椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折

目的观察和分析椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折的临床效果。方法自2007年1月至2009年9月采用椎体后凸成形术治疗骨质疏松性压缩性骨折21例,31椎。结果所有患者术后疼痛均明显减轻或消失。有3例发生骨水泥,渗漏1例有临床症状,术后椎体前缘后缘高度及Cobb角与术前相比有显著性差异（P〈0.05）。结论椎体后凸成形术可有效缓解因骨质疏松性椎体压缩性骨折所引起的疼痛,恢复椎体高度,但也有一定的并发症,应严格掌握适应证。     

球囊扩张椎体后凸成形术治疗多节段骨质疏松性胸腰椎压缩骨折

目的探讨应用球囊扩张椎体后凸成形术（PKP）治疗多节段老年骨质疏松性脊柱骨折的疗效和安全性。方法自2005年1月至2007年10月,采用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折28例67个病椎,均经单侧椎弓根置入可扩张球囊使骨折塌陷椎体复位,然后使用骨水泥充填椎体,观察术后症状改善及骨折复位情况。结果28例手术均顺利,疼痛于术后24h内均明显缓解,术后无脊髓神经根受损表现,X射线片复查,显示病椎高度明显恢复,后凸畸形大部分矫正。结论经皮球囊扩张椎体后凸成形术治疗多节段性老年骨质疏松脊柱骨折安全有效。     

单侧椎弓根穿刺椎体后凸成形术治疗胸腰段椎体骨质疏松压缩性骨折

目的评估单侧椎弓根穿刺椎体后凸成形术治疗胸腰段椎体骨质疏松压缩性骨折的临床疗效。方法 2010年6月至2013年9月采用单侧椎弓根穿刺技术结合经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩性骨折27例,T₁₁ 1例,T₁₂例8例,L₁15例,L₂ 3例。随访分析患者疼痛、影像学变化情况。结果患者均安全耐受手术。骨水泥渗漏4例。所有患者术后腰痛均不同程度缓解,术后第2天均能下地行走。其中有7例患者术后伴有腰背肌肉疼痛或下腰痛,接受非甾体、抗骨质疏松药物后均缓解。伤椎前缘高度及后凸角度指标术前、术后比较有显著差异（P<0.05）,术后与末次随访指标无显著差异（P>0.05）。结论单侧椎弓根穿刺椎体后凸成形术可安全有效的治疗胸腰段椎体骨质疏松压缩性骨折。     

经皮椎体成形术与经皮后凸成形术治疗胸腰椎压缩性骨折

目的探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）及经皮后凸成形术（percutaneous kyphoplasty,PKP）治疗骨质疏松性胸腰椎压缩性骨折的临床疗效。方法回顾性分析行PVP或PKP治疗骨质疏松性胸腰椎骨折的患者38例,共54个节段,临床均表现为腰背部痛,且无神经症状及体征。其中33个节段采用PKP治疗,21个节段采用PVP治疗。结果术后1个月门诊随访患者疼痛视觉模拟量表（visual analogue scale,VAS）与活动能力评分均较术前明显改善,未发生骨水泥渗漏及神经受损等症状。术后3个月复查未见椎体压缩。结论应用PVP或PKP治疗骨质疏松性胸腰椎压缩性骨折应用PVP或PKP可有效缓解疼痛,恢复椎体高度。     

SKy骨扩张器治疗老年骨质疏松性椎体压缩骨折

目的探讨SKy骨扩张器系统治疗老年骨质疏松性椎体压缩骨折的临床应用价值。方法选取经X线片确诊为骨质疏松性胸腰椎压缩骨折患者24例,俯卧位下行SKy椎体成形术治疗。对术前、术后X线片上伤椎前缘及中线高度进行比较分析。结果根据VAS疼痛评价标准：术后1d0分5例,1分11例,2分7例,3分1例。骨折椎体前缘高度术前为（17.85±2.45）mm,术后为（20.75±1.45）mm。后凸畸形纠正范围较术前恢复15°～27°。24例均获随访,时间6～12个月,手术椎体均无复发,未发生明显不良反应及并发症。结论SKy骨扩张器系统治疗老年骨质疏松性椎体压缩性骨折是一种安全有效的治疗方法。     

经皮椎体成形术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮椎体成形术（PVP）治疗老年骨质疏松性椎体压缩性骨折的临床效果。方法应用椎体成形术治疗8例骨质疏松性压缩骨折患者15个椎。结果术后1—3d所有患者疼痛消失或明显减轻，2～3d后下床活动。随访8～12个月，所有患者疼痛无反复，无严重并发症发生。X线片显示椎体高度无进一步丢失。结论椎体成形术治疗骨质疏松性椎体压缩性骨折是一种安全、微创、有效的治疗方法。     

