手法复位配合PVP治疗老年骨质疏松性椎体压缩骨折患者54例分析

[目的]探讨手法复位配合经皮椎体成形术(PVP)治疗老年骨质疏松性椎体压缩骨折患者的临床疗效。[方法]将108例老年骨质疏松性椎体压缩骨折患者随机分为2组,每组54例。PVP组给予PVP治疗,手法复位配合PVP组给予手法复位配合PVP治疗。治疗前后,观察两组疼痛视觉模拟评分(visual analogue scale,VAS)以及残疾功能障碍指数(ODI)评分、椎体前缘高度、伤椎Cobb角、骨水泥渗漏情况。[结果]治疗后,两组VAS、ODI评分显著降低(P<0.05),手法复位配合PVP组VAS、ODI评分分别为(2.40±0.90)、(23.60±3.70)显著低于PVP组的(3.10±0.60)、(29.80±2.90)(P<0.05);治疗后,两组椎体前缘高度均明显升高(P<0.05),手法复位配合PVP组椎体前缘高度为(28.10±1.30)mm显著高于PVP组的(23.40±2.00)mm(P<0.05);治疗后,两组伤椎Cobb角均显著降低(P<0.05),手法复位配合PVP组伤椎Cobb角(19.20±2.80)°显著低于PVP组(23.90±2.30)°(P<0.05);手法复位配合PVP组骨水泥渗漏率为11.11%,低于PVP组的18.51%。[结论]手法复位配合PVP治疗老年骨质疏松性椎体压缩骨折可有效恢复老年骨质疏松性椎体压缩骨折患者的椎体畸形,改善残疾功能障碍指数,并降低疼痛程度。     

手法复位在骨质疏松性椎体压缩骨折经皮椎体后凸成形术中的应用

[目的]评价手法复位在骨质疏松性椎体压缩骨折经皮椎体后凸成形术中的临床应用.[方法] 2009年1月～2012年6月行经皮椎体后凸成形术的骨质疏松性椎体压缩骨折患者65例随机分为治疗组和对照组,分析比较两组骨水泥外漏发生率及术后2d、术后3个月、末次随访时疼痛恢复情况、椎体高度和脊柱后凸角(Cobb角)的变化.[结果]所有患者均获得6 ～21个月随访,平均11.3个月.于术后2 d、术后3个月及末次随访时进行测量,治疗组VAS评分较术前分别降低(4.32±1.01)、(4.97±0.70)、(5.45±1.95),椎体高度分别增加(6±1.12) mm、(6+1.12) mm、(5.97±1.13) mm,后凸cobb角分别减小(12.48+2.06)°、(12.35±1.96)°、(12.29±1.90)°,有6个椎体发生骨水泥外漏,对照组VAS评分较术前分别降低(4.74±1.24)、(5.21±1.01)、(5.38±0.89),椎体高度分别增加(3.18±0.87) mm、(3.18±0.87) mm、(3.15±O.86) mm,后凸Cobb角分别减小(5.85±1.81)°、(5.59±1.73)°、(5.29±1.45)°,有8个椎体发生骨水泥外漏.术后2d、术后3个月及末次随访时治疗组椎体高度恢复及脊柱后凸畸形矫正均明显优于对照组(P＜0.01),VAS评分变化及骨水泥泄漏率差异无统计学意义(P＞0.05).[结论]手法复位应用于骨质疏松性椎体压缩骨折经皮椎体后凸成形术是安全有效的,可以更好的恢复椎体高度和纠正脊柱后凸畸形,不增加骨水泥泄露的发生率,也不影响术后疼痛的改善.     

闭合复位及撬拨法在椎体成形术中的应用

目的 探讨闭合复位及撬拨法在椎体成形术治疗骨质疏松性压缩骨折中椎体高度的恢复及后凸畸形矫正的效果.方法 2005年1月至2007年6月应用闭合复位及椎体成形术中经椎弓根用穿刺针撬拨塌陷的椎体终板治疗38例骨质疏松性压缩骨折患者,手术前后用视觉模拟评分及Oswestry功能障碍指数的变化来评价患者疼痛缓解和功能改善情况,参照Lee等方法观测病椎的高度和后凸畸形的改变以及骨水泥在椎体内的分布. 结果术后随访6～24个月,平均13.4个月.视觉模拟评分从术前平均(8.6±2.3)分降至术后平均(3.8±2.6)分,差异有统计学意义(P<0.05);Oswestry功能障碍指数指数从术前平均64.8%降至术后平均48.7%,差异有统计学意义(P<0.05).椎体前、中、后壁高度平均增加5.8mm、6.6mm、1.0mm,椎体后凸畸形矫正平均9.7°,椎体高度前、中、后壁恢复率平均为54.6%、58.1%、46.5%,手术前后差异均有统计学意义(P<0.05). 结论闭合复位结合椎体成形术中撬拨法是治疗骨质疏松性压缩骨折的有效方法.     

