注入骨水泥椎体成形与非手术治疗骨质疏松性椎体压缩骨折的Mela分析

背景：注入骨水泥椎体成形或称经皮椎体成形术作为治疗骨质疏松性椎体压缩骨折的微创技术,一些病例报道及非随机对照研究揭示了椎体成形对骨质疏松性椎体压缩骨折引起的疼痛有效。然而,这些研究主要基于回顾性的病例分析,缺乏高质量的随机对照研究。目的：通过系统评价Meta分析的方法对椎体成形术与非手术治疗骨质疏松性椎体压缩骨折的疗效进行评价。方法：计算机检索Cochrane Library（2010年第4期）、PubMed（1966／2010-11）、EMBASE（1974／2010-11）、CBM（1978／2010-11）、CNKI（1994／2010-11）、和万方数据库（1997／2010-11）。纳入椎体成形术与非手术治疗骨质疏松性椎体压缩骨折的随机对照试验,按照CochraneHandbook5．0进行严格的质嚣评估,采用RevMan5.0.1软件进行Meta分析。结果与结论：共纳入4个随机对照试验,共445例患肯。Meta分析结果硅示,与保守治疗比较,随访1,4,24,48周时椎体成形术在缓解疼痛方面更明显,在新发骨折发生方面,两种治疗方法没有差别：与安慰剂相比,随访4周时椎体成形术在缓解疼痛、提高腰部功能活动及改善生活质量方面并无明昆优势。受系统评价纳入研究数量以及质最的限制,上述结论尚需要更多高质量的随机对照试验进一步验证。     

单双侧球囊灌注骨水泥椎体成形修复骨质疏松性椎体压缩骨折的系统评价

背景:经皮球囊灌注骨水泥椎体成形已被证实对骨质疏松性压缩骨折有效,但相关的随机对照试验存在样本量小和方法学上的缺陷,因此单侧入路或者双侧入路椎体后凸成形修复骨质疏松性压缩骨折孰优孰劣,仍存在争议。目的:使用系统评价的方法对经皮球囊灌注骨水泥椎体成形单侧入路与双侧入路方法进行分析,以期为椎体后凸成形入路及灌注骨水泥过程中的技术选择提供依据。方法:计算机检索Cochrane Library、PubMed、OVID、Embase、中国生物医学文献数据库、万方数据库、维普资讯等中英文数据库,手工检索9种国内相关杂志,检索日期均从创刊至2014年3月,收集单侧与双侧入路经皮球囊灌注骨水泥椎体后凸成形修复骨质疏松性椎体压缩骨折的随机对照试验,由2名系统评价员按纳入与排除标准选择试验、提取资料和质量评价后,并用RevMan 5.2软件进行Meta分析。结果与结论:最终纳入8个随机对照试验,共507例患者656个椎体。结果显示,骨水泥渗漏方面两组差异无显著性意义;术前目测类比评分[WMD=-0.05(P=0.58)]、短期随访(≤3个月)[WMD=-0.02(P=0.25)]与长期随访(≥12个月)[WMD=-0.08(P=0.64)],两组差异无显著性意义;Oswestry功能障碍指数(ODI)短期随访[WMD=-0.13(P=0.73)]和长期随访[WMD=-0.26(P=0.81)],两组差异无显著性意义;骨水泥用量和操作时间两组差异有显著性意义,单侧入路较双侧入路有优势;影像学结果中术前、术后后凸角及角度恢复值,差异均无显著性意义提示单侧和双侧入路经皮球囊灌注骨水泥椎体后凸成形修复骨质疏松性椎体压缩骨折,在目测类比评分、影像学结果、并发症方面无明显差异;但在手术时间和放射暴露时间上,单侧入路优于双侧入路。     

