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1.
既往在治疗上多采用保守疗法,但不少患者难以坚持长期卧床休养,导致治疗效果欠佳,并由于长期卧床导致骨质疏松程度加重、发现压力性溃疡、坠积性肺炎、血栓等并发症。经皮穿刺椎体成形术(PVP)是在影像监视下,经皮穿刺,通过椎弓根路径进入病变椎体,向内注入调配后的骨水泥〔主要成分为聚甲基丙烯酸甲酯(PMMA)〕的一种脊柱微创手术,达到稳定  相似文献   

2.
骨质疏松性骨折往往发生于老年人,造成持续性腰背部剧烈疼痛,椎体变形,脊柱后凸,如果引起神经症状可导致双下肢不全瘫、大小便失禁等,严重影响中老年人的生活质量[1].传统的保守治疗不但恢复时间长,而且易引起多种并发症.本研究拟比较分析经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗骨质疏松脊柱压缩性骨折的疗效.  相似文献   

3.
目的建立胸腰段骨质疏松性椎体压缩性骨折的病理三维有限元模型,分析手术前后病椎及邻近椎体应力变化情况。方法取CT三维重建资料通过软件MIMICS10.0建立椎体的三维实体模型,以三维有限元分析软件ANSYS12.0模拟经皮椎体成形术(PVP)过程在腰1(L1)椎体中置入不同容量骨水泥(2、4、6、8 ml),分析轴向压缩直立、前屈、后伸、侧弯、旋转5种加载状态下手术前后相邻椎体的应力变化。结果小剂量骨水泥注入(2、4 ml),病椎所受应力逐渐增加,而较大治疗量骨水泥注射入(6、8 ml),随着病椎硬度及刚度加强,其所受应力逐渐下降;而临近椎体在骨水泥注入量逐渐增加过程中,所受应力未见明显改变。结论对于老年骨质疏松性压缩性骨折的力学研究,三维有限元力学分析具有良好的应用前景及临床价值;在能够避免大治疗剂量骨水泥注入所带来并发症(如渗漏)前提下,48 ml骨水泥注入量更加有效,且不增加邻近椎体骨折的风险。  相似文献   

4.
【摘要】 目的  评估经皮椎体后凸成形术对骨质疏松椎体压缩骨折的临床疗效。 方法  将50例骨质疏松椎体压缩骨折患者随机分为试验组与对照组,试验组患者采取经皮椎体后凸成形术治疗,对照组患者采取常规经皮椎体成形术治疗,比较两组患者视觉模拟评分(VAS)、Oswestry评分以及4项影像学指标(后凸角以及伤椎前缘、中线、后缘高度)变化。 结果  两组患者术后VAS评分均显著下降(P<0.05),但试验组下降幅度更大(P<0.05);两组患者术后Oswestry评分均显著下降(P<0.05),但试验组下降幅度较对照组更大(P<0.05);试验组患者后凸角以及伤椎前缘、中线、后缘高度术后均显著改善(P<0.05),而对照组手术前后差异无统计学意义(P>0.05)。 结论  采用经皮椎体后凸成形术治疗骨质疏松椎体压缩骨折疗效优于经皮椎体成形术,但经皮椎体后凸成形术治疗成本高于经皮椎体成形术。今后应根据患者实际情况选择术式。  相似文献   

5.
目的探讨经皮椎体成形术(PVP)治疗老年骨质疏松性胸腰椎压缩性骨折的临床效果。方法选取2016年4月至2011年8月间该院收治的118例患者为研究对象,针对实施经皮椎体成形术后的相关结果进行比较分析。结果实施手术治疗前VAS评分为(7.23±8.24)分,实施手术治疗后VAS评分为(2.51±6.54)分,治疗后VAS评分明显优于治疗前(t=19.321,P<0.001);实施手术治疗前活动能力评分为(3.20±0.58)分,实施手术治疗后活动能力评分为(1.87±0.51)分,治疗后活动能力评分优于治疗前活动能力评分(t=17.478,P<0.001);实施手术治疗前使用止痛药评分为(2.27±0.88)分,实施手术治疗后使用止痛药评分为(0.67±0.97)分,治疗后使用止痛药评分优于治疗前评分(t=12.874,P<0.001)。结论应用经皮椎体成形术老年骨质疏松性胸腰椎压缩性骨折的临床实际效果显著,可靠性和安全性较高,具有较高的临床应用价值。  相似文献   

