分步体位复位椎体成形术治疗胸腰椎压缩性骨折

目的探讨分步体位复位经皮椎体成形术治疗胸腰椎椎体压缩性骨折的临床效果。方法90例胸腰椎椎体骨折患者分2步体位复位,经单侧椎弓根穿刺向椎体注入聚甲基丙烯酸甲酯,手术前后用影像学资料评估伤椎椎体高度恢复率、后凸角度矫正率,用视觉模拟分级法（visual analogue scale,VAS）评估疼痛程度。结果手术均获成功,伤椎椎体前缘高度恢复率为（85．6±12．6）％,椎体中线高度恢复率为（86．6±9．7）％,后凸角度矫正率为（62．2±23．5）％,与术前相比差异均有统计学意义（P〈0．05）,无并发症发生。术后1周VAS评分为2．6±0．2分,与术前8．2±0．2分相比差异有统计学意义（t=21．95,P〈0．01）。82例患者术后获得随访,平均随访36．3个月,胸腰背疼痛无复发,椎体高度无改变,邻椎无骨折。结论分步体位复位经皮椎体成形术能恢复椎体高度,矫正后凸畸形,消除疼痛,增加椎体强度和脊柱稳定性。是治疗胸腰椎椎体骨折经济、安全、有效的方法。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的评价球囊扩张椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效和安全性。方法自2008年8月至2011年7月采用椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折30例42椎,患者均有腰背部疼痛。取俯卧位调节手术床使椎体骨折部位过伸,达到满意的闭合复位后,经皮双侧或单侧椎弓根穿刺球囊扩张,填充骨水泥。随访观察患者的疼痛、日常功能以及影像学改变情况。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,进行统计学分析。利用Oswestry评分、视觉模拟评分（visualanaloguescale,VAS）评定临床疗效。观察有无骨水泥渗漏等并发症。结果术后随访6～24个月,平均10个月。术后伤椎处疼痛均明显缓解,VAS评分从术前平均（8．45±0．48）分降至术后平均（2．45±0．52）分,椎体高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。未出现严重的骨水泥渗漏并发症。术后椎体高度及伤椎后凸角度与术前比较有统计学差异（P〈0．05）,术后VAS及Oswestry评分与术前比较有统计学差异（P〈0．01）。结论球囊扩张椎体后凸成形术治疗骨质疏松脊柱压缩性骨折,能有效恢复椎体高度和矫正后凸畸形,能迅速缓解疼痛,减少骨折并发症,提高患者生活质量。     

PKP治疗骨质疏松性椎体压缩性骨折

目的探讨经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的临床疗效和安全性。方法2010年1月至2012年1月采用经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折42例48椎,其中男10例,女32例;年龄55—86岁,平均68．1岁。在C型臂x线机引导下,经皮穿刺进针,建立工作通道后放人可扩张球囊,复位骨折、形成空腔以及充填骨水泥。观察术后疼痛症状改善、骨折复位及后凸矫正情况。结果42例患者手术均顺利完成,术后随访6～18个月,平均随访12．5个月。疼痛VAS评分由术前平均（7．6±1．8）分降低为术后的（1．9±1．2）分,椎体前缘、中部高度分别由术前的（1．63±0．43）cm、（1．52±0．42）cm增加至术后的（2．06±0．37）cm、（1．96±0．34）cm,差异有统计学意义,椎体后缘高度术前、术后差异无统计学意义。椎体矢状面Cobb角由术前平均（27．8±6．5）°,矫正为术后（16．5±5．3）°。结论经皮球囊扩张椎体后凸成形术是治疗骨质疏松性椎体压缩性骨折安全且近期疗效明显的方法。     