闭合复位经皮椎体成形术治疗骨质疏松性脊柱压缩性骨折(附62例报告)

目的探讨闭合复位下经皮椎体成形术(PVP)治疗骨质疏松性脊柱压缩性骨折的效果。方法对62例骨质疏松性脊柱压缩性骨折在C型臂X线透视下先行手法闭合复位,再进行PVP治疗。随访时进行疼痛视觉模拟评分(VAS)、计算椎体前后缘高度比值(Beck值)和脊柱后凸畸形Cobb角。结果骨水泥向椎体前方、侧方渗漏各2例,无椎体后方(椎管内)渗漏。术后12个月,VAS评分由术前(8.9±1.3)分降低至(2.5±1.4)分,Beck值由术前(32.3±5.7)升高至(68.5±5.6),Cobb角由术前(25.4±7.6)°,改善至(14.4±5.2)°。结论闭合复位下PVP是治疗骨质疏松性脊柱压缩性骨折的有效方法。     

闭合复位联合椎体成形术治疗骨质疏松性椎体压缩骨折

目的 探讨闭合复位联合椎体成形术治疗骨质疏松性椎体压缩骨折的效果.方法 应用闭合复位联合椎体成形术治疗49例骨质疏松性椎体压缩骨折,手术前后用视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)的变化来评价患者疼痛缓解和功能改善情况,测量病椎的高度和后凸畸形的改变以及骨水泥在椎体内的分布.结果 32例术后获得随访7～26个月.VAS评分从术前平均(9.2±3.1)分降至术后平均(4.2±2.5)分,ODI指数从术前平均71.4%降至术后平均43.3%,椎体前、中、后壁高度平均增加5.2、6.8、1.3 mm,椎体后凸畸形平均矫正10.2°,手术前后差异均有统计学意义(P<0.05).结论 闭合复位联合椎体成形术是治疗骨质疏松性椎体压缩骨折的有效方法.     

骨质疏松性椎体骨折不同复位程度椎体成形比较

[目的]评价骨折复位器不同复位高度联合经皮椎体成形术（percutaneous vertebroplasty, PVP）治疗骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fractures, OVCF）的疗效。[方法] 2020年1月—2021年12月本院收治的86例单节段OVCF患者,随机分为3组。所有患者均行仰卧位复位器复位后PVP术,其中,低复位组30例,复位器高度7～9 cm;中复位组29例,高度10～12 cm;高复位组27例,高度为13～15 cm。比较三组患者的围手术期、随访和影像资料。[结果]低复位组骨水泥注入量显著少于中复位组和高复位组[(3.4±0.9) ml vs (4.1±0.9) ml vs (3.9±1.0) ml, P=0.015],三组间骨水泥渗漏率差异无统计学意义（P>0.05）。所有患者均获随访12个月以上,随时间推移,三组患者术后VAS和ODI评分均显著降低（P<0.05）。术前至术后6个月,三组间VAS评分的差异无统计学意义（P>0.05）,所有相应时间点,三组间ODI评分差异无...     

自制脊柱撑开复位器治疗骨质疏松性椎体压缩骨折临床对照试验

目的：探讨自制脊柱撑开复位器治疗骨质疏松性椎体压缩骨折的临床效果。方法：采用随机数字表法随机分组，治疗组42例共56椎体，男14例，女28例，年龄50～69岁；对照组54例共68椎体，男19例，女35例，年龄51—75岁。均摄X线片和CT扫描，其中27例加行MR以排除肿瘤继发性骨折和陈旧性骨折，均确诊为骨质疏松脊柱压缩性骨折。CT扫描椎体后壁完整无椎管占位，均无脊髓神经损害症状。骨质疏松程度以L3X线骨小梁变化分级。治疗组应用脊柱牵引复位器经椎弓根向椎体注入骨水泥，对照组采用椎体成形术。用视觉模拟疼痛评分（VAS），参照Lee方法测量椎体高度压缩率和恢复率，计算骨水泥渗漏率。结果：治疗组平均随访2．5年，VAS评分治疗组由术前的平均（8．6-＋0．8）分降至平均（1．7±0．5）分，对照组由平均（8．5±0．4）分降至平均（3．5±1．4）分，术后评分两组比较，差异有统计学意义P〈0．05。治疗组术前、术后椎体前壁和中间高度压缩率差异有统计学意义（P〈0．05）。治疗组后凸角度恢复率71．8％，对照组恢复率37．8％，差异有统计学意义（P〈0．05）。治疗组无骨水泥渗漏，对照组渗漏率47％。疗效评定治疗组36例完全缓解，4例部分缓解，对照组43例完全缓解，3例部分缓解。两组差异有统计学意义，P〈0．05。结论：自制脊柱撑开复位器是一种能替代进口球囊的微创技术，可迅速止痛，恢复椎体高度且无骨水泥渗漏。     

