椎体后凸成形治疗骨质疏松性脊柱骨折：注入骨水泥的要点

背景：球囊扩张椎体后凸成形是近年来发展起来的脊柱微创外科新技术，为老年骨质疏松性脊柱骨折的治疗开辟了新途径。目的：观察经皮穿刺球囊扩张椎体后凸成形技术对骨质疏松性脊柱骨折的治疗效果，探讨注入骨水泥的要点。方法：采用经皮穿刺球囊扩张椎体后凸成形技术治疗22例骨质疏松性椎体骨折患者，年龄60—78岁。在C臂X射线机透视引导下，行经皮穿刺球囊扩张椎体后凸成形治疗。按WHO标准对止痛效果进行评估，并分析骨水泥的注入时机、方式及用量等。结果与结论：所有患者均得到随访，随访时间1—12个月。治疗后15例疼痛完全缓解，7例部分缓解，有效率达100％，患者脊柱活动度增加。所有患者无需切开手术治疗，未出现肺栓塞、神经损伤等并发症。提示经皮穿刺球囊扩张椎体后凸成形技术在治疗骨质疏松性椎体骨折时，创伤小、操作简单、并发症少，能有效地重建椎体强度，并能较好地缓解疼痛，是一种有效的脊柱微创治疗技术。严格掌握治疗要点，能够获得满意的临床疗效，包括准确的疾病诊断，明确患者的疼痛等症状是否因骨折所致，术前术中准确的定位病椎，良好的穿刺技术，以及合适的术后治疗和护理。严格把握骨水泥的推注时间及量也很重要，骨水泥的推注一般在拉丝期，太早容易泄露，发生毒性反应；太晚影响骨水泥的扩散，从而影响治疗效果。骨水泥的推注最好全程在透视下进行，这样才能有效避免骨水泥的泄露。

Balloon kyphoplasty for osteoporotic vertebral fracture： key point of bone cement injection

BACKGROUND： Balloon kyphoplasty is a new technique of microtraumatic surgery of spine developed in recent years, and brings a new pathway for the treatment of osteoporotic vertebral fracture in the elderly. OBJECTIVE： To investigate the therapeutic effect of percutaneous balloon kyphoplasty on osteoporotic vertebral fracture, and to explore the main point of injecting bone cement. METHODS： A total of 22 patients with osteoporotic vertebral fracture at the age of 60-78 years underwent percutaneous balloon kyphoplasty under C-arm fluoroscopy. In accordance with the standards of WHO, antalgic effects were evaluated. The injection time, manner and dose of bone cement Were analyzed. RESULTS AND CONCLUSION： All patients were followed up for 1-12 months. Postoperative pain was completely lessened in 15 patients, and partially relieved in 7 cases, with an effective rate of 100%. Spinal mobility increased. No incision surgery was needed in all patients. No complications such as pulmonary embolism or nerve injury appeared. These results indicate that percutaneous balloon kyphoplasty for treatment of osteoporotic vertebral fractures is minimally invasive and simple, has less complication and effectively reconstructs vertebral body strength, and can better alleviate the pain, is an effective minimally invasive spinaltreatment technology. To strictly understand the main treatment point can obtain satisfactory clinical curative effects, including precise diagnosis of the disease, identification whether patient＇s pain is induced by fractures, preoperative intraoperative exact localization of the affected vertebra, perfect puncturing technique, suitable postoperative treatment and nursing. It is also important to strictly master the time of injecting bone cement and the dose of bone cement. Bone cement injection was commonly done in drawing-wire stage. Too early injection easily induced leakage and toxic reaction. Too late injection affected the expansion of bone cement and therapeutic effects. The injection of bone cement should be finished under a perspective environment, which can effectively avoid bone cement leakage.