PKP联合PVP治疗多节段骨质疏松性椎体压缩性骨折的疗效评价

目的老年性骨质疏松导致的椎体压缩性骨折常导致脊柱畸形及顽固性腰背痛，传统方法因患者身体情况等原因以保守治疗为主，长期卧床常导致骨质疏松加剧而形成恶性循环，本文采用经皮椎体后凸成形术（PKP）联合椎体成形术（PVP）治疗多节段老年骨质疏松性椎体压缩性骨折（OVCF），观察临床疗效并分析相关并发症。方法2008年8月至2011年2月共收治30例OVCF患者，其中男1In，女19例，年龄54～85岁，平均71．5岁，共计108个椎体骨折，其中R1个，T7 2个，T84个，T9 6个，T10 9个，T11 3个，T12 18个，L，23个，L219个，L3 6个，L4 5个，L5 2个，全部采用PKP联合PVP手术进行治疗，术前及术后采用疼痛视觉模拟量表（visualanaloguescale，VAS）评分及Oswestry功能障碍指数（oswestrydisabilityindex，ODI）对患者进行评分。结果所有患者随访1—2年，平均1．4年，所有患者症状均得到显著改善。术前VAS评分为7．97±0．76，术后0、24、48周VAS评分分别为2．70±0．79、2．40±0．72、2．13±0．57；术前ODI评分为79．7±4．16，术后0、24、48周ODI评分分别为20．1±3．79、22．3±4．12、24．5±6．51。对术前及术后的VAS评分及ODI评分进行配对t检验，P值均〈0．01，表明术前与术后的VAS及ODI评分差异有统计学意义，术后VAS及ODI评分显著优于术前。其中4例患者发生骨水泥渗出、拖尾，无神经症状，1例发生邻椎骨折，给予2次手术后症状改善。结论府用PKP联合PVP治疗多节段OVCF能有效缓解疼痛．节约手术时间．是一种简单、安全有效的方法。

Effect evaluation of percutaneous kyphoplasty combined with pereutaneous vertebroplasty for the treatment of multiple-level osteoporotic vertebral compression fractures

Objective Vertebral compression fractures caused by senile osteoporosis always led to spinal malformations and long-term low back pain. Due to the patients＇ physical conditions or other reasons, conservative treatment was mainly done. Osteoporosis of the long-term bedridden patients aggravated, and was ultimately involved in a vicious circle. To observe the clinical effects of percutaneous kyphoplasty （PKP） combined with percutaneous vertebroplasty （PVP） for the treatment of multiple-level osteoporotic vertebral compression fractures （OVCF）, and to analyze the related complications. Methods From August 2008 to February 2011, 30 patients （108 vertebral bodies） with OVCF were adopted, including 11 males and 19 females, whose average age was 71.5 years old （range; 54-85 years）. There was 1 case ofT6, 2 ofT7, 4 ofTs, 6 ofT9, 9 ofT10, 13 ofT11, 18 ofT12, 23 of L1, 19 of L2, 6 of L3, 5 ofL4 and 2 of Ls. All patients were treated by PKP and PVP, and the results were evaluated with the Visual Analogue Scale （VAS） scores and Oswestry Disability Index （ODI） before and after surgery. Results All patients were followed up for a mean period of 1.4 years （range; 1-2 years）, and their symptoms were all improved. According to the VAS scores, the outcomes before surgery were 7.97~0.76, and 2.70~0.79, 2.40~0.72 and 2.13~0.57 respectively 0 week, 24 weeks and 48 weeks after surgery. According to the ODI, the outcomes before surgery were 79.7~4.16, and 20.1~3.79, 22.3＋4.12 and 24.5~6.51 respectively 0 week, 24 weeks and 48 weeks after surgery. Under paired t-test, the preoperative and postoperative VAS scores and ODI were analyzed, and the differences between them were statistically significant （P〈0.01）. The postoperative VAS scores and ODI were obviously higher than the preoperative ones. Among the patients, bone cement leakage and tailing occurred to 4 patients without neutral symptoms, and adjacent vertebral fractures happened in 1 case, which was improved after 2 surgeries. Conclusions It is a simple, safe and effective way to treat the patients with multiple-level OVCF using PKP and PVP, which can effectively relieve pain and shorten operation time.