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早期临床效果。方法：对18例骨质疏松性椎体压缩骨折病人的20个椎体，经皮椎弓根向椎体内穿针并注入聚甲基丙烯酸甲酯（PMMA）。结果：18例病人平均每个椎体注入骨水泥6．5ml，X线检查骨水泥充盈良好，骨折复位满意。术后12h至3d，疼痛明显减轻或消失，应用视觉模拟评分法测试疼痛缓解81％，术中术后无明显并发症出现。对16例病人随访3－6个月，疼痛未复发，椎体形态未见改变。结论：经皮椎体成形术治疗骨质疏松性椎体压缩骨折，能够迅速缓解疼痛，增加椎体的稳定性，是安全有效的微创技术。     

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早期临床效果。方法　对 1 8例骨质疏松性椎体压缩骨折病人的2 0个椎体 ,经皮椎弓根向椎体内穿针并注入聚甲基丙烯酸甲酯 (PMMA)。结果　 1 8例病人平均每个椎体注入骨水泥 6 5ml,X线检查骨水泥充盈良好 ,骨折复位满意。术后 1 2h至 3d ,疼痛明显减轻或消失 ,应用视觉模拟评分法测试疼痛缓解 81 % ,术中术后无明显并发症出现。对 1 6例病人随访 3～ 6个月 ,疼痛未复发 ,椎体形态未见改变。结论　经皮椎体成形术治疗骨质疏松性椎体压缩骨折 ,能够迅速缓解疼痛 ,增加椎体的稳定性 ,是安全有效的微创技术     

椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折

目的探讨单一球囊扩张经皮椎体后凸成形术治疗80岁以上老年骨质疏松性椎体压缩骨折的疗效及安全性。方法回顾分析高龄（80岁及其以上）老年骨质疏松性椎体压缩骨折患者15例,男性3例,女性12例,平均年龄（82.2±1.9）岁。共45个椎体,均为骨质疏松性脊柱压缩骨折,压缩骨折椎体后壁均完整。全部在C型臂X线机引导下行单侧入路、单一球囊椎体后凸成形术。结果患者平均能在术后第2天下床行走,未发现严重手术并发症。椎体前缘、中部及后缘平均高度分别由术前的（2.17±0.82）cm、（1.75±0.66）cm、（2.95±0.43）cm增至术后的（2.40±0.73）cm、（2.11±0.51）cm、（3.00±0.45）cm,椎体前缘、中部高度差异有显著统计学意义（P〈0.01）;术后48 h患者胸腰背痛均有缓解,术前、术后48 hVAS评分比较差异有显著统计学意义（P〈0.01）。结论应用椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折,能够安全、有效地改善骨折椎体高度,明显缓解疼痛,早期下床活动。     

PVP治疗老年骨质疏松性椎体压缩骨折患者73例分析

[目的]探讨经皮椎体成形术(PVP)治疗老年骨质疏松性椎体压缩骨折的临床疗效。[方法]回顾性分析本院收治的73例老年骨质疏松性椎体压缩骨折患者病例,临床均给予PVP治疗。手术前后,评估患者疼痛视觉模拟评分(VAS)、功能障碍指数(ODI)、活动能力评分(LAS)、椎体前缘、中线以及后缘高度比值、Cobb角及骨水泥渗漏情况,并进行统计学分析。[结果]术后1 d,患者VAS、ODI、LAS评分较术前显著降低(P<0.05),术后3、6个月、末次随访时VAS、ODI、LAS评分进一步降低(P<0.05)。术后1 d,伤椎前缘、中线、后缘高度比值均较术前明显升高(P<0.05),Cobb角明显减小(P<0.05);术后3个月伤椎前缘、中线、后缘高度比值及Cobb角出现一定程度丢失(P<0.05);术后6个月及末次随访时,伤椎前缘、中线、后缘高度比值以及Cobb角与3个月时比较无明显变化(P>0.05),但显著优于术前(P<0.05)。3例(4.1%)患者术中发生骨水泥渗漏,但均未需进一步处理。[结论]PVP手术可有效改善老年骨质疏松性椎体压缩骨折患者椎体畸形、残疾功能障碍指数及疼痛程度。     

经皮椎体成形术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮椎体成形术(PVP)在治疗老年骨质疏松性胸腰椎压缩性骨折中的应用及近期临床效果。方法对34例患者的37个椎体行经皮椎体成形术,术前均行X线片、CT检查,手术在C臂透视引导下经皮椎弓根入路,向椎体内注入骨水泥2.5～6.0mL,平均4.8 mL。结果术后随访3～12个月。术后所有患者疼痛完全缓解或者部分缓解。结论经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折,能够显著缓解疼痛,是一种有效、微创、安全的方法。     