经皮椎体后凸成形术椎体扩张器的临床应用和进展

近年来,经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）已被广泛应用于治疗骨质疏松椎体压缩性骨折。PKP技术通过球囊撑开器的撑开扩张作用,在椎体内形成一空腔,使高黏稠度骨水泥在较低压力下注入椎体,骨水泥渗漏率明显降低,取得更好的治疗效果。手术不仅能迅速缓解患者疼痛,同时又能恢复椎体高度使骨折复位,矫正后突畸形。椎体撑开器的运用成为众多研究者和手术医师关注的焦点。     

经皮椎体后凸成形术结合体外复位器治疗Kümmell病

目的探讨经皮椎体后凸成形术(PKP)结合体外复位器治疗Kümmell病的临床应用价值。方法2013年10月—2017年12月,采用PKP结合体外复位器治疗Kümmell病患者40例(共40个椎体)。记录手术前后疼痛视觉模拟量表(VAS)评分、伤椎容积、矢状面Cobb角、术中骨水泥注射量、术后骨水泥渗漏率,并观察术后并发症发生情况。结果所有手术顺利完成,无术中死亡,无神经根及脊髓损伤,无肺栓塞及心脑血管系统急性反应。所有患者随访6~24个月,平均13个月。患者术后VAS评分、伤椎容积和Cobb角均较术前显著改善,差异有统计学意义(P<0.05)。术中骨水泥注射量5.5~7.5(6.5±0.8)mL,术后11个椎体发生骨水泥渗漏,渗漏率27.5%,均为椎间隙内渗漏,椎弓根、椎管结构完整。结论对于Kümmell病患者,PKP结合体外复位器能有效止痛,并具有优越的生物力学复位性能,可有效恢复脊柱生理曲度和力学强度,降低骨水泥渗漏率,克服了单纯球囊扩张椎体高度恢复不足的缺陷,提高了手术的疗效。     

手法复位联合PVP治疗骨质疏松性椎体重度压缩骨折的影像学分析

目的比较手法复位联合经皮椎体成形术(Percutaneous vertebroplasty,PVP)与单纯PVP治疗骨质疏松性椎体重度压缩骨折的临床疗效。方法回顾性分析自2015-01—2017-06诊治的143例骨质疏松性椎体重度压缩骨折,73例采用手法复位联合PVP治疗(观察组),70例单纯采用PVP治疗(对照组),比较2组术后即刻脊柱后凸角、伤椎楔形角、伤椎前缘高度、中段高度、后缘高度、后凸角复位百分比、楔形角复位百分比、椎体前缘高度恢复百分比、椎体中段高度恢复百分比、椎体后缘高度恢复百分比、骨水泥渗漏情况,比较2组术后1 d疼痛VAS评分、ODI指数。结果 143例均顺利完成手术并获得至少12个月的随访。术后即刻观察组脊柱后凸角、伤椎楔形角较对照组小,伤椎前缘与中段高度较对照组大,差异有统计学意义(P<0.05)。2组伤椎后缘高度比较差异无统计学意义(P>0.05);观察组后凸角复位百分比、楔形角恢复百分比、椎体前缘高度恢复百分比较对照组高,差异有统计学意义(P<0.05);2组椎体中段、椎体后缘高度恢复百分比、骨水泥渗漏情况、术后1 d疼痛VAS评分与ODI指数比较差异无统计学意义(P>0.05)。观察组骨水泥注射量较对照组大,差异有统计学意义(P<0.05)。结论手法复位联合PVP治疗骨质疏松性椎体重度压缩骨折较单纯采用PVP治疗具有良好的骨折椎体复位效果,但术中需注入更多的骨水泥。     

