经皮椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折的疗效观察

目的探讨经皮椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析自2015-04—2020-03诊治的61例骨质疏松性椎体压缩骨折,29例采用经皮椎体成形术联合唑来膦酸治疗(观察组),32例单纯采用经皮椎体成形术治疗(对照组)。比较2组骨折愈合时间以及术后1年疼痛VAS评分、ODI指数、椎体前缘高度、伤椎Cobb角、腰椎骨密度值、髋部骨密度值。结果 2组均顺利完成手术并获得至少1年的随访。2组术后均未出现神经根压迫、感染、骨水泥渗漏、肺栓塞及脊髓功能障碍等并发症。2组骨折愈合时间比较差异无统计学意义(P0.05)。术后1年2组疼痛VAS评分、ODI指数、椎体前缘高度、伤椎Cobb角比较差异无统计学意义(P0.05);观察组腰椎骨密度值与髋部骨密度值较对照组高,差异有统计学意义(P0.05)。结论经皮椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折可以取得满意的临床疗效,患者术后骨密度值恢复满意。     

唑来膦酸联合瑞舒伐他汀辅助治疗老年骨质疏松性椎体压缩性骨折临床观察

目的探讨唑来膦酸联合瑞舒伐他汀辅助治疗老年骨质疏松椎体压缩性骨折的临床观察。方法 108例老年压缩性骨折女性患者随机分为对照组和治疗组。两组患者均进行给予PVP结合抗骨质疏松药物唑来膦酸治疗,治疗组在术后加用瑞舒伐他汀治疗。分别在治疗前后12个月评定两组患者视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数评分(ODI);治疗前后12个月检测患者骨密度及骨特异性碱性磷酸酶(BAP)和I型前胶原肽(CTX);观察两组患者药品不良反应及邻近椎体再骨折发生情况。结果治疗后12个月两组患者VAS与ODI评分均较治疗前有明显改善(P0.05),且治疗组患者评分明显低于对照组(P0.05)。治疗后12个月,治疗组患者骨密度较治疗前显著改善(P0.05),血清BAP和CTX较术前明显下降(P0.05),且均明显优于对照组(P0.05)。两组药品不良反应发生率比较,差异无统计学意义(P0.05);而邻近椎体再骨折发生率治疗组相对对照组明显降低,比较有统计学意义(P0.05)。结论唑来膦酸联合瑞舒伐他汀治疗老年骨质疏松椎体压缩性骨折疗效较好,能增加患者骨密度,降低邻近椎体再骨折发生率,降低骨吸收水平,安全性好。     

唑来膦酸联合维生素K2在经皮椎体成形术治疗多节段骨质疏松性椎体压缩骨折中的临床应用

目的:探究唑来膦酸联合维生素K2方案在经皮椎体成形术治疗多节段骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)中的临床应用效果。方法:选取自2014年1月至2017年1月收治入脊柱外科的364例OVCFs患者为研究对象,根据术后是否采用唑来膦酸联合维生素K2抗骨质疏松治疗方案分成两组(对照组和试验组)。其中对照组257例患者采用碳酸钙和维生素D方案,试验组107例患者在对照组基础上加用唑来膦酸联合维生素K2方案。统计并比较两组患者的疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI),术前和术后腰椎和股骨近端骨密度,责任椎体的椎高比,椎体Cobb角,骨代谢相关血清学指标,以及术后发热、头晕、骨关节痛、肌肉软组织疼痛和相邻椎体再骨折等不良反应发生率。结果:两组患者一般资料差异无统计学意义(P0.05)。两组患者术前和术后24 h VAS评分比较差异无统计学意义(P0.05);术后1、3个月和术后1年的VAS评分比较,试验组明显低于对照组(P0.05)。两组术前ODI比较差异无统计学意义(P0.05);术后24 h、3个月、1年ODI比较,试验组均明显低于对照组(P0.05)。两组术前责任椎体的椎高比和Cobb角差异无统计学意义(P0.05),术后3个月、1年责任椎体的椎高比比较,试验组明显高于对照组(P0.05)。术后3个月和术后1年Cobb角比较,试验组明显低于对照组(P0.05)。两组术前腰椎骨密度和股骨近端骨密度比较差异无统计学意义(P0.05);术后3个月、1年的腰椎骨密度和股骨近端骨密度比较,试验组明显低于对照组(P0.05)。试验组和对照组骨代谢标志物如总Ⅰ型胶原氨基端延长肽、β-胶原降解产物和25羟基维生素D术前含量比较差异无统计学意义(P0.05);术后1年两组总Ⅰ型胶原氨基端延长肽、β-胶原降解产物比较,试验组明显低于对照组(P0.05)。试验组术后1年25羟基维生素D明显高于对照组(P0.05)。试验组术后并发症如发热、头晕、骨关节痛、肌肉软组织疼痛和相邻椎体再骨折等不良反应发生率明显低于对照组(P0.05)。结论:唑来膦酸注射液联合维生素K2方案可以用于OVCFs椎体成形术的抗骨质疏松治疗,疗效肯定,安全系数高,值得推广。     

