PVP治疗老年骨质疏松性椎体非压缩性骨折的疗效观察

[目的]提出老年骨质疏松性椎体非压缩性骨折概念的初步设想,探讨经皮椎体成形术(PVP)治疗老年骨质疏松性椎体非压缩性骨折的疗效.[方法]选取老年骨质疏松性椎体非压缩性骨折患者57例(共74节),根据治疗方式分为两组,观察组31例(42节)给予PVP治疗,对照组26例(32节)给予保守治疗.采用下腰痛疗效结果评分表LBOS评估疼痛程度和生活质量,同时随访观察病椎椎体形态学变化.[结果]观察组42节椎体穿刺全部成功,无严重并发症发生.观察组31例患者比较治疗前后疼痛程度和生活质量,有显著性差异(P＜0.05).治疗后1周,1、6、12个月患者疼痛程度和生活质量观察组和对照组比较,均有显著性差异(P＜0.05).治疗后1周,1、6个月两组患者病椎高度丢失比较,无显著性差异(P＞0.05),治疗后12个月对照组病椎高度丢失显著高于观察组,有显著性差异(P＜0.05).[结论] PVP治疗老年骨质疏松性椎体非压缩性骨折,能迅速缓解疼痛,提高患者生活质量,显著预防椎体的塌陷,防止脊柱畸形的发生.     

保守疗法和椎体成形术治疗骨质疏松性椎体压缩骨折的系统评价

[目的]评价保守疗法和经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效.[方法]全面收集保守疗法和PVP治疗骨质疏松性椎体压缩骨折的随机对照研究,在严格文献质量评价的基础上,进行系统评价.[结果]共纳入4篇RCT,共计285例患者.在减轻疼痛方面,经皮椎体成形术组在术后ld、2周均优于保守组.在再骨折和邻椎骨折方面,尚不能得出确切结论.[结论]经皮椎体成形术和保守疗法均是治疗骨质疏松性椎体压缩骨折的有效治疗方法,近期疼痛缓解情况经皮椎体成形术组优于保守组,再骨折的评价缺乏足够的证据,尚需更多设计严谨的临床试验证实.     

应用经皮椎体成形术治疗骨质疏松性椎体骨折的研究

目的 探讨椎体成形术（PVP）在治疗骨质疏松性椎体压缩性骨折（OVCF）中的作用.方法 31例骨质疏松性压缩性骨折患者接受了椎体成形术,患者均有背部疼痛.在X线透视引导下,经单侧或双侧椎弓根入路行PVP,每个椎体注入骨水泥量为3～8 ml,平均6.0 ml,完成46个椎体成形术.术后患者随访1～18个月.结果 31例中绝大多数患者术后6 h～2 d疼痛明显缓解或消失.结论 椎体成形术为骨质疏松压缩性骨折经保守治疗无效患者提供了一种安全、微创、有效的治疗方法.     

经皮球囊扩张式椎体成形术治疗骨质疏松性椎体压缩骨折疗效研究

[目的]探讨经皮球囊扩张式椎体成形术治疗骨质疏松性椎体压缩骨折疗效研究.[方法]本院自2009年3月～2011年9月收治骨质疏松性椎体压缩骨折151例,手术组(行经皮球囊扩张式椎体成形术)69例,非手术组82例,经过随访术后48 h,1周,3个月,比较手术组与非手术组疗效.[结果]2组治疗效果比较差异有统计学意义(P＜0.05).手术组与非手术组比较症状缓解时间早,下床活动时间早,住院时间明显缩短.椎体成形组无1例发生并发症.非手术组有3例发生并发症,其中肺部感染2例,尿路感染1例.[结论]经皮椎体成形术是一种简单、微创、安全有效的治疗方法.     

经皮椎体成形术联合鲑鱼降钙素治疗骨质疏松椎体压缩性骨折的临床观察

目的通过对比研究,观察经皮椎体成形术联合密盖息治疗骨质疏松性椎体压缩骨折的疗效。方法 2008年2月至2011年1月,我们将脊柱压缩性骨折行PVP手术患者随机分成两组,治疗组在术后当日予以肌注鲑鱼降钙素,治疗3周后改用鼻喷剂,连续使用至少3个月;观察组单纯予以椎体成形术,分别在术前,术后1周,1月,3月以及6月采用VAS评分以及Barthel指数来评估两组治疗效果。结果两组患者均在术后疼痛均有明显的缓解,但是相对于观察组,治疗组在术后1月,3月,以及6月疼痛缓解以及生活质量提高更为明显,随着随访时间的延长,这种差别越来越明显。结论椎体成形术结合鲑鱼降钙素治疗骨质疏松性椎体压缩性骨折更能缓解患者的疼痛,提高患者的生活质量,值得临床推广。     