后凸成形术结合体位复位治疗创伤性胸腰椎椎体骨折的临床观察

目的：观察在体位复位辅助下后凸成形术治疗创伤性胸腰椎椎体骨折的临床疗效。方法：37例新鲜单节段胸腰椎椎体骨折患者,男28例,女9例;年龄24～79岁,平均48岁。通过体位复位及Sky扩张器撑开复位后,经双侧椎弓根穿刺充填自固化磷酸钙人工骨（CPC）。根据Denis胸腰椎骨折的分型：压缩性骨折,B型27例,C型3例,D型5例;爆裂性骨折2例,均为B型。利用体位复位,经皮穿刺,Sky椎体成形器扩张椎体,注入可降解的自固化磷酸钙人工骨。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,并计算椎体高度丢失率和后凸畸形矫正率,记录分析视觉模拟评分（VAS）及伤椎形态变化。结果：术后随访9～24个月,平均13个月。术后伤椎处疼痛均显著缓解,VAS评分改变从术前平均（7.6±2.5）分降至术后平均（1.8±1.5）分,椎体前壁高度和中间高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。结论：在严格掌握适应证、选择合适病例的前提下,采用体位复位辅助下经皮椎体后凸成形术治疗创伤性胸腰椎椎体骨折,能迅速缓解疼痛,有效恢复椎体高度和矫正后凸畸形。     

过伸复位加椎体后凸成形治疗重度骨质疏松性椎体压缩性骨折

目的探讨过伸复位与椎体后凸成形术联合治疗重度骨质疏松性椎体压缩性骨折的疗效。方法患者俯卧在能透X线的手术床上,头胸部及髂嵴下肢垫高,使腹部悬空,在C形臂X线机下进行过伸复位,然后联合应用椎体后凸成形术治疗,并在术前,术后3天,术后3月进行椎体压缩率,矢状面Cobb角,疼痛视觉模拟评分（VSA）,SF-36健康调查评分进行对比。结果20例患者均顺利完成手术,术后6-8小时疼痛迅速缓解,术后1-2天均能下床活动。椎体高度压缩率由术前（7．8±0．14）cm增加至术后第3天（14．2±0．26）cm,COBB角由术前28°±2．9°矫正至术后20．20°±2．7°,VAS评分由术前（7．0±1．38）分降至术后第3天（1．30±0．90）分,SF-36健康调查评分由术前（30．90±4．30）分提高至术后第3天（43．7±3．20）分,各项目差异均有显著性（P〈0．05）。结论通过过伸复位联合椎体后凸成形术治疗重度骨质疏松性椎体压缩骨折有效并安全。     

经皮椎体成形联合术前复位治疗老年骨质疏松性压缩性骨折

目的：探讨经皮椎体成形联合术前复位对骨质疏松性胸腰椎骨折压缩性骨折的疗效。方法选择自2010年1月至2013年1月骨质疏松所致严重椎体骨折患者67例,术前采用体位复位,复位后行PVP,比较患者术前及术后椎体高度及后凸角度、VAS评分及活动能力评分。结果经术前体位复位,伤椎椎体高度较术前有显著性增加（P〈0.05）,术后椎体高度较体位复位后均有显著性增加（P〈0.05）。术后VAS评分较术前有显著性下降（P〈0.05）;术后6个月VAS评分与术前比较差异有统计学意义（P〈0.01）;术后及术后6个月后凸角度较术前有显著性下降（P〈0.01）,患者活动能力显著性增加（P〈0.05）。结论经皮椎体成形联合术前复位治疗严重骨质疏松性胸腰椎骨折患者,可显著改善手术效果,提高患者生活质量,减轻患者的痛苦。     