单侧椎弓根穿刺椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折

目的分析单侧椎弓根穿刺椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的效果。方法对36例(38个椎体)老年骨质疏松性椎体压缩骨折患者实施单侧椎弓根穿刺椎体后凸成形术。观察术后患者的疼痛VAS评分、椎体前缘高度和Cobb角改善效果。结果 36例患者均顺利完成手术,仅1例(1个椎体)骨水泥渗漏至椎体侧方,但未出现神经损伤症状。术后腰部疼痛均显著缓解。平均随访12个月,患者VAS评分、椎体前缘高度及Cobb角均较术前显著改善,差异有统计学意义(P0.05)。结论单侧椎弓根穿刺椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折,可迅速缓解疼痛,并发症少,并能显著改善椎体前缘高度及Cobb角,疗效肯定。     

老年骨质疏松椎体压缩骨折的经皮椎体后凸成形术

目的探讨椎体后凸成形术治疗老年骨质疏松椎体压缩骨折的手术技术及适应证等相关问题。方法用椎体后凸成形术治疗老年骨质疏松椎体压缩骨折20例,采用经皮穿刺双侧椎弓根入路,单枚球囊依次撑开压缩的椎体,每个椎体充填骨水泥平均5·2ml。结果20例患者腰背部疼痛在术后24h缓解并下床活动,椎体高度基本恢复,后凸畸形平均矫正18°。随访6~18个月,患者均恢复伤前生活状况,无脊髓神经损伤、骨水泥漏、肺栓塞等并发症。结论椎体后凸成形术能达到缓解疼痛、恢复椎体高度的目的,是治疗老年骨质疏松椎体压缩骨折的有效方法。但必须熟练掌握椎体后凸成形术的经皮穿刺技术、骨水泥灌注技术及掌握手术适应证,才能保证这一技术的安全性和有效性。     

经皮椎体成形术治疗骨质疏松性椎体骨折的初步观察

目的：探讨经皮椎体成形术治疗严重骨质疏松性椎体骨折的临床效果。方法：采用新型注射材料磷酸钙骨水泥（cacium phosphat cement,CPC)对6例严重骨质疏松性椎体骨折病人（共14个椎体），在C型臂X线机透视下行经皮经椎弓根CPC注入椎体成形术，平均随访3个月。结果：所有病人腰背痛症状均在术后8-24h基本缓解。5例术前因疼痛不能坐立的病人术后卧床24h后均能坐起，随访2-4个月病情稳定。结论：采用CPC经皮椎体成形术治疗骨质疏松性椎体骨折操作简单，较安全，可有效缓解疼痛。     

经皮椎体后凸成形术治疗骨质疏松性椎体骨折的临床应用

目的探讨经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体骨折的临床疗效。方法采用PKP治疗骨质疏松性椎体骨折27例(46椎)。结果17例(28椎)术中有典型的疼痛复制,8椎发生骨水泥渗漏,未引起临床症状。术后疼痛均明显缓解。术后椎体前缘、中缘、后缘高度及Cobb角与术前相比,有显著性差异(P<0.05)。未发现与手术有关的并发症。结论PKP治疗骨质疏松性椎体骨折可以有效缓解疼痛,恢复椎体高度,疗效满意。     

经皮椎体成形术治疗骨质疏松性椎体压缩骨折50例临床分析

目的探讨经皮椎体成形术(Percutaneous Vertebroplas-ty,PVP)治疗骨质疏松性椎体压缩骨折的临床应用。方法 X线透视下经皮椎体成形术治疗50例骨质疏松性椎体压缩骨折,共62个椎体。结果术后1～2d疼痛消失23例,明显减轻20例,部分减轻7例;5例出现椎体两侧骨水泥渗漏,3例椎间盘内渗漏,无骨水泥进入椎管及椎间孔处,无神经根脊髓损伤;手术后随访1～9月,平均6月,患者均恢复伤前生活,原伤椎疼痛均缓解或明显减轻,伤椎高度平均恢复约10%,高度无明显丢失,2例出现相邻椎体骨折。结论经皮椎体成形术治疗骨质疏松性椎体压缩骨折,手术创伤小,术后恢复快,效果明显,卧床时间短,疗效佳。     