唑来膦酸和特立帕肽对预防椎体成形术后再发骨折的疗效比较

目的比较唑来膦酸和特立帕肽对椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)术后再发骨折的影响。方法收集2016年6月到2017年6月在我院骨科接受PVP治疗且符合条件的女性患者共60例,其中40人在术后接受了唑来膦酸治疗(A组),20人在术后接受了特立帕肽治疗(B组),两组患者均给予维生素D和钙剂基础治疗。术前、术后6月、末次随访行骨代谢指标血清I型前胶原N末端前肽(PINP)和Ⅰ型胶原羧基端β降解产物(β-CTX)检测及骨密度检测,同时记录随访期间再发骨折不良事件。结果 A组患者术后6个月PINP和β-CTX值较术前显著下降(P0. 05),而末次随访时PINP较术后6月未见明显改变,β-CTX则进一步降低,差异具有统计学意义(P0. 05); A组患者术后6月和末次随访骨密度检测与术前相比虽有增长,但差异未见统计学意义(P0. 05)。B组患者术后6个月PINP和β-CTX值较术前显著上升,且其上升趋势可以维持到末次随访,与术前比较差异具有统计学意义(P0. 05); B组患者术后6个月骨密度较术前明显提高(P0. 05),尽管在末次随访时骨密度略有降低,但仍较术前明显升高(P0. 05)。A组再发骨折率(10/40,25%)明显高于B组(1/20,5%),相关性分析显示再发骨折与骨密度(r=0. 028,P0. 05)和PINP检测值(r=-0. 013,P0. 05)密切相关。结论特立帕肽较唑来膦酸能更好预防椎体成形术后再发骨折,其潜在机制与更有效改善骨代谢,提高骨密度有关。     

骨质疏松性椎体压缩骨折椎体成形术后非术椎再骨折的相关因素分析

目的探讨骨质疏松性椎体压缩骨折椎体成形术后非术椎再骨折的相关因素。方法回顾性分析自2015-04—2018-06行椎体成形术治疗的797例骨质疏松性椎体压缩骨折,根据术后非手术椎体是否再骨折分为再骨折组(108例)和无再骨折组(689例),分析性别、年龄、骨折节段、椎体压缩超过1/2、肺部疾病、糖尿病、骨密度T值、手术方式、穿刺方式、骨水泥渗漏、骨水泥分布与术后非术椎再骨折的相关性。结果单因素分析结果显示再骨折组与无再骨折组在年龄、骨折节段、肺部疾病、骨密度T值、手术方式、穿刺方式方面差异有统计学意义(P 0.05);但是2组在性别、椎体压缩超过1/2、糖尿病、骨水泥渗漏、骨水泥分布方面差异无统计学意义(P0.05)。多因素Logistic回归分析结果显示年龄、T5～10节段骨折、双侧穿刺与椎体成形术后非术椎再骨折具有相关性。结论年龄较大、T5～10节段骨折、双侧穿刺手术是导致骨质疏松性椎体压缩骨折椎体成形术后非术椎再骨折的危险因素。     