自制脊柱撑开复位器治疗骨质疏松性椎体压缩骨折临床对照试验

目的：探讨自制脊柱撑开复位器治疗骨质疏松性椎体压缩骨折的临床效果。方法：采用随机数字表法随机分组，治疗组42例共56椎体，男14例，女28例，年龄50～69岁；对照组54例共68椎体，男19例，女35例，年龄51—75岁。均摄X线片和CT扫描，其中27例加行MR以排除肿瘤继发性骨折和陈旧性骨折，均确诊为骨质疏松脊柱压缩性骨折。CT扫描椎体后壁完整无椎管占位，均无脊髓神经损害症状。骨质疏松程度以L3X线骨小梁变化分级。治疗组应用脊柱牵引复位器经椎弓根向椎体注入骨水泥，对照组采用椎体成形术。用视觉模拟疼痛评分（VAS），参照Lee方法测量椎体高度压缩率和恢复率，计算骨水泥渗漏率。结果：治疗组平均随访2．5年，VAS评分治疗组由术前的平均（8．6-＋0．8）分降至平均（1．7±0．5）分，对照组由平均（8．5±0．4）分降至平均（3．5±1．4）分，术后评分两组比较，差异有统计学意义P〈0．05。治疗组术前、术后椎体前壁和中间高度压缩率差异有统计学意义（P〈0．05）。治疗组后凸角度恢复率71．8％，对照组恢复率37．8％，差异有统计学意义（P〈0．05）。治疗组无骨水泥渗漏，对照组渗漏率47％。疗效评定治疗组36例完全缓解，4例部分缓解，对照组43例完全缓解，3例部分缓解。两组差异有统计学意义，P〈0．05。结论：自制脊柱撑开复位器是一种能替代进口球囊的微创技术，可迅速止痛，恢复椎体高度且无骨水泥渗漏。     

过伸体位复位在PVP治疗椎体压缩性骨折中的应用

目的探讨利用螺旋推进器在过伸体位手法复位后连续高压注射骨水泥行经皮椎体成形术治疗老年脊柱椎体压缩性骨折的临床疗效。方法本组选新鲜骨质疏松性椎体压缩性骨折132例患者共196个椎体,实验组在过伸体位手法复位后,应用螺旋推进器产生高压向伤椎椎体内注入骨水泥,行经皮椎体成形术,对照组则按照一般的PVP手术方式进行,未实行过伸体位复位。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,并计算椎体高度恢复率和后凸畸形矫正率。根据手术前后功能学改变进行视觉模拟疼痛（visual analogue scale,VAS）与Oswesty功能评分。结果 132例手术均顺利完成,对照组50例72椎体术前术后椎体前缘高度恢复率、中线高度恢复率、后缘高度恢复率、椎体后凸畸形矫正率均无显著差异。实验组82例124椎体术前术后椎体前缘高度恢复率、中线高度恢复率、椎体后凸畸形矫正率存在显著差异（P〈0.05）,VAS评分、Oswesty功能评分对照组与实验组手术前后比较均有显著差异（P〈0.05）。术后37例出现骨水泥渗漏者,其中3例出现向椎管渗漏压迫脊髓、神经根（对照组1例,实验组2例）。术后随访两组椎体高度无再丢失。结论过伸体位复位后,采用螺旋推进器连续高压注射骨水泥行经皮椎体成形术,可有效恢复椎体高度和矫正后凸畸形,安全可行,实用性强。     

经皮椎体成形术与椎体后凸成形术治疗胸腰椎压缩性骨折的临床疗效比较

目的比较经皮椎体成形术与椎体后凸成形术治疗胸腰椎压缩性骨折的临床疗效。方法对98例胸腰椎压缩性骨折，根据手术方法不同分为椎体成形组和椎体后凸成形组。比较两组术前术后椎体前缘、中线、后缘高度变化，疼痛视觉模糊评分（VAS），手术时间，出血量等方面的差异。结果两组对椎体高度的恢复比较差异有统计学意义（P〈0．01），VAS、手术时间和出血量比较差异无统计学意义（P〉0．05）。结论经皮椎体成形术与椎体后凸成形术具有创伤小、手术时间短、出血量少等微创优点，而椎体后凸成形术具有较好的复位作用。     

