骨水泥强化椎弓根螺钉内固定减压椎间植骨融合治疗老年腰椎滑脱症

目的探讨应用骨水泥强化椎弓根钉内固定、复位、减压、椎体间融合治疗老年骨质疏松患者腰椎滑脱症的临床疗效。方法对19例老年骨质疏松患者腰椎滑脱症进行后路椎管减压,应用骨水泥强化椎弓根钉固定的方法对腰椎滑脱椎体进行复位固定,椎体间植骨融合。结果随访7～24个月,临床优良率87％,6～12个月复查X线片均显示椎体间骨性融合,无椎弓根螺钉松动。结论椎弓根螺钉经骨水泥强化后固定力增强,减少内置物失败,能有效提高椎体间植骨融合率,增加脊柱的稳定性,是治疗骨质疏松患者腰椎滑脱症的有效方法之一。     

后路经椎管内椎体植骨结合椎弓根螺钉系统固定治疗严重腰椎爆裂性骨折的临床研究

目的探讨后路经椎管内椎体植骨结合椎弓根螺钉系统固定治疗腰椎爆裂性骨折的临床疗效。方法回顾性分析泰安市中心医院骨科2006年12月-2012年12月共68例腰椎爆裂性骨折患者,31例为后路椎管减压经椎管内椎体植骨结合椎弓根螺钉系统固定,37例为单纯椎管减压椎弓根螺钉系统固定,随诊6⁴8个月,评价两组术前、术后及随诊时伤椎高度比值、脊柱后凸成角矫正、腰背疼痛并发症、内固定失效情况。结果经椎管内椎体植骨结合椎弓根螺钉系统固定术后椎体前缘高度及术后后凸成角丢失少,内固定失效率低,与单纯内固定无植骨组比较具有统计学差异(P<0.05)。结论经椎管内椎体植骨结合椎弓根螺钉系统固定能有效防止复位固定后的矫正丢失和内固定失效,对治疗严重腰椎爆裂性骨折有良好的临床疗效。     

经椎弓根植骨和自制打平器椎管成形术治疗胸腰椎爆裂骨折

目的：探讨经椎弓根植骨和自制打平器椎管成形术治疗胸腰椎爆裂骨折的方法和效果。方法：对26例胸腰椎骨折在椎弓根固定同时,后路椎板开窗用自制椎管打平器椎管成形,椎弓根内植骨结合中后路植骨治疗,手术后功能康复锻炼。结果：本组随访半年～4年,26例病人中全部Cobb’s角矫正到接近正常。19例椎管功能容积完全恢复,7例狭窄还剩1／10椎管容积。所有病例脊柱稳定,内固定牢固,其中5例Cobb’s角不同程度丢失。无严重的下腰部疼痛和下肢痛,未见断钉、脱钉及断棒现象。结论：经椎弓根植骨在后路手术不加大创伤的同时,增加了椎体骨容量和脊柱前柱的抗压稳定性,椎板开窗后采用自制椎管打平器较少干扰后柱的稳定性就可以探查和椎管成形,手术操作简单容易,创伤小。病人可以早期活动,减少因内固定应力过大造成的断钉脱钉及断棒现象。     

经椎弓根螺钉周围加用骨水泥治疗骨质疏松性脊柱骨折7例的体会

目的 探讨经椎弓根螺钉周围加用骨水泥治疗骨质疏松性脊柱骨折的效果.方法 本组7例严重骨质疏松性脊柱骨折,采用经后路椎管减压,取自体髂骨植骨,经椎弓根螺钉内固定,同时在钉道加用骨水泥.结果 所有患者经过6～48个月随访均达到骨性融合,复位满意,随访期间内固定无松动及断裂现象,腰腿痛JOA评分由术前平均12分恢复至术后平均26分,伤椎高度由术前20％～50％恢复至术后95％;脊柱生理弧度无丢失.结论 椎弓根螺钉周围加用骨水泥治疗骨质疏松性脊柱骨折,是一种有效而安全方法,术后腰腿痛缓解及椎体高度恢复满意.     