椎体成形术治疗骨质疏松椎体骨折并椎体内囊性变

[目的]探讨椎体成形术治疗骨质疏松椎体骨折并椎体内囊性变的特性和治疗效果.[方法]应用椎体成形术治疗骨质疏松椎体骨折并椎体内囊性变13例.根据骨质疏松和囊性变的程度决定充填骨水泥的剂量,并加入适当比例的异体骨粉.[结果]按照WHO疼痛缓解标准,CR(完全缓解)10例,PR(部分缓解)2例,MR(轻微缓解)1例.1例出现椎体周围少量骨水泥泄漏,无临床症状.1例手术后16 d发生下位椎体骨折,经过再次椎体成形术症状缓解,随访1年无复发,无再次骨折发生.[结论]椎体成形术治疗骨质疏松椎体骨折并椎体内囊性变是发生在高龄患者的特殊疾病,椎体成形术是治疗的首选,效果理想.但是在局部治疗的基础上要注意全身抗骨质疏松治疗和规范的康复训练,可以减少手术后并发症的发生.     

侧前路钢板固定结合注射性硫酸钙椎体成形术治疗骨质疏松性胸腰段多椎体压缩性骨折

[目的] 探讨侧前路钢板固定结合椎体成形术治疗骨质疏松性胸腰段多椎体压缩性骨折的效果.[方法] 对22例患有骨质疏松性多椎体压缩性骨折的病例,进行侧前路钢板固定结合注射性硫酸钙椎体成形术治疗.本组22例患者均有骨质疏松并胸腰段多椎体不同程度的压缩骨折,脊髓神经功能有不同程度损伤.术前常规行X线片、CT或MRI检查,术后X线片,观察脊柱稳定性、脊髓功能及慢性胸腰背痛恢复情况.[结果] 所有患者经术后随访植骨部位均达到骨性愈合,感觉、运动功能均有不同程度改善,胸背部疼痛或不适明显缓解,无复发,行椎体成形术的椎体无一渗漏,近期疗效均较满意.[结论] 侧前路钢板固定结合椎体成形术有利于同时解决胸腰椎后凸畸形对神经的压迫、脊柱的不稳定及骨质疏松椎体压缩骨折造成的顽固性胸腰背疼痛等问题.     

扶杖行走在pkp治疗骨质疏松性压缩性骨折后的作用

目的 评估pkp后扶杖行走在经皮椎体成型术治疗骨质疏松性压缩性骨折后的疗效.方法 2008年2月至2010年10月采用经皮后凸成形术治疗45例骨质疏松性压缩性骨折患者术前疼痛的部位、程度.手术后患者随机分为扶杖行走组(25例)和对照组(20例),将术后疼痛缓解时间、程度和活动能力评分分别采用视觉模拟法(VSA评分)和日常生活能力法(ADL评分)评分.随访时间3～24个月.平均12个月.结果 45例患者术后疼痛均明显减轻,而25例术后扶杖行走患者在术后(7±3.4)天恢复到伤前活动水平.对照组20例患者在术后(14±5.7)天恢复到伤前活动水平.两组差异有显著性(P<0.01).在随访时间内扶杖组无相邻椎体的再压缩、无疼痛复发.对照组有7例(29%)疼痛复发、伴有相邻椎体的压缩.结论 pkp治疗骨质疏松性压缩性骨折疼痛的有效方法,而术后扶杖行走,能促进患者的恢复,能增加pkp术后疗效.     

经皮椎体成形术治疗老年多节段骨质疏松性椎体压缩性骨折

[目的]探讨微创技术经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗老年多节段骨质疏松性椎体压缩骨折(osteoporosis vertebral compression fracture,OVCF)的疗效.[方法]回顾性分析本院2010年4月～2012年4月41例患者,明确诊断为老年多节段骨质疏松性椎体压缩性骨折,接受多节段的椎体成形术和规范抗骨质疏松药物治疗；年龄59 ～97岁,平均75.8岁；其中2个椎体压缩4例,3个椎体压缩29例,4个椎体压缩7例,5个椎体压缩1例.在X线片上分别测量术前、术后椎体前缘、后缘高度及术后后凸畸形纠正程度.术前、术后临床所见及随访结果均采用Oswestry功能障碍指数和疼痛视觉模拟评分进行评定.[结果]41例在术后腰背部疼痛基本消失,24h后均离床活动,椎体高度恢复可,后凸畸形矫正0.5° ～5.7°,平均2.83°.随访3～35个月,平均24.8个月,患者无诉明显不适,X线片示椎体高度未见明显丢失,未出现严重并发症.术后3个月及最后随访时Oswestry 功能障碍指数和疼痛视觉模拟VAS评分均较术前有明显改善(P＜0.05),有显著统计学意义.[结论]对老年多节段骨质疏松性脊柱骨折的患者,采用微创技术经皮椎体成形术治疗能取得满意的疗效.     