镁与骨质疏松

镁离子是人体内重要的阳离子,参与多种生理活动。。镁缺乏易导致骨质疏松,适当补充镁可以增强骨密度,改善骨组织形态,缓解骨质疏松等症状。此外,可降解金属镁及其镁合金因其在骨折和骨缺损治疗中的潜在优势,有望在未来的骨外科治疗中得到广泛应用。然而镁离子促进成骨细胞增殖和分化,促进骨骼生长作用机制仍待深入研究。本文综述了镁在骨代谢中的作用及相关分子机制的最新研究进展。     

Epidemiology of osteoporosis

Osteoporosis represents a major and increasing public health problem with the aging of population. Major clinical consequences and economic burden of the disease are fractures. Many risk factors are associated with the fractures including low bone mass, hormonal disorders, personal and family history of fractures, low body weight, use of certain drugs (e.g. glucocorticoids), cigarette smoking, elevated intake of alchohol, low physical activity, insufficient level of vitamin D and low intake of calcium. This epidemiological review describes frequency, importance of risk factors and impact of osteoporosis and osteoporotic fractures. Objective measures of bone mineral density along with clinical assessment of risk factors can help identify patients who will benefit from prevention and intervention efforts and eventually reduce the morbidity and mortality associated with osteoporosis-related fractures.     

Genetics of osteoporosis

Osteoporosis is a disease affecting mainly women but also an increasing number of men. The destruction of the bone microarchitecture and the reduction of bone mass lead to increased fragility and pathologic bone fractures. Family studies and twin studies have shown that peak bone mass, mechanical strength, and physiological bone turnover are subject to genetic control. Vitamin D receptor polymorphisms were one of the first genetic factors suggested to influence bone phenotype, although their impact on bone metabolism was initially overestimated. Meanwhile, polymorphisms in numerous other genes such as collagen I alpha 1, estrogen receptor, transforming growth factor beta (TGF-beta), interleukin-1, interleukin-6, calcitonin, parathyroid hormone, and apolipoprotein E have been found to be associated with bone mineral density. In the interpretation of genetic findings, genetic differences between different ethnic groups, environmental factors such as calcium intake, vitamin D status, hormonal status, body size, and total body bone mineral density have to be considered. Understanding the molecular physiology of the genes described in this article and all genes influencing bone metabolism identified in the future will enable us to identify persons at risk for osteoporosis and to develop more specific therapies.     

Prevention of osteoporosis

Osteoporosis is a major public health problem, and its prevalence may be increasing. Unfortunately, once spinal fractures occur, the treatment of osteoporosis is less than satisfactory. Prevention is thus the preferred approach. To initiate a prevention program would require identification of those at greatest risk. Usually, small, thin, white or Asian women who have had an early menopause (or oophorectomy) can be considered most at risk. Other factors may include low calcium intake, inactivity, alcohol and cigarette consumption, and nulliparity. For those clinically thought to be at greatest risk, bone mass measurements may be used to more clearly define the population for whom preventive therapy would be indicated. Prevention consists of dietary and lifestyle alterations, primarily increases in calcium intake and exercise, and the judicious use of estrogens. Estrogen therapy remains the single most effective method for prevention of bone loss.     

Treatment of osteoporosis

The objectives of the treatment of osteoporosis are to decrease the morbidity associated with the disease. An important aspect of treatment is to manipulate bone loss of the untreated disorded disorder to decrease the risk of future fracture. Many of the interventions that are used in osteoporosis decrease the rate of bone remodelling, and this is the mechanism whereby they decrease the rate of bone loss. Such interventions include pharmacological doses of calcium, the calcitonins and the bisphophonates. The gonadal steroids have added effects in that, not only do they decrease bone remodelling, but they also correct the imbalance at each remodelling site. This means that bone loss is prevented. The ability of these agents to prevent or decrease bone loss makes them ideal candidates for the prevention of osteoporosis but, as currently formulated, cannot restore skeletal mass once this has been lost in established osteoporosis. There are a number of other interventions and cyclical regimes which appear to have greater anabolic effects on the skeleton. Of these, the greatest interest has been shown in fluoride which has marked effects on trabecular bone mass by altering the balance between the amount resorbed and formed at each remodelling site. A major problem in the application of anabolic regimes is that several forms of osteoporosis, including postmenopausal osteoporosis, are associated with loss of trabecular elements in spongy bone. This decreases the strength of bone out of proportion to the amount of bone lost. Anabolic regimens such as fluoride increase trabecular width but do not restore skeletal connectivity, so that despite the restoration of skeletal mass, strength is not proportionaly increased. The ultimate indicator of osteoporosis treatments is their effect on fracture frequency. A great deal of evidence indicates that early intervention, i.e. shortly after menopause or in later life, is associated with the maintenance of bone mass and a decrease in the future frequency.