单侧通道椎体后凸成形术治疗骨质疏松脊柱压缩性骨折的初步临床疗效

目的 探讨单侧通道球囊扩张椎体后凸成形术治疗骨质疏松脊柱压缩性骨折的临床疗效.方法 自2004年11月-2007年12月,采用单侧通道球囊扩张椎体后凸成形术治疗骨质疏松脊柱压缩性骨折32例(38椎),观察症状改善及骨折复位情况.结果 手术均顺利完成.术后VAS评分及ODI指数较术前均有显著下降.术后椎体前缘高度和中部高度丢失较术前明显改善.结论 单侧通道球囊扩张椎体后凸成形术治疗骨质疏松脊柱压缩性骨折创伤小、操作安全、疗效满意.     

经皮椎体成形术后再发骨折的临床研究

目的 观察经皮椎体成形术后患者再发椎体骨折的临床特点.探讨其发生机制、疗效及临床意义.方法 回顾分析2004年2月～2009年3月行经皮椎体成形术共342例,其中经诊断并治疗的再发椎体骨折19例.结果 再发椎体压缩性骨折率5.6%.平均年龄70.1岁,男女比例7:12,相邻椎体再发率71.4%,非相邻椎体再发率28.6...     

四步法单侧入路椎体成形术在胸椎骨质疏松性骨折中的应用

目的探讨四步法单侧入路的经皮椎体成形术(PVP)在胸椎骨质疏松性骨折中的应用。方法运用四步法,对胸椎骨质疏松性骨折椎体进行单侧入路的经皮椎体成形术,计录手术时间,观察骨水泥弥散分布情况,在术前、术后3 d、术后12个月随访时进行疼痛视觉类比评分(VAS)。结果18例21个椎体操作均成功,手术时间10~25 min,平均(16±2.2)min,骨水泥在椎体内弥散分布均越过椎体中线,VAS评分由术前(8.5±1.2)分降低至(2.5±1.4)分,术后效果良好。结论四步法单侧入路椎体成形术治疗胸椎骨质疏松性骨折简单快速、安全有效。     

经皮椎体成形术在骨质疏松椎体压缩性骨折治疗中的应用

目的 评估经皮椎体成形术在治疗骨质疏松椎体压缩性骨折中的疗效。方法 对19例22个骨质疏松椎体压缩性骨折患行经皮椎体成形术。结果 所有患经3～12个月的随访，疗效满意，其中优4例(21％)，良12例(63％)，可3例(19％)。术后5例患需阶段性口服药物缓解疼痛，2例骨水泥外溢，但未造成不良后果。结论 经皮椎体成形术是一种微创治疗方法，用于治疗骨质疏松椎体压缩性骨折有明显疗效，可在短时间内解除患痛苦，恢复正常活动。     

Percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fracture adjacent to lumbar instrumented circumferential fusion

The purpose of this study was to evaluate the efficacy and safety of percutaneous vertebroplasty for patients with symptomatic osteoporotic vertebral compression fractures adjacent to lumbar instrumented circumferential fusion. Between January 2005 and June 2010, eighteen patients in the authors' institution with lumbar instrumented circumferential fusion had adjacent symptomatic osteoporotic vertebral compression fractures. The patients received percutaneous vertebroplasty using polymethylmethacrylate bone cement augmentation. Radiographs and magnetic resonance imaging were used. The visual analog pain scale and modified Brodsky's criteria were used to compare clinical outcomes pre- and postoperatively. Minimum follow-up was 18 months. Dual-energy x-ray absorptiometry scan confirmed osteoporosis in all patients. The average interval between fusion surgery and sustaining osteoporotic vertebral compression fractures was 24.8 months. The average interval between sustaining osteoporotic vertebral compression fractures and undergoing percutaneous vertebroplasty was 49.3 days. One-level percutaneous vertebroplasty was performed in 13 patients, and 2 levels were performed in 5 patients. The patients' visual analog pain scale scores improved by an average of 53 points postoperatively. Fifteen patients returned to preinjury activities of daily living. The average restoration of the fractured vertebral body height was 12.1%. No major surgery-related complications, occurred except asymptomatic cement leakage in 3 patients. Elderly patients undergoing lumbar instrumented fusion surgery should be aware of the possibility of adjacent vertebral compression fractures. Percutaneous vertebroplasty is a minimally invasive and effective procedure to treat such adjacent segment disease.     