不同充填材料强化椎体在骨质疏松性椎体压缩骨折中的应用

目的分别以聚甲基丙烯酸甲酯骨水泥(PMMA)和注射型自固化磷酸钙人工骨(CPC)作为强化椎体的充填材料,采用椎体成形术和膨胀式椎体成形器(Sky)后凸成形术治疗骨质疏松性椎体压缩骨折,观察其临床疗效。方法对45例骨质疏松性椎体压缩骨折患者采用以下4种方法治疗:椎体成形术 PMMA(15例17个椎体),椎体成形术 CPC(13例16个椎体),Sky后凸成形术 PMMA(8例8个椎体),Sky后凸成形术 CPC(9例10个椎体)。根据患者术前和术后侧位X线片计算椎体高度压缩率和恢复率、椎体后凸角度和恢复率,并采用VAS(vasual analogscale)进行术前和术后疼痛评分。结果所有患者均未出现并发症。Sky后凸成形术椎体高度恢复率和后凸角度恢复率优于椎体成形术。椎体增强材料充填剂量各组间无显著性差异。椎体成形术与Sky后凸成形术手术时无显著性差异。VAS评分术前各组无显著性差异,术后充填PMMA者优于充填CPC者,术后6周两者间无显著性差异。结论用PMMA和CPC强化椎体是一种微创、安全、有效治疗骨质疏松性椎体压缩骨折的方法,应根据患者的具体情况选择治疗方法和椎体充填材料。     

Percutaneous vertebroplasty of a myelomatous compression fracture in the presence of previous posterior instrumentation. Report of two cases

The authors report the use of percutaneous transpedicular vertebroplasty performed using polymethylmethacrylate (PMMA) in two patients. These men (53 and 57 years old) had previously undergone open surgery and posterior instrumentation to treat myelomatous compression fractures. Both patients presented with acute back pain that manifested after minor activities. Kyphotic wedge fractures were diagnosed at T-1 in one case and at L-1 in the other. Both patients were treated at other hospitals with laminectomy and instrumented fusion; multiple myeloma was diagnosed after surgery. The patients experienced severe, recalcitrant, and progressive pain; on referral, they were found to have persistent kyphosis. Multiple myelomatous lesions of the spine were seen in one case and in the other the L-1 fracture represented the only site of disease. Percutaneous vertebroplasty was performed by injecting PMMA into the anterior third of the compressed vertebral body. Both patients experienced a 50% reduction in pain immediately after treatment; 3 months later both were walking and reported minimal back pain while undergoing treatment for multiple myeloma. Three years after surgery one patient reported no back pain and no progressive instability of the spine. Four years after surgery the other patient remains pain free, ambulatory, and with overall disease remission. Percutaneous vertebroplasty provided effective analgesia in these two patients with progressive back pain despite posterior stabilization. In both cases, the anterior column was effectively stabilized. A much larger operative intervention with its attendant risks of morbidity was avoided. In addition, subsequent aggressive medical treatment was well tolerated.     

后路减压椎弓根钉固定骨水泥注射椎体成形术治疗胸腰椎骨折

目的探讨采用后路减压,椎弓根钉内固定结合分步骨水泥注射,椎体成形术治疗胸腰椎骨折的临床疗效。方法 2007年1月至2010年4月,我科采用后路减压,椎弓根钉系统内固定结合分步骨水泥注射,椎体成形术治疗胸腰椎骨折28例,其中M cA fee分类,Ⅰ型15例,Ⅱ型10例,Ⅲ型3例,并观察患者术前及术后2周、术后12个月以伤椎为中心的脊柱功能单位的前后缘压缩比,椎管侵占率和Cobb角。结果本组患者全部得到随访,时间12～16个月。患者均于术后2周后下床活动,无断钉、断棒、椎体再压缩等并发症,椎体高度恢复满意,无神经症状加重,术前脊柱功能单位前后缘压缩比、椎管侵占率和Cobb角与术后2周相比有明显差异,而术后2周与术后12个月无明显差异。结论后路减压,椎弓根钉系统内固定结合分步骨水泥注射椎体成形术治疗胸腰椎骨折,能在早期恢复脊柱前后柱的稳定性,避免了单纯后路椎弓根系统内固定断钉、断棒的危险,从而能使患者早期无痛下床活动,临床效果满意。     

