椎体强化术后邻近椎体再骨折的治疗

[目的]探讨椎体强化术后邻近椎体再骨折行椎体成形术的治疗方案。[方法]2008年11月~2014年6月采用经皮椎体成形术、抗骨质疏松及康复功能锻炼治疗经皮椎体强化术术后椎体再骨折22例。记录并分析伤椎高度压缩率、伤椎后凸Cobb角、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)评价及再骨折发生率。[结果]术后随访15~49个月,平均(17.3±6.2)个月。所有患者骨水泥注射过程顺利。术后CT扫描显示5例出现骨水泥渗漏,渗漏发生率为22.73%,其中椎管内渗漏1例,椎间隙渗漏2例,椎间盘渗漏1例,针道渗漏1例。均无明显症状,未行特殊处理。1例邻近椎体骨折,发生率为4.55%。患者术后伤椎高度压缩率、伤椎后凸Cobb角、VAS及ODI评价较术前明显改善,差异具有统计学意义(P0.01)。[结论]经皮椎体成形术、抗骨质疏松及康复功能锻炼是治疗椎体强化术后邻近椎体再骨折的有效方法,止痛效果好,并且能够改善椎体形态,减少邻近椎体再骨折的发生率。     

Classification of vertebral compression fractures in the osteoporotic spine

OBJECTIVE: The purpose of this study was to clarify the relationship between initial radiographs of osteoporotic vertebral compression fractures (VCFs) and clinical results. METHODS: Of the 135 VCFs in the elderly, 73 consecutive patients (84 vertebrae) were reviewed retrospectively. All patients were treated without rigid immobilization. The subjects consisted of 15 men and 58 women. The mean age was 75.0 years with a range from 61 to 91 years. The early radiographic features were classified into five types based on lateral radiographs. Radiographic results during follow-up were evaluated according to the number of collapsed vertebrae and vacuum clefts. Clinical results were evaluated by Visual Analog Scale and activities of daily living. RESULTS: Of the five types, swelled-front-type, bow-shaped-type, and projecting-type fractures had a poor prognosis with late collapse and often showing a vacuum cleft. On the other hand, concave-type and dented-type fractures had a good prognosis and almost achieved fusion. Clinical results of 28 patients with vacuum clefts were fair at the final follow-up. Nineteen patients had little back pain, and nine patients experienced moderate back pain. Regarding the activities of daily living, four patients had difficulty walking.     

骨质疏松性椎体压缩性骨折手术治疗后的死亡率分析

背景：骨质疏松性椎体压缩性骨折（OVCFs）是老年人常见的骨折类型,椎体成形术（PVP）或椎体后凸成形术（PKP）可有效缓解OVCFs引起的疼痛,提高老年患者的生活质量,国内外针对其术后死亡率的相关文献报道鲜见。目的：总结OVCFs手术治疗的术后死亡率,探讨患者术后死亡的原因。方法：回顾性分析2003年3月至2010年6月因OVCFs行PVP或PKP并获得随访的203例患者资料。根据总体死亡率和术后1年内死亡率分析患者的死亡原因及其构成特点。结果：PVP或PKP治疗OVCFs的术后死亡率为14.7%%（30/203）,术后1年内死亡率为5.4%（11/203）,无一例发生围手术期死亡。死亡原因依次为心血管事件（9例）、呼吸功能衰竭（7例）、慢性疾病引起的多器官功能衰竭（5例）、恶性肿瘤（5例）、脑血管疾病（3例）、原因不明（1例）。统计结果显示年龄、性别、是否有基础疾病是影响死亡率的主要因素。PVP与PKP治疗OVCFs的患者死亡率无统计学差异。结论：行PVP或PKP治疗OVCFs的创伤小,能显著缓解疼痛,适用于高龄患者,可降低术后死亡率。     

骨质疏松性椎体压缩性骨折椎体强化术后再骨折相关因素研究

目的探讨骨质疏松性椎体骨折椎体强化术(椎体成形PVP和椎体后凸成形PKP)术后椎体再骨折发生的临床特点和危险因素。方法回顾性分析2008年8月～2011年8月在我院行经皮椎体强化术的171例患者,其中再发椎体骨折19例27个椎体(A组),未再发骨折152例作为对照(B组)。所有患者获得随访6～16个月,平均13个月。记录患者临床资料、骨水泥注入量、测量椎体前缘椎体高度及Cobb角变化等并进行多因素Logistic回归分析;记录再次手术前、后第1天及末次随访VAS评分。结果 16个椎体发生在PVP术后相邻椎体(84.2%),其中9个椎体术后2个月内发生;骨水泥向椎间盘渗漏在A、B组间有显著性差异(P<0.05);椎体强化术在再骨折术前、后VAS评分有显著性差异(P<0.05)。结论骨质疏松性椎体再骨折发生具有一定危险因素,椎体强化术可以取得满意的治疗效果,同时应该加强骨质疏松药物治疗。     