后路椎管减压椎弓根螺钉内固定用于腰椎滑脱治疗效果观察

目的观察分析后路椎管减压椎弓根螺钉内固定用于腰椎滑脱治疗效果。方法选取我院从2012年4月到2013年4月收治的腰椎滑落患者共56例。随机将患者分为观察组和对照组两组,其中观察组患者采用后路椎管减压椎弓根螺钉内固定手术方法;对照组采用椎体间植骨融合结合椎弓根内固定手术方法。结果观察组患者的手术时间以及术中的出血量明显要比对照组患者的低,观察组的手术治疗效果的JOA评分优良率为100%,明显高于对照组的93.1%;两组患者手术前后椎间间隙高度的变化,观察组患者椎间间隙增加(2.9±1.0)mm,明显高于对照组的(1.5±0.8)mm。结论后路椎管减压椎弓根螺钉内固定用于腰椎滑脱治疗能够减少手术时间和术中出血量,同时能够取得满意的手术治疗效果。     

后路椎间植骨融合椎弓根钉复位内固定治疗腰椎滑脱

目的回顾性分析后路减压植骨融合椎弓根钉复位内固定治疗腰椎滑脱的疗效及其适应证。方法回顾分析笔者所在医院1997～2006年间收治腰椎滑脱32例患者行后路椎管减压、植骨融合椎弓根钉复位内固定治疗的疗效,观察复位、融合、客观疗效评价及并发症等。结果随访时间3～72个月,X线片示全部患者滑脱椎体复位、植骨融合良好,一过性下肢痛1例,远期并发下腰痛1例。结论后路椎管减压、植骨融合椎弓根钉复位内固定治疗腰椎滑脱可取得良好复位和固定,植骨融合良好,有利于恢复腰椎的正常解剖结构,减少并发症发生并能取得满意临床疗效。     

经伤椎椎弓根植骨治疗胸腰椎爆裂性骨折疗效观察

目的评价经伤椎椎弓根椎体内植骨在治疗胸腰椎爆裂性骨折的疗效。方法通过对15例手术患者的临床疗效进行分析,所有患者均采用经后路短节段内固定联合伤椎椎弓根椎体内植骨的方法,其中2例同时行椎板开窗减压。结果术后平均随访18个月,根据术前及术后的影像学检查显示,术后椎体高度、取出内固定术后伤椎椎体高度及骨折愈合情况良好。结论经伤椎椎弓根椎体内植骨,可有效填充椎体内的骨缺损,恢复椎体高度,重建脊柱前、中柱的稳定性、促进骨折愈合防止内固定取后椎体高度的再次丢失。     

后路短节段椎弓根钉内固定结合骨水泥灌注伤椎成形治疗胸腰椎骨折

目的 探讨后路短节段椎弓根钉内固定结合骨水泥灌注伤椎成形治疗胸腰椎骨折的临床效果.方法 对60例胸腰椎骨折患者在后路短节段椎弓根钉内固定的同时,经伤椎椎弓根注入磷酸钙骨水泥.结果 60例患者手术均成功,术后切口无感染,脊髓神经症状无恶化.随访12～67个月,除3例神经功能A级症状无改善外.其余均有1～3级的恢复.术后3个月腰背疼痛视觉模拟评分法评分2～5分,术后x线摄片显示后凸Cobb角0°～13°,椎体前缘高度恢复至92%～100%,平均96.5%.随访12个月后X线摄片显示后凸Cobb角0°～15°,动力位X线片显示同定段无异常活动,未发现椎弓根钉松动、断裂,椎体高度较术后平均恢复0.5%,12个月后的Frankel分级较术前平均上升2级.结论 椎弓根系统对胸腰椎骨折具有良好的复位和固定作用,经椎弓根注入磷酸钙骨水泥能即时增加椎体的骨容量和脊椎前柱的抗压稳定性.椎弓根钉内固定结合骨水泥灌注伤椎成形是胸腰椎骨折的一种安全有效的治疗方法.     