骨水泥椎间渗漏与椎体成形术术后再发椎体压缩骨折相关性研究

目的 评估骨水泥椎间渗漏与椎体成形术（percutaneous vertebroplasty,PVP）术后再发椎体压缩骨折风险的相关性.方法对2009年6月～2011年6月行PVP手术治疗的153例骨质疏松性椎体压缩骨折患者进行回顾性研究,根据椎体再发骨折情况分为再发骨折组与对照组,记录2组患者骨密度、骨水泥注射量与骨水泥椎间隙渗漏情况.结果共124例患者（148个椎体）获得完整随访,平均随访18个月;24例患者（32个椎体）再发椎体压缩骨折.再发椎体压缩骨折患者骨水泥椎间渗透率为25.0%（6/24）与对照组的21.0%（21/100）差异无统计学意义（P＞0.05）.再发椎体压缩骨折患者骨密度低于对照组,差异有统计学意义（P＜0.05）.结论 骨水泥椎间渗漏并不增加PVP术后再发椎体压缩骨折风险,低骨密度是再发椎体骨折的危险因素.     

骨质疏松椎体压缩性骨折PKP术后椎体再骨折的临床研究

目的 探讨骨质疏松脊柱压缩性骨折（osteoporosis vertebral compression fracture,OVCFs）行经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）后再骨折的相关因素。 方法 回顾性分析了2014年1月—2015年12月行经皮椎体后凸成形术治疗骨质疏松脊柱压缩性骨折患者133例（174个椎体）。根据有无椎体新发骨折,分为再骨折组与对照组。随访时间12-18个月,平均15.5个月,统计并分析了患者性别、年龄、身高、体重、体质指数、骨密度、受伤椎体个数、骨水泥用量、注入骨水泥的方式、骨水泥是否椎间盘渗透、是否再次骨折、术后伤椎前缘恢比率及术后Cobb恢复比率等因素,并对上述因素进行统计学分析。 结果 术后再发骨折患者有28例,发生率为21%。再骨折组与对照组比较,年龄、术前骨密度、骨水泥向椎间盘渗漏、术后Cobb角度纠正程度及椎体前缘高度恢复程度在单因素分析中差异有统计学意义（P＜0.05）。多因素Logistic回归分析示术前骨密度与再骨折有显著相关性（P＜0.05）。 结论 术前骨密度、年龄、骨水泥向椎间盘渗漏、椎体高度的恢复比率及Cobb角的纠正比率是PKP术后出现其临近椎体再骨折的相关因素,但术前骨密度是其独立危险因素。     

强骨饮治疗骨质疏松性椎体压缩性骨折的临床研究

目的观察强骨饮对骨质疏松性椎体压缩性骨折患者经皮椎体后凸成形术(PKP)后的临床疗效。方法将90例骨质疏松性椎体压缩性骨折患者随机分为两组,所有患者均行PKP手术治疗,术后对照组每日服用碳酸钙D3片每日1次,每次1片,治疗组在此基础上每日加服强骨饮颗粒冲剂,每日2次,每次1袋,均服用12个月。分别于术前、术后6个月、术后12个月测定两组患者腰椎骨密度值、血清骨转换指标(PINP、S-CTX)、VAS评分、ODI评分及1年内椎体再骨折发生率等指标。结果治疗组与对照组术后6个月及12个月腰椎骨密度值比较,差异有统计学意义(P0.05);治疗组腰椎骨密度值组内比较,差异有统计学意义(P0.05)。治疗组与对照组术后6个月及12个月血清PINP和S-CTX的含量比较,差异有统计学意义(P0.05);治疗组血清PINP和S-CTX的含量组内比较,差异有统计学意义(P0.05)。治疗组术后6个月及12个月VAS和ODI评分下降明显,与对照组相比,差异有统计学意义(P0.05)。两组共有11例患者发生椎体再次骨折,再骨折率为12.9%,其中治疗组2例(4.8%),对照组9例(20.9%),差异有统计学意义(P0.05)。结论强骨饮可增加患者骨密度,降低骨转换速率,改善腰背部疼痛及日常生活能力,有效降低椎体再次骨折发生率。     