对比单侧与双侧PKP治疗骨质疏松性胸腰椎压缩性骨折的疗效

目的对比单侧与双侧经皮穿刺球囊扩张椎体后凸成形术（PKP）治疗骨质疏松性胸腰椎压缩性骨折的疗效。方法对于骨质疏松性胸腰椎压缩性骨折行双侧椎体成形术15例,单侧椎体成形术18例。结果对于行单侧椎体成形术与双侧椎体成形术后的患者随访12～48月,行单双侧PKP术后的指标与术前对比,VAS与术前比较差异有统计学意义（P〈0.01）。结论行单侧与双侧椎体成形术能有效的缓解骨质疏松性胸腰椎压缩性骨折导致的疼痛,并部分恢复病椎的高度,可改善脊柱的功能。     

PKP联合PVP治疗胸腰椎多节段骨质疏松性椎体压缩性骨折的临床研究

目的探讨经皮椎体后凸成形术(PKP)联合椎体成形术(PVP)治疗胸腰椎多节段骨质疏松性椎体压缩性骨折的临床疗效。方法自2008-01-2011-02采用PVP+PKP术治疗胸腰椎多节段骨质疏松性椎体压缩性骨折30例(108椎)均为新鲜骨折,选择椎体压缩程度≥1/3且≤2/3采用PKP技术,椎体压缩程度<1/3及>2/3采用PVP技术,Cobb’s角观察术后椎体后凸畸形矫正情况及视觉模拟疼痛评分(VAS)对患者疼痛进行评价。结果平均随访14个月(6～24个月),术后骨折后凸畸形Cobb’s角平均矫正20.6°,术后胸腰背部疼痛VAS评分明显改善。结论 PKP联合PVP治疗胸腰椎多节段骨质疏松性椎体压缩性骨折具有创伤小,用时短,止痛效果好,恢复椎体高度,矫正脊柱后凸畸形,能增强脊柱稳定性,是一种简单、安全有效的方法。     

经皮椎体成形术治疗骨质疏松性脊柱压缩性骨折

目的探讨经皮椎体成形术治疗骨质疏松性脊柱压缩性骨折的临床疗效及并发症。方法随访老年骨质疏松脊柱压缩性骨折患者21例,男5例,女16例,年龄61~82岁,平均72岁,21例36椎行经皮椎体成形术(PVP),术前及术后3 d进行疼痛视觉类比评分(VAS)和活动能力评分;随访期间观察患者疼痛缓解及生活能力状况,并分析骨水泥渗漏、邻椎骨折、临近器官损伤等并发症。结果手术全部成功,术后早期疼痛明显缓解,VAS评分术后3 d(2.5±0.6)较术前(7.5±0.7)明显下降(P<0.01);活动能力评分术后3 d(1.2±0.4)较术前(2.4±0.6)明显改善(P<0.01)。随访6~26个月(平均16个月);4例发生周围椎体骨折;3例发生骨水泥渗漏。患者对治疗效果满意。结论经皮椎体成形术是一种治疗老年骨质疏松性椎体压缩性骨折的微创手术,能够有效缓解骨质疏松性椎体骨折引起的疼痛,维持椎体稳定性,恢复椎体的高度,是一种简单、安全、有效的新方法。     

球囊扩张椎体成形术联合降钙素治疗老年骨质疏松性椎体骨折的疗效

目的回顾性分析球囊扩张椎体后凸成形术联合降钙素治疗骨质疏松性椎体骨折的疗效。方法 2007年2月～2010年1月,对25例35个椎体发生骨质疏松性椎体骨折患者行球囊扩张椎体后凸成形术联合降钙素综合治疗。术中在透视机监视下采用单侧椎弓根穿刺,置入1枚可扩张球囊使骨折塌陷椎体复位,灌注骨水泥充填由球囊扩张所形成的椎体内空腔。术后每天静脉注射鲑鱼降钙素,通过观察患者术后症状改善及骨折复位情况来评估其疗效。结果所有患者随访6～32个月,平均（21.3±0.2）个月。全部患者均顺利完成手术,无症状性并发症发生。术后疼痛明显减轻或消失。术后椎体高度平均恢复率59.5%。结论球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折可有效缓解疼痛、改善功能及恢复脊柱序列,联合降钙素的应用能有效缓解骨质疏松性椎体压缩骨折引起的疼痛,是治疗骨质疏松性椎体骨折的较好微创方法之一。     

椎体后凸成形术联合金天格胶囊治疗骨质疏松性椎体压缩骨折

目的 探讨应用球囊扩张椎体后凸成形术联合金天格胶囊治疗骨质疏松性椎体压缩骨折.方法 2005年3月至2011年 8月以来,应用球囊扩张椎体后凸成形术联合金天格胶囊治疗80例102个椎体骨质疏松性椎体压缩骨折患者,并观察疗效.结果 术后1～2天所有患者疼痛消失或明显减轻,2～3 天后下床活动.随访3～15个月,所有患者疼痛无反复,无严重并发症发生.结论 微创球囊扩张椎体后凸成形术联合金天格胶囊是治疗骨质疏松性椎体压缩骨折安全有效的方法.     

