经皮穿刺椎体成形术治疗椎体骨质疏松性压缩骨折  

Treatment of osteoporotic spinal compression fractures with percutaneous vertebroplasty

作　　者：邓忠良[1] 陈富[1] 柯珍勇[1] 任广军[1] 黄朝梁[1] 安洪[2] 

机构地区：[1]重庆医科大学第二附属医院骨科,400010 [2]重庆医科大学第一附属医院骨科

出　　处：《中华创伤杂志》2003年第5期267-270,共4页Chinese Journal of Trauma

摘　　要：目的　通过X线透视下进行经皮穿刺椎体成形术治疗椎体骨质疏松性压缩骨折 ,探讨该技术的临床疗效及应用注意事项。　方法　本组 2 3例 ( 44个椎体 ) ,男 8例 ,女 15例 ;年龄 48～ 83岁 ,平均 6 9岁。脊柱骨折部位为T5～L3,其中胸椎 2 0个椎体 ,腰椎 2 4个椎体。采用C形臂X线机透视引导下于俯卧位或侧卧位进行经皮穿刺椎体成形术 ,注射聚甲基丙烯酸甲酯 (骨水泥 )。在术前、术后 2d、随访期进行疼痛视觉类比评分 (VAS)、活动能力评分和止痛药使用评分。随访时间 1～ 7个月 ,平均 3.1个月。　结果　 2 1例 40个椎体手术成功 ,2例 ( 4个椎体 )因不能耐受俯卧位而手术失败。骨水泥注射量 1.0～ 8.0ml 椎体。VAS术前 ( 7.5± 1.2 ) ,术后 2d ( 2 .8± 1.0 )较术前显著下降 (P <0 .0 0 1) ;随访时为 2 .3± 0 .9,比术后 2d又略有下降。活动能力评分 ,术后 2d ( 1.6± 0 .3)较术前 ( 2 .3± 0 .8)明显改善 (P <0 .0 5 ) ;随访时为 1.4± 0 .4,行动能力进一步改善。止痛药使用评分 ,术后 2d ( 0 .6± 0 .6 )较术前 ( 2 .2± 0 .5 )显著改善 (P <0 .0 1) ;随访时为 0 .8± 0 .6 ,与术后比较无显著变化。　结论　经皮穿刺椎体成形术是治疗椎体骨质疏松性压缩骨折的有效微创技术 。Objective To evaluate the curative effect and problems of X-ray fluoroscopy guided percutaneous vertebroplasty (PVP) in treating osteoporotic spinal compression fractures. Methods Twenty-four patients (15 females and 8 males) with 44 vertebral compression fractures underwent PVP. They were average 69 years of age (48-83 years). The fracture segment was within T 5-L 3 (20 thoracical vertebrae, 24 lumbar vertebrae). Under the guidance of C-arm fluoroscopy, bone marrow biopsy needle was inserted percutaneously via transpedicular way into the fractured vertebrae. Polymethylmethacrylate (PMMA) was then injected into the fractured vertebrae. Vasual analogue scale (VAS), mobility and analgesic usage were evaluated 2 days before and after PVP and in the follow-up period. Results PVP was successful in 21 cases (40 vertebrae ), but failed in 2 cases (4 vertebrae) due to weak position endurance. The volume of PMMA injected was 1.0-8.0 ml per vertebrae. The average follow-up period was 3.1 months (1-7 months). VAS was sharply decreased from pre-PVP 7.5±1.2 to 2.8±1.0 at day 2 after PVP (P<0.001). It decreased slightly to 2.3± 0.9 during the follow-up period at day 2 after operation. Scale of patient's mobility was increased from pre-PVP 2.3± 0.8 to 1.6± 0.3 at day 2 after PVP with a significant difference (P< 0.05). It was 1.4± 0.4 during the follow-up period and the mobility improved further. Scale of analgesic usage changed from 2.2± 0.5 before PVP to 0.6± 0.6 2 days after PVP with a significant difference (P< 0.01), and was 0.8± 0.6 during the follow-up period without significant difference compared with post PVP. Conclusions PVP is an effective mini-invasive technique for osteoporotic spinal compression fractures and can be accomplished safely with a C-arm single-plane fluoroscopy in most cases.

关 键 词：骨质疏松 脊椎骨折 经皮穿刺椎体成形术 聚甲基丙烯酸甲酯 X线机透视监视 

分 类 号：R687.3[医药卫生—骨科学]