椎体后凸成形术治疗骨质疏松胸椎椎体重度压缩性骨折

目的 探讨单侧球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)在高龄骨质疏松性胸椎重度压缩性骨折(severe vertebral compression fracture,SVCF)的应用及临床疗效.方法 2006年5月-2007年7月,采用单侧球囊扩张PKP治疗高龄骨质疏松性椎体SVCF 6例(7个椎体),其中男2例(2个椎体),女4例(5个椎体);年龄64～83岁.均为陈旧性骨折.压缩骨折椎体T5 1例,T8 2例,T10 3例,T12 1例,椎体压缩比为60%～75%者5个椎体,＞75%者2个椎体.胸背部疼痛明显,视觉疼痛模拟评分法(visual analogue scale,VAS)评分为6.5～9.0分,平均7.7分.均无神经症状及体征.术前CT示椎体后壁均完整.在C臂X线机透视下,采用经皮椎体后外侧入路穿刺,在伤椎内植入1枚球囊,扩张使椎体部分复位后,将骨水泥填充椎体扩张所形成的空腔内.灌注骨水泥2.6～4.4mL,平均3.5 mL.结果 患者手术顺利,术后疼痛明显减轻或消失.术后3 d X线片复查未见椎体进一步压缩、变形,骨水泥分布均匀,椎体高度恢复9.7%4-1.4%.2例发生骨水泥渗漏,但均无神经受损等不适症状发生.术后1个月VAS评分0～2.45分,平均1.32分,与术前比较差异有统计学意义(P＜0.05).术后3个月所有患者于门诊复查,患者对手术效果均满意VAS评分0～3分,平均2.13分,与术后1个月比较差异无统计学意义(P＞0.05);X线片检查未见病变椎体压缩、变形,相邻椎体也未见有新的明显压缩骨折.结论 PKP治疗高龄骨质疏松性脊柱SCVF可有效缓解疼痛,部分恢复椎体高度,疗效满意.     

经皮椎体成型术在骨质疏松性椎体压缩骨折中的临床应用分析

目的探讨经皮椎体成型术在骨质疏松性椎体压缩骨折中的临床疗效。方法对笔者所在医院就诊的18例患者采用经皮椎体成型术治疗骨质疏松性胸腰椎压缩骨折,手术在C臂机监测下,经皮向椎体内穿刺并注入骨水泥,并对患者术后椎体疼痛症状及椎体前缘高度进行分析。结果术后全部患者获得随访,随访时间1～18个月,平均11个月,患者腰背部疼痛明显好转,椎体前缘高度无明显继发丢失,椎体后凸角度无明显增大。结论经皮椎体成型术治疗骨质疏松性椎体压缩骨折安全有效,疗效满意。     

Effect of vertebroplasty on the compressive strength of vertebral bodies

Background contextPercutaneous vertebroplasty has been used successfully for many years in the treatment of painful compressive vertebral fractures due to osteoporosis.PurposeTo compare the effect of vertebroplasty on the compressive strength of unfractured vertebral bodies.Study designBiomechanical study on cadaveric thoracic vertebrae.MethodsForty vertebral bodies from four cadaveric thoracic spines were used for this experiment. Before testing, each thoracic spine was submitted to bone density testing and radiographic evaluation to rule out any obvious fractures. Under image intensification, 6 mL of a mixture of polymethylmethacrylate (PMMA) with barium (8 g of barium/40 g of PMMA) was injected into every other vertebral body of each spine specimen. After vertebroplasty, all soft tissues were dissected from the spine, and the vertebral bodies were separated and potted for mechanical testing. Testing to failure was performed using a combination of axial compression and anterior flexion moments. Two pneumatic cylinders applied anterior and posterior loads at a distance ratio of 4:3 relative to the anterior vertebral body wall, whereas two additional cylinders applied lateral loads, each at a constant rate of 200 N/s.ResultsThe average failure loads for nonvertebroplasty specimens was 6724.02±3291.70 N, whereas the specimens injected with PMMA failed at an average compressive force of 5770.50±2133.72 N. No statistically significant difference in failure loads could be detected between intact specimens and those that had undergone vertebroplasty.ConclusionsUnder these specific loading conditions, no significant increase in compressive strength of the vertebral bodies could be documented. This suggests that some caution should be applied to the concept of “prophylactic” vertebroplasty in patients at risk for fracture.     

Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge

Most osteoporotic vertebral fractures (OVFs) can be treated successfully with conservative methods. In about 10% of patients, nonunion develops and warrants surgical management with minimally invasive procedures such as vertebroplasty and kyphoplasty. Nevertheless, for patients with nonunion fractures that involve the posterior vertebral body wall, vertebroplasty and kyphoplasty are relatively contraindicated due to the risk of extravertebral polymethylmethacrylate cement leakage through vertebral fracture cracks. To this end, we developed a method for pedicle screw fixation combined with transpedicular bone grafting for such a condition. Briefly, after posterior pedicle screw fixation and reduction in the affected vertebra, the demineralized bone matrix was inserted into the vertebral body via a ‘bone grafting funnel’ created through the pedicle of the affected vertebra. The current retrospective study analysed the safety and efficacy of this approach. A total of 12 patients who fulfilled the criteria were treated with this procedure. Visual analogue scale scores for back pain and anterior vertebral heights were recorded. At 3-month follow-up, pain was significantly relieved compared with presurgery and the anterior vertebral heights were successfully restored and maintained. In conclusion, short-segment pedicle instrumentation combined with transpedicular bone grafting is a useful alternative in the treatment of nonunion of OVFs with loss of posterior edge integrity.     

短节段内固定并椎体成形术治疗重度椎体骨质疏松性骨折伴脊柱后凸畸形

目的 评估行后路内固定并椎体成形术治疗椎体骨质疏松性压缩性骨折的疗效.方法 2007年1月～2011年12月,对32例椎体压缩＞2/3并伴脊柱后凸畸形的老年患者行后路脊柱后凸矫正及椎体成形术.对手术前后患椎高度、脊柱后凸Cobb角、腰背部疼痛视觉模拟量表（visual analog scale,VAS）评分和Oswestry功能障碍指数（Oswestry disability index,ODI）进行评价分析.结果 全部病例平均随访13.5个月.手术前,患椎平均剩余高度为27.8 %,脊柱后凸Cobb角25.3°,腰背痛VAS评分8.06,ODI为90%;术后1周,各项指标分别为63.1%,8.5°,3.14,59.7%;手术后3个月,分别为62.7%,8.69°,1.4,31.32%.与术前相比,差异均有统计学意义（P＜0.05）.结论对于重度椎体骨质疏松性骨折合并脊柱后凸畸形的患者,行脊柱后凸矫正及开放椎体成形术,治疗效果良好.     

扩张管辅助下Wiltse入路小关节融合短节段内固定治疗不稳定胸腰椎骨折

目的探讨扩张管辅助下Wiltse入路小关节融合短节段内固定治疗不稳定胸腰椎骨折的临床疗效。方法回顾性分析自2014-01—2017-06采用扩张管辅助后路经Wiltse入路小关节融合伤椎置钉短节段内固定治疗的42例不稳定胸腰椎爆裂骨折,比较手术前后椎体楔形角、椎体前缘高度、椎体后缘高度、椎体横断面积、腰痛VAS评分。结果42例均顺利完成手术且获得完整随访,随访时间平均18个月。术后2例合并尿道相关泌尿系感染,1例合并伤口皮缘坏死,未出现伤口感染、血管及脊髓损伤、神经根损伤、内固定松动等并发症。术后椎体楔形角角度、椎体前缘高度、椎体后缘高度、椎体横断面积、腰痛VAS评分较术前均显著改善,差异有统计学意义(P<0.05)。结论扩张管辅助下Wiltse入路小关节融合短节段固定治疗不稳定型胸腰椎骨折手术创伤小,术后恢复快,有良好的临床及影像学表现。     

椎弓根钉固定及高压分步注射椎体成形术治疗老年胸腰椎爆裂骨折并神经损伤

目的探讨椎弓根螺钉内固定结合高压注射椎体成形术治疗老年胸腰椎爆裂性骨折并神经损伤的疗效。方法回顾分析椎弓根螺钉内固定结合经椎弓根高压分步注射骨水泥治疗老年胸腰椎爆裂性骨折并神经损伤患者22例,随访平均19月。术后观察骨折椎体前缘压缩率、椎管侵占率、Cobb角、神经功能改善情况及并发症。结果椎体前缘压缩率由术前的58.7%恢复为术后7.0%,后凸Cobb角由术前平均24.0°矫正至6.6°,椎管侵占率由术前52.6%恢复为术后11.8%,术后与术前比较差异均有统计学意义(P0.01)。VAS术前平均8.7分,术后2.2分。脊髓功能恢复按Frankel分级,除1例A级病例术后截瘫症状无明显恢复外,其他病例均达到1级或1级以上的恢复。有2椎体发生椎体外骨水泥渗漏,无肺栓塞、感染和神经损伤等并发症发生。未发现内固定松动、断裂现象。结论椎弓根螺钉内固定结合椎体成形术有利于同时解决胸腰椎骨折对神经的压迫、脊柱的不稳定及骨质疏松椎体压缩骨折造成的顽固性胸腰背疼痛等问题。高压分步注射可降低骨水泥渗漏的风险。