后凸成形与椎体成形治疗骨质疏松性椎体压缩骨折的Meta分析

背景：经皮椎体成形和经皮球囊扩张椎体后凸成形均可有效治疗骨质疏松性压缩骨折,但具体采用哪种方法,国内外仍存在争议。 目的：比较球囊后凸成形与经皮椎体成形治疗骨质疏松性腰椎压缩性骨折的临床疗效和安全性。 方法：计算机检索 PubMed,Springer 以及万方等数据库,手工检索相关的中英文骨科杂志。按照既定的纳入和排除标准查找有关后凸成形术与经皮椎体成形术治疗骨质疏松性椎体压缩骨折疗效进行比较的文献。利用Cochrane协作网提供的RevMan5.0软件进行统计学分析。 结果与结论：共纳入符合标准的文献10篇,其中随机对照研究1篇,前瞻性队列研究9篇。Meta分析结果显示：两种方法操作时间、治疗后长期疼痛目测类比评分比较差异均无显著性意义。与经皮椎体成形组相比,椎体后凸成形组可以更好地增加椎体前缘高度,降低骨水泥渗露的发生率,以及减小远期后凸角。表明与经皮椎体成形相比,经皮球囊扩张椎体后凸成形可以更好地减小远期后凸角,增加椎体前缘高度,降低骨水泥渗露率。     

椎体成形治疗伴椎体裂隙骨质疏松性椎体压缩骨折

背景：临床实践证明经皮椎体成形治疗骨质疏松性椎体压缩骨折有显著的疗效。 目的：比较经皮椎体成形治疗伴或不伴椎体内裂隙样变骨质疏松性椎体压缩骨折的治疗效果,以确定椎体成形治疗椎体裂隙样变骨质疏松性椎体压缩骨折的有效性和安全性。 方法：选择骨质疏松性椎体压缩骨折患者76例,分两组,实验组27例伴椎体内裂隙样变,对照组49例不伴椎体内裂隙样变。采用椎体成形治疗后,比较两组间目测类比评分和Oswesty功能障碍指数值、椎体前缘高度的变化,以及发生骨水泥外漏的类型和特点。 结果与结论：两组治疗后的目测类比评分、Oswesty功能障碍指数值均明显低于治疗前（P0.05）。两组治疗后的伤椎高度与治疗前比较差异无显著性意义（P〉0.05）。说明椎体成形是减轻伴或不伴有椎体裂隙骨质疏松性椎体压缩骨折患者疼痛,改善脊柱活动功能及提高患者社会活动能力的有效方法,但不能有效恢复椎体高度。     

经皮椎体成形术治疗骨质疏松性椎体压缩骨折

目的 探讨椎体成形术治疗骨质疏松性椎体压缩骨折的疗效。方法 对9例有腰背部疼痛的骨质疏松性椎体压缩骨折的患者进行了椎体成形术治疗；其中3例PVP，6例PKP。术后随访1～9月。结果 9例患者均于术后2～24小时疼痛消失或明显改善。结论 椎体成形术是治疗骨质疏松性椎体压缩骨折的一种有效、安全和微创的方法。     

骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折患者的围术期护理

目的:探讨骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折患者的围术期护理方法及效果。方法:选择2018年3月1日～2019年3月31日94例骨质疏松性椎体压缩骨折患者作为研究对象,均在我院接受骨水泥椎体成形术,按照随机数字表法分为研究组和对照组各47例;对照组给予常规护理,研究组在对照组基础上细化围术期护理;调查干预前后两组情绪状态[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)],椎体高度,Cobb角,疼痛程度采用视觉模拟评分(VAS)、日常生活能力[采用生活能力量表(ADL)]、生活质量[采用生活质量评分调查问卷(QOL)]及满意程度。结果:两组干预后SAS、SDS评分均低于干预前(P0.01),且研究组低于对照组(P0.01);研究组椎体高度、满意度、ADL评分及QOL评分均高于对照组(P0.01);研究组Cobb角、VAS评分均低于对照组(P0.01)。结论:在骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折中运用围术期护理效果显著,可减轻患者负性情绪,缓解疼痛,提高满意度,促进日常生活能力恢复,提升生活质量。     