甲状旁腺素对经皮椎体成形术早期疗效的影响

[目的]探索甲状旁腺激素特立帕肽(TPTD)对骨质疏松性椎体压缩性骨折经皮椎体成形术(PVP)后早期疗效的影响。[方法] 2019年1月～2019年6月,70例骨质疏松性椎体压缩性骨折患者纳入本研究,依据医患沟通结果将患者分为两组。两组患者均接受PVP术,术后30例患者接受TPTD治疗,而40例患者未接受TPTD治疗。比较两组患者术后早期临床、骨密度和影像资料。[结果]随时间推移,两组患者VAS和ODI评分均显著减少(P0.05)。术前、术后1周和术后3个月,两组间VAS和ODI评分的差异均无统计学意义(P0.05),但是,术后6个月TPTD组的VAS和ODI评分显著低于对照组(P0.05)。随时间推移,TPTD组骨密度显著增加(P0.05),而对照组骨密度无显著改变(P0.05);术后6个月时,TPTD组骨密度显著大于对照组(P0.05)。影像显示,TPTD组再骨折2例,而对照组共发生再骨折11例,差异有统计学意义(P0.05)。[结论]骨质疏松性椎体压缩性骨折椎体成形术后使用甲状旁腺激素能够更有效的缓解疼痛、改善生活功能,并且能够增加骨密度,降低再骨折风险。     

双侧双平面与单侧经椎弓根椎体成形术疗效比较

[目的]比较双侧双平面与单侧经椎弓根椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效.[方法]2005年10月～2009年6月,60例(71节)骨质疏松性椎体压缩性骨折患者,在C型臂X线机或(和)CT引导下,双侧双平面或单侧经椎弓根向病椎内穿针并注入骨水泥聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA).术后X线片和CT观察骨水泥的分布和渗漏情况,采用椎体高度恢复率、椎体后凸Cobb角、VAS评分及ODI指数进行手术疗效比较,并观察有无并发症发生.[结果]71节60例骨质疏松性椎体压缩性骨折中,36节椎体行双侧双平面经椎弓根入路、35节行单侧经椎弓根人路经皮椎体成形术.术后1周、1年时,两组椎体高度恢复率、椎体后凸Cobb角、VAS评分及ODI指数较术前均有改善(P＜0.05).术后1周双侧双平面组与单侧组比较,椎体高度恢复率、椎体后凸Cobb角、VAS评分有显著性差异(P＜0.05),ODI指数及并发症发生率无显著性差异(P＞0.05).而术后1年时,VAS评分无显著性差异(P＞0.05).[结论]不同入路经椎弓根椎体成形术中,椎体高度恢复率、椎体后凸Cobb角、早期VAS评分的改善在双侧双平面组优于单侧组;并发症发生率、ODI指数、中远期VAS评分两组疗效相近.     

经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折

[目的]观察经皮椎体成形术（PVP）治疗疼痛性高龄骨质疏松性胸腰椎压缩骨折的临床疗效。[方法]在C臂X线透视监控下，以骨水泥（PMMA）为充填材料，经单侧或双侧椎弓根穿刺行PVP治疗6例、脊柱后凸成行术治疗2例。[结果]术中无骨水泥渗漏，术后患者疼痛明显缓解或消失，无1例出现严重并发症。[结论]PVP治疗疼痛性高龄骨质疏松性胸腰椎压缩性骨折是安全、有效、经济的。     

Transpedicular vertebroplasty after intravertebral cavity formation versus conservative treatment for osteoporotic burst fractures