6.
骨质疏松性椎体压缩性骨折在老年人群中非常常见,由于骨折愈合速度较慢,需长期卧床休养,并发症较多,骨折常引起严重的疼痛,严重影响老年人的生活质量.保守治疗效果不佳,大部分老年人又不能耐受或不接受较大型手术.我科自2007年5月至2010年1月应用球囊扩张椎体后凸成形术(pecutaneous kyphoplasty,PKP)治疗老年骨质疏松性椎体压缩骨折28例,取得了满意的疗效.  相似文献   

7.
目的观察经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床效果。方法回顾性分析2013-06~2014-11宜春市人民医院骨科采用经皮椎体成形术治疗骨质疏松性椎体压缩性骨折28例患者临床资料,其中胸椎8例,腰椎20例。对所有患者进行随访,采用视觉疼痛模拟量表(VAS)对患者进行疼痛评分,采用0swestry功能障碍指数(ODI)进行脊柱功能评分,术前、术后X线片测量病椎椎体高度及Cobb角恢复情况,并记录相关并发症。结果 28例患者术后随访12~23个月,平均15.8个月。患者视觉疼痛模拟评分由术前(8.7±3.5)分降至(1.9±2.2)分(P0.01),ODI由术前(68.4±13.3)%降低到末次随访时(10.1±6.6)%(P0.01)。椎体前缘高度术前、术后分别为(58.1±15.4)%和(62.2±8.6)%,差异无统计学意义(P0.05)。Cobb角术前、术后分别为(21.3±3.8)和(18.2±2.5),差异无统计学意义(P0.05)。结论经皮椎体成形术能有效缓解疼痛,提高患者生活质量,是治疗骨质疏松性椎体压缩骨折安全、有效的方法。  相似文献   

8.
目的对比经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法回顾分析自2013年6月至2014年12月该院单纯行PVP或PKP的OVCF患者92例(共128个椎体),根据手术方式分成PVP组和PKP组,统计两组患者手术的有效率、后凸矫正率及骨水泥渗漏率,并比较患者手术前及术后1个月的疼痛视觉模拟评分(VAS)及伤椎高度变化情况。结果 PVP组有效率为90.00%,PKP组有效率为92.86%,两组无统计学差异(P0.05);两组患者术后VAS均明显低于手术前,其中PKP组VAS评分显著低于PVP组(P0.05);两组患者间后凸矫正率比较无统计学差异(P0.05);PKP组发生骨水泥渗漏率为16.67%,明显低于PVP组的36.00%(P0.05);两组患者术后伤椎高度明显高于手术前,其中PVP组伤椎高度显著高于PKP组(P0.05)。结论 PVP和PKP治疗OVCF均具有良好的临床疗效,PKP可以更好地降低患者的VAS评分,且骨水泥渗漏率更低,而PVP可以更有效地提高伤椎的高度。两种方式各有特点,临床应根据患者的实际情况进行选择。  相似文献   

9.
目的探讨老年经皮椎体成形术(PVP)后新发椎体压缩性骨折的发生率及相关危险因素。方法行择期PVP患者180例,按照有无出现新发椎体压缩性骨折分为骨折组(48例)和对照组(132例)。收集所有患者年龄、性别、体质量指数(BMI);病史、骨密度(BMD)的T值、术前已存在的骨折椎体个数、椎体强化术治疗的椎体个数、手术部位、骨折椎体严重程度、注入骨水泥量、骨水泥渗漏例数、新发骨折的部位等临床资料进行分析。结果单因素分析结果表明:BMI>24 kg/m2或<18.5 kg/m2、有过骨折病史、BMD>2.5 SD、术前已存在的骨折椎体个数>2、椎体强化术治疗的椎体个数>2的患者医院发生新发椎体压缩性骨折的比率较高。Logistic多元逐步回归分析结果显示:年龄、BMI值、骨折病史、BMD值、术前已存在的骨折椎体个数、椎体强化术治疗的椎体个数是与PVP后新发椎体压缩性骨折发生相关的危险因素。结论术后新发椎体压缩性骨折是老年PVP较为常见的并发症,应针对危险因素采取积极的预防,改善患者生存质量。  相似文献   