An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture

STUDY DESIGN: Ex vivo biomechanical study using osteoporotic cadaveric vertebral bodies. OBJECTIVES: To determine if the inflatable bone tamp (tamp) restores height to compressed vertebral bodies and to compare the biomechanical properties of isolated, fractured osteoporotic vertebral bodies treated by kyphoplasty (tamp) or vertebroplasty. SUMMARY OF BACKGROUND DATA: Previous biomechanical studies have shown that vertebroplasty increases vertebral body strength and restores vertebral body stiffness, but does not restore vertebral body height lost as a result of compression fracture. METHODS: Compression fractures were experimentally created in 16 osteoporotic VBs assigned to either the tamp or percutaneous vertebroplasty group. The tamp treatment consisted of inserting balloon-like devices into the vertebral body, inflating the bone tamp, and filling the void with Simplex P (Howmedica, Rutherford, NJ) bone cement. The percutaneous vertebroplasty treatment consisted of directly injecting Cranioplastic bone cement (CMW, Blackpool, UK) into the vertebral body. Pre- and posttreatment heights were measured, and the repaired vertebral bodies were recompressed to determine posttreatment strength and stiffness values. RESULTS: The tamp treatment resulted in significant restoration (97%) of vertebral body height lost after compression, whereas percutaneous vertebroplasty treatment resulted in a significantly lower restoration of lost height (30%) (P < 0.05). Both treatments resulted in significantly stronger vertebral bodies relative to their initial state (P < 0.05). The tamp treatment restored vertebral body stiffness to initial values, but the percutaneous vertebroplasty treatment did not (P < 0.05). CONCLUSIONS: Tamp treatment resulted in significantly greater height restoration than did percutaneous vertebroplasty, without loss of vertebral body strength or stiffness.     

改良法经皮椎体成形术治疗骨质疏松性椎体重度压缩骨折

目的探讨改良法经皮椎体成形术(PVP)治疗骨质疏松性椎体重度压缩骨折的可行性、疗效及椎体高度的变化。方法回顾性分析应用改良法PVP治疗的36例骨质疏松症患者并46节重度压缩骨折椎体的临床及影像学资料。患者术前接受二维CT及MR检查。术中采用单侧跨中线穿刺,注射骨水泥前摒弃椎体骨静脉造影。术后1日复查二维CT。于CT矢状面图像测量椎体高度,并比较PVP术前及术后椎体前缘、中央和后缘的高度变化。结果 36例患者采用单侧跨中线穿刺治疗全部成功,椎体前缘、中央、后缘恢复高度分别为(2.37±2.10)mm、(2.61±2.21)mm、(0.23±0.44)mm。随访1～29个月,完全缓解(CR)、部分缓解(PR)和无效(NR)例数分别为27例、8例、1例,总有效率为97.22%。结论改良法PVP治疗骨质疏松性椎体重度压缩骨折可行、有效,可提高压缩椎体的高度。     

经皮椎体成形术自固化磷酸钙人工骨充填治疗骨质疏松性胸腰椎压缩性骨折

目的探讨应用经皮椎体成形术(PVP)自固化磷酸钙人工骨(CPC)充填治疗骨质疏松性胸腰椎压缩性骨折的临床疗效。方法自2004年1月起,对26例29个椎体骨质疏松性胸腰椎压缩骨折患者,采用术中手法复位、PVP自固化CPC充填治疗。结果26例患者经单侧或双侧椎弓根穿刺椎体成形术成功治愈。胸腰椎自固化CPC平均充填量为4.6mL。术中CPC渗漏者5例5个椎体。无一例出现严重并发症。经3～8个月(平均4.6个月)随访,术后所有患者疼痛消失。除3例椎体高度丢失15%外,其余椎体高度平均恢复达正常的80%。结论PVP自固化CPC充填治疗骨质疏松性胸腰椎压缩性骨折是一种安全、简单、有效的方法。     