Background contextThere has been no study regarding the comparison between vertebroplasty and conservative treatment for osteoporotic burst fracture.PurposeTo compare the results of vertebroplasty after intravertebral cavity formation with that of conservative treatment alone.Study designA case-control study.MethodsThe vertebroplasty group included 40 consecutive patients with primary osteoporotic burst fracture who underwent vertebroplasty using calcium phosphate cement, and the control group was made up of 40 patients given conservative treatment alone who were matched for age, gender, the injury level, and the type of fracture. Two groups of patients who had no neural deficit were prospectively examined. Clinical and radiological outcomes of these two groups were compared blindly. The authors do not report any conflict of interest in this study.Outcome measuresOutcome measures included visual analog scale (VAS) of the back pain, analgesic requirements, and mobility; in a lateral radiograph, the deformity index was measured and expressed as the ratio of the vertebral body (VB) height (sum of measurements at anterior, middle, and posterior regions of VB) to the longitudinal diameter of VB. Anteroposterior height comparison was expressed as the percentage of VB height at the anterior region compared with the height at the posterior region. Each recovery rate was calculated as a percentage by the formula: (value at the examination?value before treatment)/value before treatment×100.ResultsThe duration of follow-up was more than 12 months (mean; 22.5 months). The mean VAS at 12 months after injury was 2.17 cm in the conservative group and 0.61 cm in the vertebroplasty group (p=.0002). The mean duration of analgesic medication required was 157.2 days in the conservative group and 21.3 days in the vertebroplasty group (p=.0048). The mean deformity index at 12 months after injury was 1.66 in the vertebroplasty group and 1.38 in the control group, and the mean recovery rate was +7.3% and ?18.4%, respectively (p<.0001). Anteroposterior height comparison at 12 months after injury was 49.1% in the conservative group and 71.2% in the vertebroplasty group, and the mean recovery rate was ?26.4% and +30.1%, respectively (p<.0001). One fracture in the vertebroplasty group showed delayed union until 6 months after injury. In the control group, there were six delayed union including four pseudoarthroses at over 6 months after injury that caused leg pain and were treated by conservative therapy.ConclusionsWe conclude that vertebroplasty after intravertebral cavity formation provided a better clinical and radiological result than conservative treatment for osteoporotic burst fracture.     

Clinical evaluation of vertebroplasty for multiple-level osteoporotic spinal compression fracture in the elderly

INTRODUCTION: Outstanding results have been achieved using vertebroplasty for the treatment of osteoporotic spinal compression fractures. However, few reports are available in the management of multiple-level compression fractures due to severe osteoporosis. This study prospectively evaluated the clinical and surgical outcomes of patients receiving vertebroplasty due to multiple-level osteoporotic spinal compression fractures. PATIENTS AND METHODS: Eighteen patients underwent more than four levels of vertebroplasty due to multiple-level osteoporotic spinal compression fracture. All patients received a preoperative magnetic resonance imaging (MRI) check-up to determine which level needed vertebroplasty. Detailed evaluations were made in accordance with the patients' clinical tracking, pre- and postoperative daily activities, Denis pain scale, and Roland-Morris score. RESULTS: After an average follow-up period of 36 months, the group receiving multiple-level vertebroplasty showed significant improvement, as registered on the Denis pain scale, Roland-Morris score, and in the activity of daily living. No major complications occurred during operation or postoperation, except one patient who expired due to suffocation at the rehabilitation center 3 weeks after vertebroplasty. CONCLUSIONS: The use of vertebroplasty with cement to treat multiple-level osteoporotic spinal compression fractures in the elderly does have value, and brings good results to patients which were previously unimaginable. Preoperative MRI to evaluate the non-union levels and determine which levels needed vertebroplasty is very important.     

Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study

Summary  

Bone pain and spinal axial deformity are major concerns in aged patients suffering from osteoporotic vertebral compression fracture (VCF). Pain can be relieved by vertebroplasty or kyphoplasty procedures, in which the compressed vertebral body is filled with substitutes. We randomly assigned 100 patients with osteoporotic compression fracture at the thoraco-lumbar (T-L) junction into two groups: vertebroplasty and kyphoplasty; we used polymethylmethacrylate (PMMA) as the bone filler. Pain before and after treatment was assessed with visual analog scale (VAS) scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images. More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.56 ± 0.62 vs. 4.91 ± 0.65 mL, p < 0.001). Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001). VAS pain scores did not differ significantly between the treatment groups. The duration of follow-up was 6 months. Two patients in the kyphoplasty group had an adjacent segment fracture. In terms of clinical outcome there was little difference between the treatment groups. Thus, owing to the higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs.     