前路减压与脊柱重建治疗胸腰段椎体爆裂骨折

目的 探讨胸腰段椎体爆裂骨折前路减压与脊柱重建的临床效果.方法 对2005-01/2008-12收治的29例胸腰段椎体爆裂骨折采用前路减压及髂骨或肋骨植骨加Z-plate内固定系统重建脊柱稳定的临床资料进行总结,通过比较术前、术后和随访时X线片和CT片上Cobb角和骨块椎管占位比例来评价后凸畸形矫正、椎管减压程度及植骨融合情况.结果 29例患者术后脊柱序列及生理曲度恢复正常,伤椎椎管内骨折块已完全去除.经平均10个月随访,脊柱序列及生理曲度正常,椎管无占位,植骨融合良好,无继发性后凸畸形发生,无钢板、螺丝钉断裂及松动移位等并发症.结论 该手术可一期实现椎管前方直接减压,使神经获得最大限度的功能恢复,Z-plate内固定直接作用于骨折部位可以对椎体间支撑和对植骨加压,促进植骨融合,适合于胸腰段椎体爆裂骨折的脊柱稳定性重建和早期功能恢复.     

USS复位固定结合球囊扩张椎体成形术治疗胸腰椎爆裂性骨折的临床研究

目的探讨USS椎弓根固定复位并椎体缺损空洞部充填骨水泥即刻获得骨折椎体前中后三柱稳定的方法治疗胸腰椎爆裂性骨折的疗效。方法对9例胸腰椎爆裂骨折患者,采用短节段椎弓根USS钉棒系统复位内固定,根据临床神经症状和影像学资料进行椎管减压或不减压。复位后路于伤椎进行球囊扩张骨水泥充填缺损即刻获得骨折椎体前中后柱稳定。术前术后随访,X线检查。测量伤椎椎体高度变化和相邻间隙变化等。了解术后骨折复位情况以及随访期间内固定有无失败和复位丢失情况。结果椎体高度恢复良好,无塌陷,椎间隙无明显改变,术前神经症状消失。结论USS短节段复位固定骨水泥充填伤椎缺损即刻获得骨折椎体前中后三柱稳定,治疗胸腰椎爆裂性骨折不仅能有效地填充椎体内骨缺损,而且早期下床活动,无椎体高度丢失情况。     

PVP治疗骨质疏松性椎体压缩骨折27例临床观察

目的探讨经皮穿刺椎体成形术治疗骨质疏松性椎体压缩骨折的骨水泥渗漏情况和临床效果。方法回顾性收集我科2008年1月至2010年12月实施的经皮椎体成形术27例（男性6例,女性21例;年龄54～89岁,平均60.7岁）共42节椎体,均为骨质疏松性压缩骨折。通过对术后影像资料的分析统计骨水泥渗漏情况,并采用疼痛视觉模拟标度（visualanaloguescale,VAS）评价患者术前、术后第二天腰背疼痛情况。结果 27例共计42节椎体均成功实施经皮椎体成形术,每个椎体骨水泥注射量在1.5～5ml,平均（2.58±0.30）ml,共有7节椎体出现渗漏,1节发生椎间盘渗漏,其余6节为椎体旁渗漏,总体渗漏率为16.7%（7/42）,未见神经根、脊髓压迫症状等其它相关并发症。所有患者术后VAS评分（1.9±0.3）较术前（7.5±0.6）明显改善（P〈0.001）。结论 PVP能迅速缓解骨质疏松性椎体压缩骨折患者疼痛,手术安全性高,并发症少,适合基层医院开展。     

