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1.
骨质疏松性椎体压缩骨折的微创治疗   总被引:41,自引:3,他引:38  
骨质疏松性椎体压缩骨折常导致患者疼痛、活动受限,特别是随着老龄人群的增加,其发病率逐渐升高。传统采用保守治疗或者手术治疗效果不理想。近年采用椎体成形术(PVP)或后凸成形术(PKP)微创治疗骨质疏松性椎体压缩骨折,经皮穿刺椎体内注入骨水泥或先用球囊撑开压缩的椎体后再注入骨水泥进行椎体强化,可以达到稳定骨折、恢复椎体力学强度和缓解疼痛的目的=本文就有关这种微创治疗骨质疏松性椎体压缩骨折的最新进展加以综述。  相似文献
2.
目的 探讨一种治疗骨质疏松性椎体压缩骨折的简单、微创、安全、有效、经济的方法。方法 2001年3-9月,对9例14个椎体骨质疏松性椎体压缩骨折患者,采用经皮经椎弓根向椎体内注射骨水泥或可注射性自固化磷酸钙人工骨,男l例,女8例,年龄33—85岁,平均72岁。行椎体成形术。结果 术后l一2天所有患者疼痛消失或明显减轻,第2或3天下地活动。随访l一6个月,所有患者疼痛无反复。无严重并发症发生。结论 经皮椎体成形术治疗骨质疏松性椎体压缩骨折是一种简单、安全、经济、有效的治疗新方法,能早期去除疼痛,尽快使患者下床活动,减少卧床的并发症。  相似文献
3.
经皮椎弓根钉外固定系统联合椎体成形术治疗胸腰椎骨折   总被引:20,自引:2,他引:18  
目的:探讨经皮椎弓根钉外固定系统联合椎体成形术治疗胸腰椎新鲜压缩性骨折的临床疗效。方法:36例胸腰椎骨折患者,在C型臂X线导向下,经皮穿刺分别置入4枚Schanz椎弓根钉进入伤椎上下椎体,安放自行研制的外固定复位器并进行三维矫形,透视下复位满意后,用骨水泥(聚甲基丙烯酸甲酯PMMA或自固化磷酸钙CPC)行伤椎椎体成形术(percutaneousvertebroplasty,PVP)。随访观察治疗效果。结果:全组顺利完成手术,平均手术时间为90min;平均失血量为70ml;平均每个椎体注入PMMA或CPC3.5ml,术后1周X线片示伤椎椎体前缘高度由术前的平均19mm恢复至35mm;后凸Cobb角由术前的平均29°矫正到平均4.5°。术后CT发现椎体后缘少量渗漏2例,椎间隙骨水泥渗漏2例,均无临床症状。术后随访6~30个月,平均17个月。患者Cobb角及椎体前缘高度无明显丢失,相邻节段椎间隙形态无明显改变。结论:应用经皮椎弓根钉外固定系统联合经皮椎体成形术治疗胸腰椎新鲜骨折创伤小,出血量少,疗效满意,伤椎非融合性固定既能有效地防止矫正度的丢失又能避免邻近节段椎间盘退变加速。  相似文献
4.
[目的]介绍一种用于重建T5-L5间的椎体压缩性骨折的新方法。[方法]12例(19椎)骨质疏松性椎体压缩骨折患者,应用Sky膨胀式椎体成形器进行椎体扩张,使用PAMMA作为填充物重建骨折椎体,比较手术前后疼痛缓解程度(VAS法)的变化与Cobbg角的变化。[结果]本组病例均获随访2—8个月,平均6个月,无1例死亡,1例出现椎管内渗漏,无神经缺失症状,均达到疼痛缓解,手术前后Cobbg角有显著差异。[结论]Sky方法具有满意的止痛效果,还能较好的纠正后突畸形,有效恢复并保持椎体高度。而且可减少患者的经济负担,操作简单,值得临床推广。  相似文献
5.