经皮椎体成形术在骨质疏松椎体压缩性骨折治疗中的应用

目的 评估经皮椎体成形术在治疗骨质疏松椎体压缩性骨折中的疗效。方法 对19例22个骨质疏松椎体压缩性骨折患行经皮椎体成形术。结果 所有患经3～12个月的随访，疗效满意，其中优4例(21％)，良12例(63％)，可3例(19％)。术后5例患需阶段性口服药物缓解疼痛，2例骨水泥外溢，但未造成不良后果。结论 经皮椎体成形术是一种微创治疗方法，用于治疗骨质疏松椎体压缩性骨折有明显疗效，可在短时间内解除患痛苦，恢复正常活动。     

人工股骨头置换与动力髋螺钉治疗老年股骨颈基底部骨折并骨质疏松的疗效比较

目的 分析人工股骨头置换术(artificial femoral head replacement,AFHR)与动力髋螺钉(dynamic hip screw,DHS)内固定在治疗老年股骨颈基底部骨折并骨质疏松患者中的应用,对比两者在疗效上的差异.方法 回顾性分析我科2008年6月至2014年6月期间收治的47例老年骨质疏松股骨颈基底部骨折患者,按照手术方式进行分组:AFHR组22例,DHS组25例.详细记录并比较两组患者术中的出血量、术后引流量、手术时间、手术前后血红蛋白量以及术后第6、12个月髋关节功能的Harris 评分.根据骨盆平片及患髋侧位X线片观察股骨假体及钢板周围骨质的变化情况.结果 AFHR组的术中出血量、术后引流量、手术时间、手术前后血红蛋白量以及术后髋关节功能Harris评分优于DHS组,差异有统计学意义(P＜0.05).结论 对于合并有骨质疏松的股骨颈基底部骨折的老年患者,AFHR手术时间短、出血少、近期髋关节功能恢复良好,临床效果较DHS更具优势.     

椎弓根内固定结合椎体成形术治疗胸腰椎体转移瘤临床研究

[目的]观察椎弓根内固定术结合直视下椎体成形术治疗胸腰椎体转移性肿瘤的临床疗效.[方法]对30例胸腰椎转移性肿瘤的患者采用后路椎弓根内固定术结合直视下骨水泥椎体成形术,共治疗32个椎体,患者均有顽固性腰痛及下肢神经症状,部分患者行椎管减压.随访观察临床疗效.[结果]本组32个椎体全部穿刺成功,骨水泥渗漏3例,均未出现神经症状,患者术后1周,3、6、12个月各时间点VAS评分疼痛缓解率＞80％,活动能力和生活质量评分明显改善,随访12个月期间生存患者有24例,胸腰椎疼痛未见明显加重,病椎高度未见明显压缩,1例肺癌患者术后10个月出现肿瘤复发,其余患者手术椎体未出现新的病理性骨折及神经症状加重.[结论]椎弓根内固定结合椎体成形术治疗胸腰椎转移性恶性肿瘤能明显改善患者生存质量,预防病理性骨折进一步塌陷,疗效满意,是综合治疗胸腰椎肿瘤的重要治疗方法之一.     

两种髓内钉固定骨质疏松股骨粗隆间骨折的比较

[目的]比较股骨近端抗旋转髓内钉(proximal femoral nail anti-rotation,PFNA)与InterTAN髓内钉联合抗骨质疏松治疗骨质疏松性粗隆间骨折的临床疗效.[方法]回顾性分析2016年1月-2019年1月苏州大学第一附属医院骨科诊治的骨质疏松性股骨粗隆间骨折的老年患者的临床资料,共10...     

经皮椎体后凸成形术中单双侧经椎弓根穿刺路径的选择

[目的]探讨骨质疏松性椎体骨折经皮后凸成形术中单双侧经椎弓根入路的选择.[方法]36例骨质疏松性椎体压缩性骨折患者,术前根据伤椎椎弓根CT层面经椎弓根进针线确定单、双侧入路,采用球囊或Sky扩张器行椎体后凸成形术.术前、术后1周及1年时摄x线片测量椎体高度恢复率、后凸Cobb's角及疼痛视觉类比评分(VAS).[结果]36例50节骨质疏松性椎体压缩性骨折中,44节椎体行经皮椎体后凸成形术.术前计划单侧经椎弓根入路32节椎体,双侧经椎弓根入路12节椎体;术中单侧入路22节椎体,双侧入路22节椎体,其中10节椎体由单侧入路改为双侧入路.术后1周及1年时VAS评分、椎体后凸Cobb's角及椎体高度恢复率较术前均改善(P<0.05).但单侧组与双侧组比较,上述参数无显著性差异(P>0.05).[结论]根据术前伤椎CT椎弓根进针线可以初步确定单、双侧椎弓根穿刺路径.腰椎及大部分胸椎可以采用单侧经椎弓根入路行经皮椎体后凸成形术,部分下胸椎骨质疏松性骨折患者需行双侧经椎弓根入路.