An evidence-based evaluation of percutaneous vertebroplasty

BACKGROUND INFORMATION: Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure that involves injection of bone cement into a cervical, thoracic, or lumbar vertebral body lesion for the relief of pain and the strengthening of bone. This procedure only recently has been introduced, and is being used for patients with lytic lesions due to bone metastases, aggressive hemangiomas, or multiple myeloma, and for patients who have medically intractable debilitating pain resulting from osteoporotic vertebral collapse. FINDINGS: Results from two uncontrolled prospective studies and several case series reports, including one with 187 patients, indicate that percutaneous vertebroplasty can produce significant pain relief and increase mobility in 70 percent to 80 percent of patients with osteolytic lesions in the vertebrae from hemangiomas, metastases, or myeloma, or with osteoporotic compression fractures. In these reports, pain relief was apparent within one to two days after injection, and persisted for at least several months up to several years. While experimental studies and preliminary clinical results suggest that percutaneous vertebroplasty can also strengthen the vertebral bodies and increase mobility, it remains to be proven whether this procedure can prevent additional fractures in the injected vertebrae. In addition, the duration of effect is not known; there were no long-term follow-up data on most of these patients, and these data may be difficult to obtain and interpret in patients with an underlying malignant process, because disease progression may confound evaluation of the treatment effect. Complications were relatively rare, although some studies reported a high incidence of clinically insignificant leakage of bone cement into the paravertebral tissues. In a few cases, the leakage of polymer caused compression of spinal nerve roots or neuralgia. Several instances of pulmonary embolism were also reported. Although patient selection criteria have not been definitely established, percutaneous vertebroplasty is considered appropriate treatment for patients with vertebral lesions resulting from osteolytic metastasis and myeloma, hemangioma, and painful osteoporotic compression fractures if the following criteria have been met: o Severe debilitating pain or loss of mobility that cannot be relieved by correct medical therapy. o Other causes of pain, such as herniated intervertebral disk have been ruled out by computed tomography or magnetic resonance imaging. o The affected vertebra has not been extensively destroyed and is at least one third of its original height. o Radiation therapy or concurrent surgical interventions, such as laminectomy, may also be required in patients with compression of the spinal cord due to ingrowth of a tumor. CONCLUSIONS: Percutaneous vertebroplasty has only recently been introduced as a treatment for osteolytic lesions and osteoporotic compression fractures of the vertebrae, but early results are promising. Up to 80 percent of patients with pain unresponsive to correct medical treatment experience a significant degree of pain relief, and few serious complications have been reported. However, relatively few patients have undergone this procedure, and there are no data from controlled clinical trials or from studies with long-term follow-up. At the present time this procedure is still in the investigational stages, but may be appropriate for patients with no other reasonable options for medical treatment.     

单、双侧PVP对治疗骨质疏松性椎体骨折的优越性探讨

目的：探讨经单、双侧椎弓根途径行PVP治疗骨质疏松性椎体压缩骨折的优越性。方法：选取2012年3月-2013年8月本院收治的53例骨质疏松性椎体压缩骨折患者,按照随机数字表法将其分为单侧组28例和双侧组25例,单侧组经一侧椎弓根行PVP,双侧组经两侧椎弓根行PVP。观察比较两组患者的手术时间、术中X线透视次数、骨水泥注入量、骨水泥在椎体内弥散程度、视觉模拟疼痛评分（VAS）改善率、椎体高度恢复及并发症发生情况。结果：两组的VAS改善率、椎骨高度恢复及骨水泥在椎体内弥散程度比较差异均无统计学意义（P〈0.05）,而单侧组的手术时间明显短于双侧组,术中X线透视次数、骨水泥用量均明显少于双侧组,差异均有统计学意义（P〈0.05）;两组均无脊髓神经损伤、肺栓塞等并发症的发生。结论：单、双侧PVP治疗骨质疏松性椎体压缩骨折均可取得同样满意的临床疗效,但单侧具有手术时间短、放射暴露少、患者痛苦小等优越性,值得临床推广。     