经皮椎体成形术改善骨质疏松性椎体压缩骨折患者的疼痛症状

采用经皮穿刺、椎弓根入路向患椎注射骨水泥(PMMA)，治疗骨质疏松症并发椎体压缩骨折患16例23个椎体，观察其临床疗效及并发症。     

改良小剂量骨水泥椎体成形治疗急性骨质疏松性压缩骨折

背景：经皮椎体成形技术已成为临床治疗脊柱骨质疏松性骨折的有效手段,但存在骨水泥渗漏风险。目的：探讨改良小剂量骨水泥椎体成形治疗急性骨质疏松性压缩骨折的效果。方法：选择2008年9月至2011年2月收治的32例骨质疏松性压缩骨折患者进行经皮椎体成形治疗,将患者按照骨水泥注入量分为改良小剂量组和常规剂量组,改良小剂量组骨水泥注入量为2-4 mL,常规剂量组骨水泥注入量为4-6 mL,将同期入院急性骨质疏松压缩骨折因手术禁忌无法进行椎体成形治疗的患者列为对照组。结果与结论：改良小剂量组和常规剂量组末次随访时疼痛缓解及椎体高度恢复率明显优于对照组（P＜0.05）。改良小剂量组骨水泥渗漏率、末次随访时相邻节段椎体继发骨折发生率明显低于常规剂量组（P＜0.05）,末次随访时椎体高度恢复率低于常规剂量组（P＜0.05）。说明椎体成形治疗操作过程中,应用改良小剂量骨水泥方法在达到满意临床效果同时,可有效减少骨水泥渗漏、相邻节段继发骨折等并发症发生率。     

骨质疏松性椎体压缩骨折患者经皮椎体成形注入黏丝期骨水泥后的再骨折

背景:目前经皮椎体成形术已成为治疗骨质疏松性椎体压缩骨折的首选方法,但其骨水泥注入后邻近椎体骨折并发症也在逐年增加,椎体成形过程中常采用黏丝期骨水泥注射,而骨水泥注射时状态可影响其在椎体内分布.目的:回顾性分析骨质疏松性椎体压缩骨折经皮椎体成形注入黏丝期骨水泥后再骨折的原因.方法:2006-07/2009-11对112例骨质疏松性椎体压缩骨折行经皮椎体成形术,术中DSA机透视引导下经单侧或双侧椎弓根入路,调配聚甲基丙烯酸甲酯骨水泥至黏丝期后经工作通道注入,并观察疗效.结果与结论:每个椎体注入骨水泥2.4～6.0 mL,平均(3.40±1.02)mL.术中骨水泥渗漏至椎旁14例,椎间隙内15例.患者术后全部得到随访,随访时间6～15个月,平均(9.61±2.82)个月,未发现特殊的材料和宿主反应,29例患者疼痛再发,其中15例经MRI证实手术相邻椎体发生新鲜骨折,再次给予经皮椎体成形手术后疼痛症状缓解.结果提示经皮椎体成形注入黏丝期的骨水泥后应力集中、术中灌注剂渗漏椎间隙等综合因素增加了术后相邻椎体再次发生骨折的危险,寻找理想的骨水泥替代物将成为今后临床研究的方向.     

骨水泥充填椎体成形治疗骨质疏松性椎体压缩骨折：6年随访

背景：经皮椎体成形应用于骨质疏松性椎体压缩骨折的治疗已取得很好的效果,但其远期的疗效及对患者的影响至今少有报道。目的：随访分析骨水泥充填椎体成形治疗骨质疏松性椎体压缩骨折的远期疗效。方法：选择骨质疏松性椎体压缩性骨折并行经皮椎体成形治疗的患者34例,对成形前、成形后1周和成形后平均6年进行目测类比评分及标准侧位X射线片上病变椎体高度、脊柱后凸畸形角进行测量与比较,观察成形后远期疗效。结果与结论：成形后1周及平均6年的脊柱后凸畸形角较成形前降低,成形后随访期内变化不明显。成形后椎体高度较成形前明显恢复（P〈0.01）;成形后1周及成形后平均6年随访期内椎体高度变化不显著。成形后1周及成形后平均6年的目测类比评分较成形前降低明显（P〈0.01）,但随时间延长,目测类比评分有升高趋势。以上各指标在成形后平均6年随访中基本维持稳定。结果证实,椎体成形治疗骨质疏松性椎体压缩骨折安全而有效,远期疗效肯定。     