10.
目的探讨经皮椎体成形术和非手术治疗老年骨质疏松性胸腰椎体压缩骨折的临床效果。方法收集2012年7月至2013年10月在该院就诊且随访时间≥1年的171例胸腰椎单节段骨质疏松性椎体压缩骨折患者,根据治疗方式不同分为PVP组83例和非手术组88例,分别于治疗前后评估疼痛视觉模拟评分(VAS)、后凸矫正率、椎体高度恢复程度、临近椎体骨折发生率等,比较两种治疗方式的临床效果。结果治疗后1 d PVP组和非手术组VAS评分分别为(3.07±0.53)分和(7.03±0.18)分,且PVP组VAS评分较治疗前明显下降;1年后随访分别为(2.51±0.87)分和(2.72±0.97)分,两组间无统计学差异(P0.05),且均较治疗前有改善。PVP组和非手术组后凸矫正率和椎体高度恢复情况1年后随访分别为(54.42±7.06)分和(55.31±11.18)分、(48.50±14.93)分和(46.53±5.74)分,两组间差异均有统计学意义(P0.05)。PVP组在治疗后1个月内出现1例骨折,3个月后4例骨折,6个月后5例骨折,1年后6例骨折,非手术组1年后1例骨折,两组比较有统计学差异(P0.05)。结论PVP组在早期缓解疼痛方面优于非手术治疗组。在远期疗效方面,PVP组和非手术治疗组均可获得明显的疼痛缓解、矫正部分后凸、恢复部分椎体高度。但非手术治疗组的再次骨折发生率小于PVP组,可见非手术治疗亦可以作为手术以外有效的治疗方式。  相似文献   

11.
目的分析经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法选取该院2017-01~2018-01因OVCF行PVP治疗的患者158例(205椎),对比患者手术前后视觉模拟评分法(VAS)、Oswesty功能障碍指数(ODI)评分,伤椎前缘高度、Cobb角变化,以评价治疗效果;同时分析临床疗效与骨水泥注入量的关系。结果所有患者术后VAS评分、ODI评分均较术前明显降低,差异有统计学意义(P<0.05);术后伤椎前缘高度、Cobb角均较术前明显恢复,差异有统计学意义(P<0.05)。结论PVP治疗OVCF具有较好的临床效果,可尽早缓解疼痛,提高患者生活质量。  相似文献   

12.
目的 探讨骨质疏松性椎体压缩骨折(OVCFs)经皮椎体成形术(PVP)及经皮椎体后凸成形术(PKP)后非手术椎体骨折的危险因素。方法回顾性研究2009年2月~2010年3月于河北医科大学第三医院脊柱外科门诊及病房共收治OVCFs患者76例,男11例,女65例,年龄56~87岁,平均(66.7±7-3)岁,随访时间6~22个月,平均13.6个月。44例患者行PVP手术,32例患者行PKP手术。记录两组患者年龄、性别、病程、体质量指数、骨密度、水泥注入量、水泥渗漏率、平均后凸角矫形,分析引起非手术椎体骨折的危险因素。结果PVP组患者水泥注入量及平均后凸角矫形均低于PKP组患者,经两样本t检验,差异有统计学意义(P〈0.05);水泥渗漏率和新发椎体骨折两组间差异无统计学意义(P〉0.05);logistic回归分析结果显示,骨密度T值≤-2.5SD是与非手术椎体骨折相关的危险因素,后凸角矫形≥5.0。组患者新发骨折与首次手术间隔时间明显短于对照组,经秩和检验显示差异有统计学意义(P〈O.05)。结论骨密度T值≤-2.5SD是与非手术椎体骨折相关的危险因素,在骨密度T值严重降低的骨质疏松患者中,过多的矫正后凸畸形可能缩短了再发骨折的发病周期。  相似文献   