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。     

Percutaneous vertebroplasty for pain relief and spinal stabilization

STUDY DESIGN: This was a retrospective review of 47 consecutive patients (1995-1998) in whom percutaneous intraosseous methylmethacrylate cement injection (percutaneous vertebroplasty) was used to treat osteoporotic vertebral compression fractures and spinal column neoplasms. OBJECTIVES: To present initial results regarding pain relief, spinal stabilization, and complications after treatment with percutaneous vertebroplasty. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty was developed in France in the late 1980s. Several European reports have described excellent results for treatment of compression fractures and neoplasms. The procedure was not performed in the United States until 1994. Only a single series of 29 patients treated in the United States has been reported. METHODS: A retrospective review was conducted of 47 consecutive patients with 84 vertebrae treated with percutaneous vertebroplasty. Thirty-eight patients with 70 vertebrae had symptomatic, osteoporotic fractures and had failed medical therapy. Eight patients with 13 vertebrae had primary or metastatic neoplasms. One patient had a hemangioma. Immediate and long-term pain response, spinal stability, and complications were evaluated. RESULTS: Among the 38 patients treated for osteoporotic fractures, 24 (63%) had marked to complete pain relief, 12 (32%) moderate relief and 2 (5%) no significant change. Only 4 of the 8 patients with malignancies had significant pain relief. In 7 of these patients, no further vertebral compression occurred, and spinal canal compromise was prevented. The patient with the hemangioma had no significant pain reduction. Minor complications occurred in 3 (6%) patients. CONCLUSIONS: Percutaneous vertebroplasty provided significant pain relief in a high percentage of patients with osteoporotic fractures. The procedure provided spinal stabilization in patients with malignancies but did not produce consistent pain relief. Complications were minor and infrequent. Percutaneous vertebroplasty is a promising therapy for patients with osteoporotic fractures and for selected vertebral column neoplasms.     

经皮椎体成型术在骨质疏松性椎体压缩骨折中的临床应用分析

目的探讨经皮椎体成型术在骨质疏松性椎体压缩骨折中的临床疗效。方法对笔者所在医院就诊的18例患者采用经皮椎体成型术治疗骨质疏松性胸腰椎压缩骨折,手术在C臂机监测下,经皮向椎体内穿刺并注入骨水泥,并对患者术后椎体疼痛症状及椎体前缘高度进行分析。结果术后全部患者获得随访,随访时间1～18个月,平均11个月,患者腰背部疼痛明显好转,椎体前缘高度无明显继发丢失,椎体后凸角度无明显增大。结论经皮椎体成型术治疗骨质疏松性椎体压缩骨折安全有效,疗效满意。     

老年骨质疏松椎体压缩骨折的经皮椎体后凸成形术

目的探讨椎体后凸成形术治疗老年骨质疏松椎体压缩骨折的手术技术及适应证等相关问题。方法用椎体后凸成形术治疗老年骨质疏松椎体压缩骨折20例,采用经皮穿刺双侧椎弓根入路,单枚球囊依次撑开压缩的椎体,每个椎体充填骨水泥平均5·2ml。结果20例患者腰背部疼痛在术后24h缓解并下床活动,椎体高度基本恢复,后凸畸形平均矫正18°。随访6~18个月,患者均恢复伤前生活状况,无脊髓神经损伤、骨水泥漏、肺栓塞等并发症。结论椎体后凸成形术能达到缓解疼痛、恢复椎体高度的目的,是治疗老年骨质疏松椎体压缩骨折的有效方法。但必须熟练掌握椎体后凸成形术的经皮穿刺技术、骨水泥灌注技术及掌握手术适应证,才能保证这一技术的安全性和有效性。     

Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures.