经皮椎体强化术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮椎体强化术（Percutaneous vertebral augmentation,PVA）治疗骨质疏松性椎体压缩性骨折的临床效果。方法对我院2004年4月至2008年1月间全部共48例应用经皮椎体强化术治疗骨质疏松性胸鹿椎压缩性骨折的临床资料进行回顾性分析。结果所有病例疼痛均得到明显缓解,无一例发生重大并发症。其中7例邻近椎体再发骨折,3例反复行3次手术。结论经皮椎体强化术是治疗骨质疏松性胸腰椎压缩性骨折的一种有效、安全和微创的方法。     

胸腰椎骨质疏松性椎体压缩性骨折椎体强化术后腰背痛原因的研究进展

<正>在我国人口老龄化进程中,骨质疏松性椎体压缩性骨折(OVCF)患者逐年增多。研究表明,我国40岁以上和50岁以上人群骨质疏松症的总发生率分别为13.2%[1]和18.56%[2],骨质疏松症是老年骨折的高危因素,且脊柱和髋部骨折排前两位[3]。目前临床治疗胸腰椎OVCF的微创手术方法主要包括经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)。据报道,PVP/PKP治疗胸腰椎OVCF疼痛     

Treatment of multiple osteoporotic vertebral compression fractures by percutaneous cement augmentation

Purpose

Vertebral compression fractures cause significant pain and some patients are debilitated by the pain due to the fracture. Conventional surgery carries a high risk and has a poor outcome. Vertebroplasty is a minimally invasive surgical procedure, which in vertebral fractures restores stability and diminishes pain. The aim of the study was to analyse the effectiveness and safety of vertebroplasty in multiple vertebral compression fractures with a 24-month follow-up.

Methods

Vertebroplasty was performed in 160 patients with multiple osteoporotic compression fractures under local anaesthesia, using a unilateral transpedicular approach. The level of pain was assessed according to a 10-cm visual analogue scale. The patients were observed for 24 months after surgery.

Results

Vertebroplasty significantly diminished the level of pain in 90 % of patients, and half of them were free of pain within 12 hours after surgery. Only 4 % of the patients did not benefit from this type of treatment. During the 24-month follow-up these results changed only slightly, and after two years almost 80 % still benefited, while the number of unsatisfactory results changed from 6 to 9 %. No serious clinical complications were noted; in three patients new fractures appeared during the two year observation period.

Conclusions

Vertebroplasty should be seriously taken into account as a primary method of treatment in patients with multiple osteoporotic vertebral compression fractures.     

经皮钛网骨水泥填充治疗骨质疏松性椎体压缩骨折

[目的]介绍经皮钛网骨水泥填充治疗老年性骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures, OVCFs)的临床技术与初步效果。[方法] 2016年5月～2018年5月,使用经皮钛网置入支撑骨水泥填充治疗OVCFs30例。术中透视定位责任椎体的双侧椎弓根,逐渐置入穿刺针,达到椎体中前1/3,将球囊带钛网支架沿外套管置入椎体内,扩张以撑开椎体恢复高度后,钛网同时释放,注入骨水泥。[结果] 30例患者均顺利完成手术。随时间推移VAS和ODI评分均显著降低,不同时间点间差异有统计学意义(P<0.05)。影像检查显示,术中正位骨水泥弥散过中线,侧位像弥散占比椎体4/5,骨水泥分布均匀。术后Beck指数和Cobb角较术前显著减小,差异有统计学意义(P<0.05)。[结论]钛网置入支撑骨水泥填充是治疗老年性OVCFs的有效方法,能较好维持强化后椎体的高度及稳定性。     

Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty

Introduction  

It is still controversial whether adjacent level compression fractures after balloon kyphoplasty (BK) and vertebroplasty (VP) should be regarded as the consequence of stiffness achieved by augmentation with bone cement or if the adjacent level fractures are simply the result of the natural progression of osteoporosis. The purpose of this study was to evaluate the adjacent level fracture risk after BK as compared with VP and to determine the possible dominant risk factor associated with new compression fractures.     

Biomechanical evaluation of kyphoplasty with calcium sulfate cement in a cadaveric osteoporotic vertebral compression fracture model.