单侧与双侧入路脊柱行后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析

背景:椎体后凸成形明显改善了骨质疏松性椎体压缩骨折的治疗过程,但临床上对于单侧入路还是双侧入路还存在一定争议.目的:对比单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的疗效.方法:全面收集椎体单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的随机对照研究,由两个研究者独立评价文献,并采集数据,在严格文献质量评价的基础上,进行Meta系统评价.结果与结论:共纳入5篇文献,241例患者.在止痛及骨水泥渗漏方面,两种脊柱入路差异无显著性意义(P=0.99,P=0.56);在改善后凸角度方面,双侧入路优于单侧入路(P=-0.05);在手术时间方面,单侧入路优于双侧入路(P＜0.000 01).表明单侧入路与双侧入路均能明显减轻疼痛,二者差异无显著性意义;二者骨水泥渗漏率差异无显著性意义;双侧入路可更好地改善脊柱后凸角度,但手术时间较长:鉴于纳入的文献质量不高,结论尚需更多设计严谨的随机对照研究加以证实.     

经皮骨水泥注入椎体成形修复骨质疏松性胸腰椎压缩骨折

背景：经皮椎体成形通过注入骨水泥材料强化压缩骨折椎体的稳定性,防止椎体进一步塌陷,发挥显著的止痛效果,但易出现骨水泥渗漏等并发症。目的：进一步评估聚甲基丙烯酸甲酯骨水泥经皮椎体成形治疗骨质疏松性胸腰椎压缩骨折的疗效及安全性。方法：65例骨质疏松性胸腰椎椎体压缩骨折患者在 DSA 机引导下行聚甲基丙烯酸甲酯骨水泥经皮椎体成形治疗,对比治疗前后目测类比评分、Oswesty 功能障碍指数、椎体高度、椎体后凸角度变化,以及骨水泥渗漏情况。结果与结论：治疗后1 d目测类比评分和Oswesty功能障碍指数较治疗前降低（P〈0.01）,治疗后1个月时目测类比评分和Oswesty功能障碍指数进一步降低,与治疗后1 d比较差异有显著性意义（P〈0.05）,治疗后1,3,6个月时间点两两比较差异无显著性意义（P〉0.05）。与治疗前比较,治疗后3 d椎体前缘高度和中央高度明显恢复（P〈0.05）,Cobb角明显矫正（P 〈0.05）,至6个月后大部分椎体高度和Cobb角仍保持稳定。影像学复查显示椎旁骨水泥少量渗漏6例,其中椎旁软组织内渗漏2例,相邻椎间盘内渗漏4例,均无明显临床症状,未见神经损伤病例。提示聚甲基丙烯酸甲酯骨水泥经皮椎体成形可迅速缓解骨质疏松性椎体压缩骨折患者的疼痛,提高多数椎体的高度,改善后凸畸形且不良反应少。     

Percutaneous vertebroplasty with bone cement in the treatment of osteoporotic vertebral compression fractures

Background. The authors report their own experience with percutaneous vertebroplasty. This is minimally invasive method indicated in treatment of certain spinal lesions affecting the vertebral bodies, as osteoporotic fractures, angiomas, neoplasms. The basic principle of this method is insertion of the needle into the vertebral body by transpediculat access. Needle gives an access for biopsy and therapeutic cement injection. Material and methods. Since October 1999 the authors treated 11 patients with osteoporotic compressive fractures of the spinal column. All patients suffered from severe back pain. Transpedicular insertion of the needle was realized under radiofluoroscopy or CT guidance. Fractured vertebral bodies were injected by Methylmethacrylate bone cement Palacos R. Results. All patients declared important improvement, no complications were observed. Conclusions. Transpedicular vertebroplasty is is effective in treatment of vertebral osteoporotic compression fractures. Minimally invasive procedure requiring local anaesthesia is well-tolerated by patients. Cement injection protects the vertebral body against further compression.     