高黏度骨水泥椎体成形术与低黏度骨水泥椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折疗效分析

[目的]比较高黏度骨水泥椎体成形术与低黏度骨水泥椎体后凸成形术治疗骨质疏松椎体压缩骨折的疗效和并发症。[方法]收集本院骨科2011年1月~2014年1月使用高黏度骨水泥椎体成形术和使用低黏度骨水泥椎体后凸成形术治疗的骨质疏松性胸腰椎压缩骨折患者110例,进行回顾性研究。将患者化分为A组(高黏度骨水泥椎体成形术组42例)和B组(低黏度骨水泥椎体后凸成形术组68例)。术前统计两组患者性别比、年龄、VAS评分及骨密度值(-T值)。采用视觉模拟量表(VAS)进行疼痛评分,观察并比较两组患者的住院花费、透视时间、骨水泥用量、术后VAS评分、椎体复位高度、骨水泥静脉渗漏、椎旁渗透率、邻近椎体骨折、其他并发症等发生情况。[结果]术后随访时间为3~36个月。术前患者的年龄、性别、术前VAS评分等基本临床资料在两组间差异无统计学意义(P0.05)。A组手术透视时间、骨水泥用量、住院花费均少于B组(P0.05);A组患者术后24h VAS评分低于B组,差异有统计学意义(P0.05);两组患者术后3 d VAS评分差异无统计学意义(P0.05)。两组患者经俯卧位并手法复位及术后椎体高度均有明显恢复,但两者之间差异无统计学意义(P0.05)。A组发生椎体周围骨水泥静脉丛渗漏3例(7.1%),椎旁骨水泥渗漏7例(16.7%),发生邻近椎体再骨折4例(9.5%),应激性胃溃疡1例(2.4%);急性脑梗塞1例;B组发生椎体周围骨水泥静脉丛渗漏6例(8.8%),椎旁骨水泥渗漏8例(11.7%),其中B组出现1例骨水泥肺栓塞,导致严重后果,应激性胃溃疡2例(2.9%),冠心病急性发作1例,脑脊液漏1例。两组比较差异无统计学意义(P0.05)。两组患者术前、术后24 h VAS评分差异具有统计学意义(P0.01)。[结论]高黏度骨水泥椎体成形术与低黏度骨水泥椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折具有相似的治疗效果及并发症发生率,但前者在治疗花费及透视时间方面占明显优势。     

唑来膦酸与PKP治疗骨质疏松性椎体压缩骨折

[目的]比较经皮穿刺椎体后凸形成术(percutaneous kyphoplasty,PKP)联合与不联合唑来膦酸治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的临床疗效。[方法]2013年1月~2013年12月,对64例OVCFs患者,术后随机给予唑来膦酸(唑来膦酸组)和不给予唑来膦酸(对照组)。术后记录患者视觉模拟评分(visual analogue scale/score,VAS)、Oswestry功能障碍指数(Oswestry disability index score,ODI)、骨密度检测T值、术后椎体再骨折情况。[结果]随访结束后获得52例完整资料,其中唑来膦酸组24例,男5例,女19例,平均74.13岁,累及椎体31节椎体;对照组28例,男5例,女23例,平均74.25岁,累及37节椎体。两组术后VAS评分及ODI值均较术前明显改善,差异有统计学意义;术后3 d两组间VAS评分及ODI值无统计学差异,术后1年两组间差异有统计学意义;术后1年两组骨密度测定t值差异有统计学意义;术后1年唑来膦酸组再骨折1例,对照组4例。[结论]PKP治疗OVCFs具有微创、高安全性、迅速改善疼痛等优点,术后应用唑来膦酸治疗,可有效改善改善骨密度及患者生活质量,降低术后椎体再骨折风险。     