MSCT多平面重组技术在观察PKP术后骨水泥渗漏中的应用价值

目的：探讨多层螺旋CT（MSCT）多平面重组技术（MPR）在观察经皮穿刺椎体后凸成形术（PKP）后骨水泥渗漏中的应用价值。方法对PKP术后存在骨水泥渗漏的21个椎体的MSCT多平面重组图像和脊柱数字化X线摄影（DR）检查的影像学资料进行回顾性对比分析,其中胸椎6个,腰椎15个。结果21个椎体MSCT多平面重组的图像均发现骨水泥渗漏现象,其中椎体静脉渗漏4处,椎间盘渗漏4处,椎管内渗漏6处,椎旁软组织内渗漏7例,其中有2个椎体为多部位渗漏,检出率为100%。21个椎体中脊柱DR检查发现15个椎体有骨水泥渗漏现象,其中椎体静脉渗漏3例,椎间盘渗漏4例,椎管渗漏2例,椎旁软组织内渗漏6例,可疑椎管渗漏1例,检出率为71.42%。结论MSCT多平面重组技术在观察PKP术后骨水泥渗漏Ⅰ、Ⅳ、Ⅴ型与DR平片无明显差异,但在Ⅱ和Ⅲ型渗漏上较脊柱DR检查更加全面、直观,敏感性更高,特别是可以观察到椎管内骨水泥的数量,占据椎管内的空间、位置,对判断渗漏的骨水泥是否会造成神经根或脊髓的损伤具有重要的临床应用价值。     

经皮球囊扩张椎体成形术的临床疗效观察

目的探讨经皮球囊扩张椎体成形术治疗骨质疏松性椎体骨折与骨肿瘤的临床疗效。方法对30例椎体病变患者采用经皮球囊扩张椎体成形术(PVP)手术方式治疗,对治疗结果进行回顾性统计分析。结果术后椎体高度、Cobb角、疼痛VAS评分均较术前改善,有13例出现少量椎体旁骨水泥渗漏;30例术后随访2～24个月,平均8个月。随访期间,患者的胸腰椎病变处疼痛明显缓解。结论经皮球囊扩张椎体成形术治疗老年骨质疏松性椎体骨折及椎体肿瘤有确切的临床疗效。     

Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: first short term results

OBJECTIVE: To describe the technique of percutaneous vertebroplasty and the short-term results in patients with symptomatic, osteoporotic vertebral compression fractures. DESIGN: Prospective follow-up study. METHOD: In a pilot-study to evaluate the short-term safety and effectiveness of percutaneous vertebroplasty, 18 consecutive patients with a total of 33 osteoporotic thoracic or lumbar vertebral compression fractures were treated from October 2001 to June 2002 with a follow-up of 3-6 months. The indication for treatment was a symptomatic, therapy-resistant osteoporotic vertebral compression fracture. Percutaneous vertebroplasty was performed under radiographic control, after previous intraossal venography, using bone cement mixed with barium sulphate. Post-procedural follow-up consisted of radiological evaluation with conventional thoracolumbar X-rays and MRI scans, and interviews of the patients. RESULTS: Percutaneous vertebroplasty was technically successful in 31 of 33 vertebral fractures (94%), and in 16 of 18 patients (89%). One patient with extreme venous contrast leakage could not be treated. Sixteen patients had less or no pain after treatment. One patient retained thoracolumbar back pain after inadequate cementations and refused further treatment. None of the patients reported aggravation of symptoms following the procedure. Contrast leakage was absent in 18 vertebrae. In 8 vertebrae there was contrast leakage to paravertebral veins. In three of these cases the leakage was so severe that embolisation was performed, with success in one case. In 13 vertebrae, cement leakage to intervertebral and paravertebral spaces and pedicular cement spurs were seen, without clinical consequences. Immediately after the procedure and during follow-up there were no clinically relevant complications. CONCLUSION: Percutaneous vertebroplasty was a technically feasible treatment in these patients with symptomatic, therapy-resistant, osteoporotic vertebral fractures. The first short-term results were comparable with results in the literature. A prospective randomised intervention study will be needed to compare percutaneous vertebroplasty with optimal conservative treatment.     