BACKGROUND CONTEXT: Vertebral compression fractures can cause deformity, pain, and disability. Kyphoplasty involves percutaneous insertion of an inflatable balloon tamp into a fractured vertebra followed by injection of polymethylmethacrylate (PMMA) bone cement. PMMA has several disadvantages such as potential thermal necrosis and monomer toxicity. Calcium sulfate cement (CSC) is nontoxic, osteoconductive, and bioabsorbable. PURPOSE: To evaluate the biomechanical performance of CSC for kyphoplasty in cadaveric osteoporotic vertebral bodies. STUDY DESIGN: Destructive biomechanical tests using fresh cadaveric thoracolumbar vertebral bodies. METHODS: Thirty-three vertebral bodies (T9 to L4) from osteoporotic cadaveric spines were disarticulated, stripped of soft tissue, and measured for height and volume. Each vertebral body was compressed at 0.5 mm/s using a hinged plating system on a materials testing machine to create an anterior wedge fracture and reduce the anterior height by 25%. Pretreatment strength and stiffness were measured. Two KyphX inflatable balloon tamps were used to reexpand each vertebral body. After randomization, three groups were created: Group A-no cement; Group B-PMMA; Group C-calcium sulfate cement. Groups B and C were filled with the corresponding cement to 25% of the vertebral body volume. All vertebral bodies were then recompressed by 25% of the post-kyphoplasty anterior height to obtain posttreatment strength and stiffness. RESULTS: Treatment with PMMA restored vertebral strength to 127% of the intact level (4168.2 N+/-2288.7) and stiffness to 70% of the intact level (810.0 N/mm+/-380.6). Treatment with CSC restored strength to 108% of the intact level (3429.6 N+/-2440.7) and stiffness to 46% of the intact level (597.7 N/mm+/-317.5). CSC and PMMA were not significantly different for strength restoration (p=.4). Significantly greater strength restoration was obtained with either PMMA or CSC, compared with the control group (p=.003 and .03, respectively). Stiffness restoration tended to be greater with PMMA than for CSC, but this difference was not statistically significant (p=.1). Both cements had significantly greater stiffness when compared with the control group (p=.001 and p=.04, respectively). CONCLUSIONS: Use of CSC for kyphoplasty yields similar vertebral body strength and stiffness as compared with PMMA. It may be a useful alternative bone cement for kyphoplasty. Further studies are required to assess the bioabsorption of CSCs after kyphoplasty in vivo.     

骨质疏松性椎体压缩骨折PVP术后相邻椎体骨折的相关因素分析

目的:探讨骨质疏松性椎体压缩性骨折(OVCFs)患者行经皮椎体成形术(PVP)后相邻椎体骨折的相关因素。方法:对2004年3月～2008年6月112例行单节段PVP治疗的OVCFs患者进行回顾性分析。记录患者的年龄、性别、病程、有无外伤、术前椎体压缩程度、骨密度、手术入路(单侧或双侧)、麻醉方式、有无侧凸畸形、骨水泥剂量、骨水泥渗漏至椎间盘等情况。应用单因素和多因素Logistic回归分析研究各因素与PVP术后发生相邻椎体骨折的关系。结果:112例患者中有21例患者术后发生相邻椎体骨折共23个椎体,发生率为18.8%。单因素分析结果显示患者术前椎体压缩程度、骨密度、骨水泥剂量、骨水泥渗漏至椎间盘与术后发生相邻椎体骨折有显著相关性(P0.05),而患者年龄、性别、病程、有无外伤、手术入路、麻醉方式、有无侧凸畸形与术后相邻椎体骨折无显著相关性(P0.05)。多因素分析结果显示患者术前椎体压缩程度较重、骨水泥注射量较大及骨水泥渗漏至椎间盘与术后发生相邻椎体骨折相关(P0.05)。结论:OVCFs患者PVP术后相邻椎体骨折可能与术前椎体压缩程度、骨水泥渗漏至椎间盘、骨水泥注射量等因素相关。     

