 in 1 patient,T11 in 2,T12 in 10,L1 in 10 and L2 in 2.All the patients were treated with secondary targeted PVP.The operation time and the amount of bone cement injected were recorded.The visual analogue scale(VAS)of lower back,Oswestry disability index(ODI),vertebral body index(VBI)and kyphotic angle(KA)were compared before surgery,at 1 day,6 months after surgery and at the last follow-up.Odom criteria were used to evaluate the efficacy of the surgical procedure at the last follow-up.The intraoperative bone cement leakage and new vertebrae fracture during follow-up were observed.Results All the patients were followed up for 23-59 months[(36.8±7.6)months].The operation time was 35-60 minutes[(42.6±5.2)minutes],with the amount of bone cement injected for 3-5 ml[(3.6±0.8)ml].The VAS scores of lower back at 1 day,6 months after surgery and at the last follow-up were 3.1(2.0,4.0)points,1.7(1.0,2.0)points and 0.6(0.0,1.0)points respectively,significantly lower than 7.6(7.0,9.0)points before surgery(P<0.01),and a statistically singnificant decrease was found over follow-up time(P<0.01).The ODI values at 1 day,6 months after surgery and at the last follow-up were(49.5±5.9)%,(28.5±4.6)%and(19.2±4.8)%respectively,significantly lower than(78.8±6.8)%before surgery(P<0.01),and a statistically singnificant decrease was found over follow-up time(P<0.01).The VBI values at 1 day,6 months after surgery and at the last follow-up were(76.6±4.5)%,(76
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