Revisable criteria for vertebral deformity

In order to study vertebral fractures in various study populations, we earlier prepared a database of vertebral dimensions derived from spinal radiographs of 191 normal women seen regularly over 25 years. In this report we have expanded the range of measurements to include vertebral levels T3 to L5. We report means and standard deviations on anterior and posterior heights, on wedge shape and on heights relative to adjacent vertebrae. When one or both of the latter two quantities are far below the mean, a vertebra is called deformed. We also describe a more flexible way of expressing damage using the number of deformed vertebrae, the degree of deformity of individual vertebrae, or the total damage to the entire spine. In assessing damage we use criteria for deformity adjusted to the limits detected by an experienced diagnostician, replacing an earlier approach based on 95% probability limits of normal variation. The normal women from whom these variations are ascertained are a low-prevalence group with respect to vertebral deformity, with prevalence of 2.8%. When the criteria developed from these women were applied to a moderate-prevalence group (37%) the model had a sensitivity of 97%, a specificity of 89% and an accuracy of 92% as regards the identification of subjects with damaged vertebrae. When used epidemiologically for a moderate-prevalence group the model has a known overestimation of 15%. The model is compared with other schemes for identifying vertebral deformities.     

Age-related changes in vertebral height ratios and vertebral fracture

Because no gold standard for the definition of vertebral fracture exists, there has been controversy about whether mild vertebral deformities are truly fractures or simply normal variation in vertebral size and shape. The aim of this study was to assess the associations of mild variations of vertebral height ratios to definite vertebral fractures. In 479 Japanese women (age 53.9±9.1 years) who visited our institute for a medical checkup, we performed lateral lumbar radiographs and morphometric parameters were derived by measuring the anterior (Ha), middle (Hm) and posterior (Hp) height of each vertebral body from T12 to L4. Vertebral height ratios, Ha/Hp, Hm/Hp or Hp/Hp of adjacent vertebrae that were more than 3 SD different from vertebra-specific means of normative data were considered to indicate fractures. Forty-five women were diagnosed with at least one fracture. After excluding the subjects with vertebral fracture, we examined the associations of the variations in vertebral height ratios with age, anthropometric parameters and lumbar bone mineral density (BMD) measured by dual-energy X-ray absorptiometry. Vertebral height ratios, especially Hm/Hp in postmenopausal women, tended to decrease with age and were positively associated with BMD. No significant correlation was observed between anthropometric parameters and vertebral height ratios. Age-related decrease in vertebral height ratios (Ha/Hp and Hm/Hp, each averaged from T12 to L4) was significant even after the correction for BMD. Mean values of height ratios of non-fractured vertebrae adjusted for age and BMD were significantly lower in postmenopausal women with vertebral fracture than in those without vertebral fracture. Logistic regression analysis showed that BMD and height ratios of non-fractured vertebrae were independent predictors of vertebral fracture risk. The results suggest that older women, and women with at least one obvious (3 SD) fracture, tend to have mild deformities which do not qualify using the 3 SD definition. These mild deformities may represent real consequences of osteoporosis, because they are more pronounced among women with obvious fracture.     