骨质疏松性椎体压缩骨折PVP术后非手术椎体骨折的相关因素分析

【摘要】　目的：探讨骨质疏松性椎体压缩骨折（OVCFs）经皮椎体成形术（PVP）后非手术椎体骨折的相关因素。方法：2007年1月～2010年3月门诊和病房共收治OVCFs PVP术后非手术椎体骨折患者42例,男8例,女34例,年龄55～82岁,平均67.3岁,均行脊柱X线片及MRI检查,确诊为相邻或非相邻椎体骨折;选取同期随访的PVP术后非手术椎体无骨折患者68例,男17例,女51例,年龄52～75岁,平均60.1岁。应用双能X线吸收法测定腰椎（L2～L4）骨密度值,并记录患者年龄、性别、体重指数、术前是否长期（超过1年）服用糖皮质激素类药物、手术部位（胸椎或腰椎）及单双侧入路等情况,分析引起非手术椎体骨折的相关因素。结果：单因素分析显示两组患者在年龄、骨密度及是否长期服用糖皮质激素方面比较差异有统计学意义（P＜0.05）,在性别、体重指数、手术部位及入路方面比较差异无统计学意义（P＞0.05）。多因素分析显示高龄、骨密度T值≤-2.5SD及长期服用糖皮质激素是导致PVP术后非手术椎体骨折的危险因素,其OR值分别为3.775、5.980、3.401（P＜0.05）。结论：高龄、骨质疏松及服用糖皮质激素药物超过1年是导致OVCFs患者PVP术后非手术椎体骨折的相关因素。     

Risk factors for newly developed osteoporotic vertebral compression fractures following treatment for osteoporotic vertebral compression fractures

Background context

It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.

骨质疏松性椎体压缩骨折经皮椎体强化术后椎体高度再丢失的研究进展

正经皮椎体强化术包括经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP),两者通过微创手术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF),可有效缓解疼痛、恢复压缩椎体高度和脊柱稳定性。但近年来观察到PVP和PKP术后恢复的椎体高度存在再丢失现象(没有创伤的情况下),术后椎体高度的再丢     

Surgical patterns in osteoporotic vertebral compression fractures

Purpose

To report morphological patterns of osteoporotic vertebral compression fractures (OVCFs) presenting for surgery. To describe surgical options based on fracture pattern. To evaluate clinical and radiological outcome.

Methods

Forty consecutively operated OVCFs nonunion patients were retrospectively studied. We define four patterns of OVCFs that needed surgical intervention. Group 1 mini open vertebroplasty (N = 10) no neurologic deficits and kyphotic deformity, but with intravertebral instability and significant radiological spinal canal compromise. Group 2 with neurologic deficits (N = 24) (2A)—transpedicular decompression (TPD) with instrumentation (N = 14). Fracture morphology similar to (1) and localized kyphosis <30° (2B)—pedicle subtraction osteotomy (PSO) with instrumentation (N = 10). Fracture morphology similar to (1) and local kyphosis >30°. Group 3 posterolateral decompression with interbody reconstruction (N = 06) endplate(s) destroyed, with instability at discovertebral junction, with neurologic deficit. Average follow-up was 34 months. VAS, ODI and Cobb angle were recorded at 3, 6, 12 months and yearly.

Results

There was significant improvement in the clinical (VAS and ODI) scores and radiologic outcome in each group at last follow-up. 30 patients out of 40, had neurologic deficits (Frankel’s grade C = 16, Frankel’s grade D = 14). The motor power gradually improved to Frankel’s grade E. Average duration of surgery was 97 min. Average blood loss was 610 ml.

Conclusion

Different surgical techniques were used to suit different fracture patterns, with good clinical and radiological results. This could be a step forward in devising an algorithm to surgical treatment of OVCF nonunions.     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折后非手术椎体骨折的原因分析

目的 探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)后非手术椎体骨折的相关影响因素.方法 回顾性分析2014年1月至2015年12月于深圳市第二人民医院行PKP治疗OVCF的133例(174椎)病人的临床资料,根据有无椎体新发骨折,分为再骨折组与对照组.随访时间为12~18个月,平均为(15.48±2.28)个月,统计分析病人的性别、年龄、身体质量指数(body mass index,BMI)、腰椎骨密度、受伤椎体个数、骨水泥用量、手术入路、骨水泥是否渗透至椎间盘、术后伤椎前缘高度恢复率以及Cobb角恢复率等因素.结果 术后28例(21.05%,28/133)病人再发骨折,再骨折组的平均年龄为(76.32±7.59)岁,5例发生骨水泥渗透至椎间盘(17.86%,5/28),腰椎骨密度T值为(-3.60±0.79)SD,椎体前缘高度恢复率为(50.39±1.87)%,Cobb角恢复率为(53.07±3.91)%,以上指标与未再发骨折的病人比较,差异均有统计学意义(P均<0.05).对以上指标进行多因素Logistic回归分析结果显示仅骨密度与再骨折的发生存在显著相关性(P=0.031).结论 骨密度、年龄、骨水泥向椎间盘渗漏、椎体前缘高度恢复率及Cobb角恢复率是PKP术后出现非手术椎体骨折的相关因素,但术前骨密度是其独立危险因素.