经皮椎体成形术治疗骨质疏松性椎体压缩骨折   总被引:15,自引:0,他引:15  
目的 探讨椎体成形术治疗骨质疏松性椎体压缩骨折的早期临床效果。方法 对 1 8例骨质疏松性椎体压缩骨折病人的2 0个椎体 ,经皮椎弓根向椎体内穿针并注入聚甲基丙烯酸甲酯 (PMMA)。结果  1 8例病人平均每个椎体注入骨水泥 6 5ml,X线检查骨水泥充盈良好 ,骨折复位满意。术后 1 2h至 3d ,疼痛明显减轻或消失 ,应用视觉模拟评分法测试疼痛缓解 81 % ,术中术后无明显并发症出现。对 1 6例病人随访 3~ 6个月 ,疼痛未复发 ,椎体形态未见改变。结论 经皮椎体成形术治疗骨质疏松性椎体压缩骨折 ,能够迅速缓解疼痛 ,增加椎体的稳定性 ,是安全有效的微创技术  相似文献
6.
经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折   总被引:12,自引:4,他引:8  
目的探讨和评估经皮椎体成形术(PVP)治疗老年骨质疏松性椎体压缩骨折的临床应用价值。方法2003年8月以来,在G型臂机监控下采用PVP治疗老年骨质疏松性椎体压缩骨折患者23例。14例为单椎体伤椎,7例为2个椎体伤椎,2例为3个椎体伤椎,共治疗34个椎体。进行临床和影像学观察评价。结果所有患者获3~16个月(平均11个月)随访。其中22例患者术后胸腰背部疼痛立即消失,10例当天离床,12例第2天离床,均在5d内出院。术后X线片示伤椎内骨水泥均匀分布,无渗漏。术后复查,疼痛无复发,X线片示椎体高度无进一步丢失。有1例因Simplex骨水泥注入量太少(仅0.5mL)而无明显效果。结论该手术方法具有显著的临床止痛效果和明显的微创优点,是治疗老年骨质疏松脊柱压缩骨折安全有效的方法。  相似文献
7.
Chen JF  Lee ST 《Surgical neurology》2004,62(6):494-500
OBJECTIVE: Percutaneous vertebroplasty can be very beneficial for patients with vertebral osteoporotic compression fractures. To the best of our knowledge, however, there has been no mention in any literature regarding the use of percutaneous vertebroplasty for the treatment of spinal burst fracture. METHODS: A preliminary study was conducted on 6 patients with traumatic burst fractures of vertebrae treated with percutaneous vertebroplasty starting in June 2000. Fractures involving the anterior and middle columns of the vertebrae and the canal were mildly compressed by the retropulsed bone fragment. However, there was no obvious neurologic deficit in these patients. They initially underwent conservative treatment and thoracolumbar spinal orthosis (TLSO) brace for at least 3 months, but the intractable pain caused patients to be bedridden for prolonged periods of time and limited daily activity. As a result, the patients underwent percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for treatment of spinal burst fractures. RESULTS: Six male patients (mean age: 38.2) who suffered from burst fractures of vertebrae with disabling back pain refractory to analgesic therapy and TLSO brace were treated in this study. The duration of conservation treatment period was 3.5 months to 8 months (mean: 5.2 months). There was no motility. However, 4 vertebrae (66.7%), on radiographs revealed evidence of PMMA leakage through the endplate fracture site into either the disc space or the paravertebral space, without any evident clinical symptoms. No intracanal leakage was seen, and no patient needed a secondary surgical intervention. Pain decreased from 84.3 +/- 5.4 mm at baseline to 34.7 +/- 4.4 mm at the third postoperative day, 30.2 +/- 5.8 at 3 months and 24 +/- 3.5 mm at 12 months. The reduction in pain from baseline to the 3-day and 3 month mark was statistically significant (p < 0.05). The mobility was at least 2 levels of improvement (mean improvement 2.7 points) at 12-months postoperative. CONCLUSION: In highly selective patients, percutaneous vertebroplasty can be an alternative method for the treatment of spinal burst fractures and the prevention of complications from major surgical procedures. However, this procedure still has potential risks and should be employed with extreme caution to prevent extravasation of PMMA into the spinal canal.  相似文献
8.