颈椎旋转、半失稳与颈性头晕的相关研究

目的:探讨颈性头晕与颈椎旋转、椎体半失稳间的关系。方法:本组86例,按其主诉有无头晕分为无头晕组和颈性头晕组。应用图像存档和传输系统(PACS)测量患者X线正位片上每个颈椎椎体的旋转度和侧位片上椎体间的位移距离。结果:无头晕组C2、C6的旋转度分别比颈性头晕组C2、C6的旋转度小,两组间差异有显著性(P<0.05)。颈性头晕组患者椎体半失稳率为66.7%,椎体间位移距离(0.20±0.18)cm;无头晕组患者椎体半失稳率为44.7%,椎体间位移距离(0.12±0.15)cm。两组患者椎体半失稳率和椎体间位移距离差异均有显著性(P<0.05)。结论:颈性头晕与椎体的半失稳、C2、C6的旋转关系密切。     

Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture

Introduction Vertebral fracture is currently underdiagnosed, despite its common severity and its value to predict further osteoporotic fracture. Morphometry using dual X-ray absorptiometry (DXA) [vertebral fracture assessment (VFA)] is a new technique that may facilitate detection of many vertebral fractures, as images are obtained at the same time as bone mineral density (BMD) measurement, and would also allow avoiding spine radiographs.Methods We conducted a cross-sectional study to assess the diagnostic value of Instant Vertebral Assessment (IVA), which is a morphometry scan using the Hologic Delphi densitometer, to detect prevalent vertebral fracture in postmenopausal women. Interobserver precision was assessed, then IVA scans were compared with lateral spine radiographs, considered the gold standard, to test diagnostic agreement between the two techniques. Sensitivity, specificity and predictive values were calculated, as well as the likelihood ratio of the positive test, using sensitivity and specificity at each vertebral level.Results Among 85 patients of whom 50% had at least one vertebral fracture identified with radiographs, we found that interobserver precision was moderate, with frequent difficulties in discerning upper thoracic vertebrae. On a per-vertebra basis, sensitivity was around 70% from L4 to T11 and lower above T11 whereas specificity was above 90% for all vertebrae, and the negative predictive value remained above 80% from L4 to T7 and decreased above T7. On a per-patient basis, sensitivity was 0.69, specificity 0.74, positive predictive value equalled 0.72 and negative predictive value 0.71. When only grades 2 and 3 fractures were considered, results were comparable, with slightly improved specificity. Then, with the likelihood ratios calculated in our sample, we obtained posttest probabilities using the prevalence of vertebral fracture at lumbar and thoracic levels in a large sample of postmenopausal women with osteopenia and osteoporosis with and without vertebral fracture [baseline data in women of the Multiple Outcomes on Raloxifene Evaluation (MORE) trial]. At levels where fractures were most common, likelihood ratios of the positive test were good or excellent, associated with sizeable posttest probabilities.Conclusion IVA allowed diagnosis of vertebral fracture at levels where vertebral fracture were most common, i.e., the lumbar and mid and lower thoracic levels, but its value was weaker at the upper thoracic levels.     

Routine versus targeted vertebral fracture assessment for the detection of vertebral fractures

SUMMARY: Fracture risk is underestimated in women with unknown vertebral fractures. Using VFA, we compared two screening methods: targeted (6,388 women) and routine (2,176 women). Routine screening detected fractures in 20%. Targeted screening only required 5% attending for DXA to undergo VFA but only detected 9.6% of women with fractures. INTRODUCTION: BMD alone underestimates fracture risk in women with unknown vertebral fractures. We report the results of routine vertebral fracture assessment (VFA) screening and compare with targeted screening. METHOD: Our centre initially targeted VFA at women with reasons to suspect a vertebral fracture. Later we changed to routine VFA screening for all women over 65. We retrospectively compare each screening method's ability to detect vertebral fractures. RESULTS: Six thousand three hundred and eighty-eight women over 65 underwent DXA during the period of targeted VFA and 2,176 during routine VFA. Routine VFA detected 420 (20.0%) women with fracture. Most vertebral fractures (56.2%) occurred in women with osteopenia. Routine VFA would be expected to alter the management of 1 in 6 osteopenic women. Targeted VFA was performed in 332 (5.2%) women detecting 122 (1.9%) women with fractures. It was estimated that targeted VFA only detected 9.6% of women with a vertebral fracture. Targeted VFA failed to detect fractures in 18.1% of the population attending for DXA and in 29% of those with osteoporosis. CONCLUSION: Routine VFA detects vertebral fractures in 20% of women over 65. Targeted VFA greatly reduces the number of VFAs performed but only detects a minority of the women with vertebral fractures.     