高黏度骨水泥弥散程度对老年骨质疏松椎体压缩性骨折患者临床疗效的影响

目的探讨高黏度骨水泥弥散程度对老年骨质疏松椎体压缩性骨折患者临床疗效的影响。方法回顾性分析2017年1月至2018年3月在我院行高黏度骨水泥椎体成形手术治疗的86例老年骨质疏松椎体压缩性骨折患者的临床资料,根据术后X线片将骨水泥弥散至上下终板两侧的43例患者纳入观察组,其他43例患者纳入对照组,比较两组患者的临床指标、伤椎高度压缩率及局部后凸角。结果观察组患者的手术时间、透视次数、骨水泥注射量均显著低于对照组(P<0.05)。治疗后,观察组患者的椎体前缘高度压缩率、中线高度压缩率、后缘高度压缩率、局部后凸角度均显著低于对照组(P<0.05)。结论高黏度骨水泥的弥散程度可影响老年骨质疏松椎体压缩性骨折患者的治疗效果,当骨水泥均匀分布于上下终板时,受伤椎体的强度和刚度得到有效提升,可减少骨水泥注射量,促进椎体恢复,有利于改善患者的病情。     

经皮椎体后凸成形术并发症危险因素的探讨

目的 探讨经皮椎体后凸成形术( percutaneous kyphoplasty,PKP)骨水泥外渗并发症的影响因素,为临床治疗和预防提供科学依据.方法 采用回顾性调查方法,收集PKP治疗的58例(97个椎体)椎体骨质疏松性骨折(osteoporotic vertebral compression fracture,OVCF)患者的临床资料,多因素Logistic回归分析骨水泥渗漏的影响因素.结果 所有患者术中均未发生球囊破裂、神经以及脊髓损伤,均对手术完全耐受.对58例患者进行6 ～ 24个月的随访,平均随访时间为(14.5±5.5)个月.患者经治疗后,VAS评分、椎体前缘及Cobb角高度均明显改善(均有P＜0.001).采用多因素Logistic回归分析显示,骨水泥注入量多(OR=7.235,P＜0.001)、有椎体周壁破坏(OR=21.165,P＜0.001)是导致骨水泥渗漏的主要影响因素.结论 骨水泥注入量过多、有椎体周壁破坏是影响PKP手术发生骨水泥渗漏的主要危险因素,应当提高手术技术以预防骨水泥渗漏并发症的发生.     

后路手术治疗中上胸椎骨折脱位

目的 探讨后路减压内固定治疗中上胸椎骨折脱位的方法及效果.方法 2002年9月至2007年9月采用后路手术治疗中上胸椎骨折脱位21例.其中压缩性骨折5例,爆破型骨折4例,骨折脱位12例;完全性瘫痪12例,不完全性瘫痪9例.本组减压复位后均采用椎弓根螺钉系统固定,骨折块突入椎管者,行侧后方骨折块复位或摘除减压.观察患者手术时间、出血量,测量手术前后胸椎滑移程度及椎间隙夹角.以Frankel评分系统评价神经功能.结果 本组患者随访0.5～5.0(2.5±0.5)年.术前Frankel评分(1.0±0.1)分,术后(1.3±0.1)分;其中不完全性瘫痪者术前评分(2.2±0.2)分,术后(3.1±0.2)分.术后椎间隙高度、椎间隙夹角及滑移百分比较术前改善(P＜0.05).内植物无松脱或移位.结论 中上胸椎骨折脱位脊髓损伤程度重,预后差.不稳定性骨折应及时行融合及内固定术,合并有不完全性脊髓损伤者应同时行减压手术.早期后路手术,患者能获得满意的复位和即刻稳定性,脊髓功能获不同程度改善.