Percutaneous vertebroplasty has been performed for more than ten years to treat painful osteoporotic vertebral compression fractures. Clinical results have been encouraging, but little is known about the efficacy and safety of this minimally invasive procedure. We therefore performed a systematic review to assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures. A search was conducted using Medline, Embase and The Cochrane Controlled Trials Register. The search yielded fifteen studies, eleven prospective, three retrospective and one controlled trial. Totally 1,136 interventions were performed on 793 patients. Mean pain scores, measured using a 0 to 10 VAS score, improved significantly from 7.8 to 3.1 (−60.3%) immediately after percutaneous vertebroplasty. The short-term complication rate varied between 0.4 and 75.6%. Leakage of cement outside the vertebral body was markedly common, ranging from 3.3 to 75.6%. Although the majority was asymptomatic, a few devastating clinical adverse effects were reported (mean 2.4%). Although percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral fractures, we revealed only a single controlled trial. We conclude that there are insufficient data available to reliably assess efficacy of percutaneous vertebroplasty. The procedure has a low rate of clinical complications, but potential complications can be devastating. In the future, assessing the efficacy of percutaneous vertebroplasty requires controlled trials with long-term follow-up.  相似文献
9.
椎体成形术对胸腰椎椎体转移癌疼痛的治疗   总被引:8,自引:2,他引:6  
目的:探讨经皮穿刺椎弓根途径椎体成形术治疗椎体转移性肿瘤疼痛的效果。方法:对20例多发性椎体转移癌患者的53个椎体施行了经皮椎弓根途径椎体成形术,采用视觉模拟评分法(visual-analogue scale,VAS)对治疗前后患者疼痛状况进行评估、分级,术后疼痛缓解程度采用6级评定法评定。术后1周、3、6、12个月常规随访,进行疼痛缓解程度评价。结果:20例患者中11例局麻药药效消失后疼痛缓解,6例48h后疼痛缓解,1例1周后疼痛缓解,2例出现下肢疼痛加重。随访时间12~21个月,平均随访13.4个月。术后1周优良率为75%。有效率为85%。术后3个月优良率为70%,有效率为80%。术后6个月优良率为60%,有效率为65%。术后1年优良率为50%,有效率为55%。结论:经皮穿刺椎弓根途径椎体成形术对椎体转移性肿瘤疼痛具有良好的止痛效果.能够有效改善患者的生存质量。  相似文献
10.
目的:评估CT引导经皮单侧椎弓根穿刺,骨水泥注入椎体成形术(percutaneous vertebroplasty,PVP)治疗老年骨质疏松椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效和安全性。方法:2009年8月至2010年6月,对26例接受CT引导PVP治疗的老年椎体压缩性骨折患者进行回顾性分析,男9例,女17例;年龄60~85岁,平均(67.50±6.76)岁;病程2~30d,平均(8.92±4.36)d。骨折部位累及35椎。临床主要表现为腰背部疼痛(翻身、弯腰时加重),不能承重等。在CT引导下将穿刺针经皮单侧穿刺到病变椎体后,向椎体内注入骨水泥3~5ml。术后应用抗生素3d预防感染,观察骨水泥渗漏情况及脊髓、神经损伤,肺栓塞等并发症发生情况。通过X线片测量治疗前后椎体前缘、中部、后缘高度变化并进行比较;采用视觉模拟疼痛评分(Visual analogue scale,VAS)对患者术前、术后48h及末次随访时的疼痛评分进行比较。结果:26例穿刺均成功,有6个椎体发生骨水泥渗漏,未出现临床症状。1例患者出现骨水泥反应,给予5mg氟美松静滴、吸氧后缓解。26例患者均获随访,时间6~12个月,平均(8.4±1.6)个月。未发生神经损伤或肺栓塞等严重并发症。治疗后(48h)测定椎体前缘、中部、后壁高度较治疗前略有增加,但差异无统计学意义(P〉0.05)。VAS评分:治疗前为7.63±0.92,治疗48h后为3.00±1.09,末次随访时为2.38±1.17。治疗前与治疗后48h相比,差异有统计学意义(P〈0.05);末次随访时与治疗后48h比较,差异无统计学意义(P〉0.05)。结论:CT引导单侧PVP具有增强椎体力度,稳定椎体的作用,是治疗老年骨质疏松椎体压缩性骨折一种安全有效的方法。  相似文献
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