骨质疏松症与脊柱骨折

骨折为骨质疏松最为严重的并发症，骨质疏松性脊柱骨折既是发生再骨折的高危因素，又是预测再次骨折发生的最重要指标。脊柱骨折作为再次骨折的高危因素，它反映了患者骨结构的退变和骨强度(BMD)的下降。预测再次骨折发生的危险性时，结合骨密度降低和有无脊柱骨折，将更有价值。通过X线片可以对脊柱骨折进行评估和分级，Genant半定量法对脊椎骨折进行评估，不需测量椎体高度，较为简便、实用。在药物疗效的评估上，只有将BMD和脊柱骨折结合起来，结果才更为客观、准确。既能增加骨密度又能减少脊椎骨折发生的药物是最为理想的药物。     

生物陶瓷人工椎体系统重建椎体缺损的研究

目的检测由脊柱前路解剖型固定钢板,生物陶瓷与骨水泥等组成的生物陶瓷人工椎体系统临床应用的可行性。方法选健康2～4岁山羊14只,平均体重28．6kg,经氯胺酮诱导,气管插管,安氟醚吸入麻醉后,取右下腹腹膜外斜切口,前路切除L4椎体后,应用钛合金解剖型固定钢板、骨水泥、磁性生物陶瓷组成的“生物陶瓷人工椎体”植入体内。结果一般情况：所有试验动物均成活,术后8h即可恢复站立,行走（不使用任何外固定支架）;24h后恢复正常行走,进食。术后6个月,腹部彩色B超检查未见血拴形成,腹部大血管血供正常。定期X线检查,肉眼大体标本观察,光境观察,扫描电镜（SEM）观察,材料与骨实现“生物愈合”。结论“生物陶瓷人工椎体系统”是一个制约性固定结构,类似于“钢筋骨水泥”,稳定性极强,能够保证生物材料与椎骨的“生物愈合”,形成“生物固定”,减少了长期固定“松动”发生的可能,整个系统操作简单,使用安全。具有极大的临床使用价值。     

编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折

目的评估编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折(OVCF)的初步临床效果。方法自2007年12月～2010年4月应用编织囊袋扩张-椎体后凸成形术治疗13例周壁破损的OVCF共15个椎体骨折。随访观察患者的VAS疼痛评分以及影像学改变情况。结果本组获随访3～6个月,平均4.5个月。术后患者疼痛均明显缓解,术后VAS评分、椎体前缘高度和伤椎后凸Cobb角改善显著。未出现骨水泥向椎体外渗漏。结论对于周壁破损的OVCF,编织囊袋扩张-椎体后凸成形术有效避免了骨水泥渗漏、显著缓解疼痛、有效恢复骨折椎体的高度,是一种安全有效的治疗方法。     

Complications of vertebral metastasis surgery

The authors report their experience concerning complications of spinal metastasis surgery. The purpose of this study was to assess the frequency of such complications and analyse the factors influencing their occurrence. The records of 145 patients treated between 1982 and 1991 for metastatic disease of the spine were retrospectively reviewed for intra- and postoperative complications. Other factors such as radiation therapy, emergent nature of surgery, and neurologic deficits were analysed for potential correlations with the frequency of complications. Twenty-seven (18.6%) patients developed postoperative complications. Wound dehiscence and infection (11%) were the most frequent complications. Statistical analysis showed a significant influence of three factors: preoperative radiation therapy, paraplegia before surgery, and surgery under emergency conditions. The rate of complications in this surgery is lower than might be expected and can be significantly reduced. Surgery should be performed before radiation therapy and before appearance of substantial neurologic deficits. Received: 5 July 1997 Revised: 30 March 1998 Accepted: 21 April 1998