Treatment of pain from osteoporotic vertebral collapse by percutaneous PMMA vertebroplasty

Summary Background. Vertebral compression fractures are common complications in advanced osteoporosis. In general, this disease of the elderly patient is characterized by severe local back pain. Pathophysiologically, bony instability triggers local pain during body movement. Serious pain immobilizes the patients and forces them to bed rest. As a result, complications like thrombosis or pneumonia occur. Invasive treatment with surgical instrumentation for vertebral stabilization is not indicated in elderly patients especially with additional diseases.The purpose of this study was to test the hypothesis that percutaneous polymethylmethacrylate (PMMA) vertebroplasty significantly reduces pain due to vertebral collapse in osteoporotic patients and improves quality of life.Methods. A total of 38 patients with osteoporotic vertebral compression fractures of the thoracic and lumbar spine were treated by PMMA vertebroplasty. After admission, before discharge from the hospital, six weeks, half a year and one year later patients answered the Oswestry Low Back Pain Disability (OLBPD) Questionnaire for assessment of treatment related change in disability. In all patients percutaneous vertebroplasty was performed under local anesthesia.Findings. A total of 92% of patients reported a significant pain reduction immediately after treatment. Also one year after vertebroplasty pain remained significantly reduced. Vertebroplasty was highly beneficial for patients with pain related to local instability of the spine. Extravasation of PMMA beyond the vertebral margins was observed in 26% of the cases. No treatment related clinical or neurological complications were noticed.Interpretation. PMMA vertebroplasty is a useful and safe method of pain relief which rapidly regains quality of life for patients with osteoporotic vertebral compression.     

经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折

[目的]观察经皮椎体成形术（PVP）治疗疼痛性高龄骨质疏松性胸腰椎压缩骨折的临床疗效。[方法]在C臂X线透视监控下，以骨水泥（PMMA）为充填材料，经单侧或双侧椎弓根穿刺行PVP治疗6例、脊柱后凸成行术治疗2例。[结果]术中无骨水泥渗漏，术后患者疼痛明显缓解或消失，无1例出现严重并发症。[结论]PVP治疗疼痛性高龄骨质疏松性胸腰椎压缩性骨折是安全、有效、经济的。     

骨质疏松性压缩骨折椎体成形术后再发椎体骨折

目的研究椎体骨质疏松性压缩骨折行椎体成形术后再发骨折的规律及相关危险因素。方法 2005年12月至2009年8月,收治外伤所致胸腰椎骨质疏松性压缩骨折行PVP治疗并资料完整的病例218例,其中男44例,女174例;年龄48～82岁,平均72.1岁。收集术前、术后1d、末次随访（至少18个月）时影像资料,对新发骨折情况进行统计分析。结果 218例（286个椎体）患者中,有22例患者进行2次以上PVP治疗,60.7%的新发椎体骨折为相邻椎体骨折;相邻椎体新发骨折较非相邻椎体新发骨折发生更快（P〈0.001）;在椎体骨折2次以上的病例,高龄、低骨密度的病例再发椎体骨折比例较大（P〈0.005）;将单次及多次骨折（2次以上）两组病例比较,性别和骨水泥注入量无明显差异（P〉0.05）。结论椎体成形术后数年内易新发椎体骨折,其中相邻椎体骨折所占比例更大,且发生更快;高龄、低骨密度的患者再发骨折可能性更大。椎间盘骨水泥渗漏亦对相邻椎体骨折的发生起重要影响。