骨水泥增强技术治疗骨质疏松性椎体压缩骨折的并发症☆

背景:椎体成形和椎体后凸成形是治疗骨质疏松性椎体压缩骨折的微创方法。目的:评价椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的安全性。方法:计算机检索Medline、EMBASE、中国知网、维普数据库、万方数据库1990年1月至2012年1月有关椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折并发症的文献。结果与结论:检索出62篇文献,8993例患者。椎体成形和椎体后凸成形治疗的穿刺手术并发症与其他并发症差异无显著性意义。椎体成形治疗的骨水泥渗漏率、新发骨折率高于椎体后凸成形治疗(P=0.00006,P=0.02);二者的相邻椎体骨折率差异无显著性意义。表明椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的严重并发症非常低,两种治疗方式相邻椎体骨折率、穿刺手术并发症及其他并发症无明显差异,但椎体后凸成形治疗后骨水泥渗漏、新发骨折率低于椎体成形治疗,此次系统评价结果尚需要大样本前瞻性研究证实。     

Osteoporotic vertebral compression fractures: surgery versus non-operative management

This 12-month retrospective study compared pain relief, quality of life (QoL), treatment cost-effectiveness and complication rates in patients with acute osteoporotic vertebral compression fracture (OVCF) undergoing percutaneous vertebroplasty (PVP; n = 58), percutaneous kyphoplasty (PKP; n = 55), or conservative medical therapy (CMT; n = 55). After surgery, Cobb angle and vertebral height were significantly improved in the PKP group. PVP and PKP patients had significantly less pain immediately after surgery than CMT patients, but this difference disappeared between weeks 2-8, only to return from months 6-12. QoL was significantly better among the surgical groups after surgery and was lower in the CMT group than in the surgical groups. Treatment times were shorter with PVP and PKP, but costs were lower with CMT. The rate of secondary fractures during follow-up was greater with CMT. Overall, PVP was considered the first choice treatment for OVCF with refractory pain.     

Kyphoplasty. A treatment for osteoporotic vertebral compression fractures

Patients experience more than 700,000 osteoporotic vertebral compression fractures each year in the United States, primarily because of bone brittleness and the inability of the vertebrae to resist increased forces applied to them. Patients diagnosed with this type of fracture are given the option of conservative or operative treatment approaches. Although a typical compression fracture generally heals in 6 to 12 weeks, patients may be offered the kyphoplasty procedure, which reduces the fracture and stabilizes it with cement. Although this procedure is not without risk, it is deemed a safe and effective treatment option. This article reviews the indications, implications, and care provided to patients pursuing kyphoplasty after osteoporotic vertebral compression fracture.     

Vertebroplasty and kyphoplasty for treatment of painful osteoporotic compression fractures

PURPOSE: To review the pathophysiology of osteoporosis and describe vertebroplasty and kyphoplasty, which are minimally invasive procedures to treat the pain associated with vertebral compression fractures (VCFs). DATA SOURCES: Extensive literature review of osteoporosis, vertebroplasty, and kyphoplasty supplemented by case study and clinical experience in the minimally invasive interventional neuroradiology interventions. CONCLUSIONS: Osteoporosis is a progressive debilitating process that destroys the cancellous bone, weakening the overall integrity and stability of the bone. The loss of bone mass places the individual at increased risk for vertebral body, hip, and wrist fractures. In the past, there was no treatment option to repair vertebral body deformity or instability after osteoporotic VCFs. Management solely relied on the use of nonsteroidal anti-inflammatory drugs, narcotics, muscle relaxants, and/or orthotic bracing to provide pain relief. VCFs alter the stability of the vertebral body and column, and the lack of stabilization can lead to chronic pain syndrome, immobility, pulmonary compromise, progression of spinal deformity, increase in the risk for additional VCFs, and increase in the risk for comorbidities and mortality related to immobility. IMPLICATIONS FOR PRACTICE: Vertebroplasty and kyphoplasty are minimally invasive procedures aimed at pain control, stabilization of the vertebral body, and with kyphoplasty, the ability to provide some correction of deformity with partial restoration of vertebral body height. Providing pain control and stabilization of the vertebral column improves mobility, thus decreasing the potential risks associated with immobility.