局麻下椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折

目的: 探讨椎体后凸成形术治疗老年骨质疏松性骨折的临床疗效. 方法: 自2007年5月至2010年5月,局麻下采用椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折129例,男47例,女82例;年龄61～92岁,平均73.7岁;胸椎88节,腰椎101节. 观察手术前后VAS评分的变化、椎体高度改变、局部Cobb角的改善情况. 结果: 所有患者顺利完成手术,随访时间24～60个月,平均34.2个月. 腰痛VAS评分术前为7.9±2.5,术后2周、末次随访时分别为2.8±1.8、3.0±2.2,与术前比较差异均有统计学意义(P<0.01).椎体高度术后得到部分恢复,Cobb角术前(28.3±13.7)°,术后2周、末次随访时分别为(16.2±9.8)°、(19.1±10.3)°,与术前比较差异均有统计学意义(P<0.05).术中发生骨水泥外漏23例(17.8%),其中1例出现短暂神经根压迫症状. 术后发生呼吸暂停1例,经抢救恢复;肠梗阻1例,经治疗好转;骨水泥致椎体骨折分离1例;邻椎骨折4例. 结论: 椎体后凸成形术是治疗老年骨质疏松性椎体骨折的微创外科手术,其创伤小,止痛效果好,可有效维持骨折稳定,近期、中期疗效肯定,远期有待继续随访. 手术适应证的掌握及手术技术的提高是防止并发症的关键,其中骨水泥外漏是最常见的并发症.

Treatment of senile osteoporotic vertebral compression fractures with percutaneous kyphoplasty under local anesthesia

Objective: To evaluate the clinical outcomes of percutaneous kyphoplasty(PKP) in treating senile osteoporotic vertebral compression fractures under local anesthesia. Methods: From May 2007 to May 2010,129 patients with osteoporotic vertebral compression fractures were treated with PKP under local anesthesia. There were 47 males and 82 females,ranging in age from 61 to 92 years old,with an average of 73.7 years old,including 88 segments of thoracic vertebrae and 101 segments of lumbar vertebrae. Visual analogue scale(VAS),height of vertebral body,Cobb's angle were evaluated before and after operation. Results: Operations were performed successfully in all patients and these patients were followed up from 24 to 60 months with an average of 34.2 months. Preoperative,postoperative two weeks and at final follow-up,VAS score was 7.9±2.5,2.8±1.8,3.0±2.2,respectively;Cobb angle was(28.3±13.7)°,(16.2±9.8)°,(19.1±10.3)°,respectively. There was significant difference between postoperative and preoperative,and between at final follow up and preoperative(P<0.05). The height of vertebral body obtained partial recovery. Bone cement leakage occurred in 23 vertebrae(with proportion of 17.8%) during operation,among one patient with temporary clinical symptom of radiculalgia. All lumbago obtained obviously anesis after operation,1 case complicated with respiratory depression and recovered after resuscitation;1 case complicated with intestinal obstruction and improved after treatment,1 case complicated with fracture separation of vertebral body by bone cement,and 4 cases complicated with fracture of adjacent vertebral body. Conclusion: Percutaneous vertebral kyphoplasty is an effective method for treatment of senile osteoporotic vertebral compression fractures,which can expeditiously relieve pain and effectively recovery height of vertebral body and Cobb angle,it has advantages of minimal invasive. The results of short and mid-term follow-up were satisfactory,long-term follow-up is still needed. Correctly choosing the operative indication and improving surgical technique may avoid complications,especially bone cement leakage which is the most frequent complication.