STUDY DESIGN: An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures. OBJECTIVES: To evaluate the safety and efficacy of inflatable bone tamp reduction and cement augmentation, "kyphoplasty," in the treatment of painful osteoporotic vertebral compression fractures. SUMMARY OF BACKGROUND DATA: Osteoporotic compression fractures can result in progressive kyphosis and chronic pain. Traditional treatment for these patients includes bed rest, analgesics, and bracing. Augmentation of vertebral compression fractures with polymethylmethacrylate, "vertebroplasty," has been used to treat pain. This technique, however, makes no attempt to restore the height of the collapsed vertebral body. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height while creating a cavity that can be filled with bone cement. PATIENTS AND METHODS: Seventy consecutive kyphoplasty procedures were performed in 30 patients. The indications included painful primary or secondary osteoporotic vertebral compression fractures. Mean duration of symptoms was 5.9 months. Symptomatic levels were identified by correlating the clinical data with MRI findings. Perioperative variables and bone tamp complications or issues were recorded and analyzed. Preoperative and postoperative radiographs were compared to calculate the percentage height restored. Outcome data were obtained by comparing preoperative and latest postoperative SF-36 data. RESULTS: At the completion of the Phase I study there were no major complications related directly to use of this technique or use of the inflatable bone tamp. In 70% of the vertebral bodies kyphoplasty restored 47% of the lost height. Cement leakage occurred at six levels (8.6%).SF-36 scores for Bodily Pain 11.6-58.7, (P = 0.0001) and Physical Function 11.7-47.4, (P = 0.002) were among those that showed significant improvement. CONCLUSIONS: The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures. Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful osteoporotic compression fractures.     

经皮椎体成形术治疗陈旧性骨质疏松性椎体压缩骨折的临床观察

目的探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗陈旧性骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析56例（77个椎体）陈旧性骨质疏松性椎体压缩性骨折患者的临床资料,均行PVP术治疗。观察并比较手术前及术后3d、3月、6月、12月患者的疼痛VAS评分、日常生活能力恢复情况（ADL评分）及椎体高度恢复情况。结果本组56例患者共77节椎体均成功实施PVP手术,13例患者16节椎体（20．78％）发生骨水泥外漏,无截瘫、肺栓塞等严重并发症。与术前比较,术后3d、3月、6月、12月患者VAS评分均显著降低,ADL评分显著升高,且随时间延长,疼痛缓解程度和日常生活能力均逐步提高（P〈0．01）。与术前比较,术后3d、3月、6月、12月患者压缩椎体前缘及中间高度均明显恢复（P〈0．01）。结论PVP术治疗陈旧性骨质疏松性椎体压缩骨折具有明显缓解疼痛及恢复日常活动能力的效果,并可以部分恢复压缩椎体的高度,可以作为其首选治疗方法。     

微创球囊扩张椎体后凸成形术治疗中老年胸腰椎骨质疏松压缩性骨折

目的 探讨微创球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)在骨质疏松性胸腰椎压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效及相关问题.方法 采用球囊扩张PKP治疗椎体OVCF 26例,术前患椎明显疼痛,但无神经症状及体征;术前CT示椎体后壁均完整.结果 26例患者腰背部疼痛在术后24 h缓解并下床活动,椎体高度基本恢复,后凸畸形矫正9°,无脊髓神经损伤、骨水泥漏、肺栓塞等并发症.结论 PKP治疗胸腰椎OVCF可有效缓解疼痛,部分恢复椎体高度,疗效满意.     

经皮椎体成形术治疗骨质疏松性椎体压缩骨折的早期疗效

目的探讨经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折1周内的临床疗效。方法对64例骨质疏松性椎体压缩骨折患者(83椎)行PVP治疗,记录术前及术后1周内疼痛VAS评分、手术前后Cobb角。结果83椎中10椎骨水泥渗漏至椎体周围及椎间隙,1椎周围静脉内出现骨水泥。VAS评分术后各时点与术前比较差异均有统计学意义(P<0.05),术后各时点比较差异均无统计学意义(P>0.05)。Cobb角手术前后比较差异无统计学意义(P>0.05)。结论PVP治疗骨质疏松性椎体压缩骨折在疼痛与稳定性上效果明确,治疗效果可在术后1 d后显现,1周内疗效稳定;PVP对椎体压缩无改善。     

陈旧性与新鲜性压缩骨折行椎体成形术的临床对比研究

目的回顾性对比研究陈旧性与新鲜性椎体压缩性骨折行经经皮椎体成形术（percutaneouss vertebra plasty,PVP）后的临床效果。方法对24例老年骨质疏松性胸腰椎压缩性骨折患者行PVP治疗,将研究对象按陈旧性骨折和新鲜性骨折分为2组,分别拍摄2组术前、术后标准正侧位X线片,从而对骨折椎体高度的恢复、后凸畸形的矫正及疼痛视觉模拟量表（visual analogue scale,VAS）评分进行研究对比。结果所有患者术后平均随访6个月,无严重并发症发生。2组患者术后疼痛缓解且恢复良好,均恢复日常活动能力。但陈旧性压缩性骨折患者术后椎体高度恢复和后凸畸形的矫正程度均不如新鲜性骨折患者。结论 PVP术操作简单、创伤小,对于骨质疏松性椎体压缩性骨折的治疗效果明显,尤其对新鲜骨折效果显著,且对于缓解陈旧性骨折疼痛症状也有良好效果。