13.
To identify the risk factors of the secondary fractures for osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).We conducted a search of relevant articles using Cochrane Library, PubMed, Medline, Science Direct, Embase, the Web of Science and other databases. The time range we retrieved from establishment of the electronic database to November 2017. Gray studies were found in the references of included literature reports. STATA version 11.0 (Stata Corporation, College Station, Texas) was used to analyze the pooled data.Fourteen studies involving 1910 patients, 395 of whom had fracture secondary to the surgery were included in this meta-analysis. The result of meta-analyses showed the risk factors of the secondary fractures for OVCFs after PVP was related to bone mineral density (BMD) [95%CI (−0.650, −0.164), SMD=−0.407, P=.001], cement leakage ((RR=0.596, 95%CI (0.444,0.798), P = .001)), and kyphosis after primary operation ((SMD=0.741, 95%CI (0.449,1.032), P = .000)), but not to gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.Bone mineral density, cement leakage, and kyphosis after primary operation are the risk factors closely correlative to the secondary fracture after PVP. There have not been enough evidences to support the association between the secondary fracture and gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.  相似文献   

14.
目的探讨个体化单侧穿刺椎体后凸成形术(UI-PKP)治疗胸腰段椎体骨质疏松性压缩骨折(OVCF)的安全性和临床疗效。方法采用UI-PKP术治疗单节段胸腰椎OVCF患者187例,男63例,女124例;年龄60~89岁,平均73.5岁。骨折椎体分布,胸椎(T)10 27例,T11 40例,T12 49例,腰椎(L)1 43例,L2 28例;PKP术后再骨折18例。患者术前常规行X线、全脊柱MRI及压缩椎体三维重建,针对不同患者影像资料进行穿刺钉道设计,指导术中穿刺。观察骨水泥灌注量、骨水泥在骨折椎体的填充情况、骨水泥渗漏及并发症;比较手术前与术后3 d、3个月、1年时间点疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及压缩椎体前缘、中线高度。结果所有患者顺利完成手术,骨水泥注入量(4.3±1.7)ml。术后3 d、3个月、1年,VAS、ODI较术前明显改善,骨折椎体前缘、中线高度较术前明显增加,差异有统计学意义(P0.05)。骨水泥在骨折椎体充分填充166例(88.8%),不充分填充21例(11.2%)。23例(12.3%)发生骨水泥渗漏(硬膜外渗漏3例,椎间隙渗漏12例,椎旁软组织渗漏8例);2例椎旁渗漏致肋间神经压迫,术后出现放射性疼痛和麻木,予非甾体类抗炎药物、封闭等治疗好转;其余渗漏均未引起临床症状,未行翻修手术。未出现气胸、血管神经损伤、脊髓损伤、脑脊液漏、感染等相关并发症。结论 UI-PKP治疗胸腰段椎体OVCF,骨水泥在骨折椎体弥散良好,临床疗效满意。  相似文献   

15.
The aim of this study was:to assess the long-term efficacy and safety of percutaneous vertebroplasty (PVP) for treating painful vertebral osteoporotic fractures, and to estimate the risk of vertebral fracture in the vicinity of a cemented vertebra. A prospective open study was conducted. PVP were carried out between July 1995 and September 2000 for 16 patients with symptomatic osteoporotic vertebral fracture that had not responded to extensive conservative medical therapy. All the patients were followed-up for more than 1 year. The efficacy of the PVP was assessed by the changes over time in pain on Huskissons visual analog scale (VAS) and on the McGill-Melzack scoring system (MGM). The efficacy of the procedure was also assessed by measuring the changes over time in quality of life assessed by the Nottingham Health Profile (NHP instrument): twenty-one vertebrae treated by PVP in 16 patients were evaluated. The mean duration of follow-up was 35 months. Pain assessed by the VAS significantly decreased from a mean of 71.4 mm±13 before PVP to 36 mm±30 after 6 months, and to 39 mm±33 at the time of maximal follow-up (p<0.05 for both comparisons). The results were also significant for the MGM: 3.00±0.57 before PVP to 1.6±1.4 at the long-term follow-up (p<0.05). The solely statistically significant decrease for quality of life was noted for pain. A slight but not significant improvement was noted for 3/6 dimensions of the NHP scores. A slight but significant increase in social isolation was also found. No severe complication occurred immediately after PVP. At the long term follow-up (35 months) there was a slight but not significantly increased risk of vertebral fracture in the vicinity of a cemented vertebra: odds ratio 3.18 (95% confidence interval (CI) 0.51–19.64). The odds ratio of a vertebral fracture in the vicinity of an uncemented fractured vertebra was 2.14 (95% CI: 0.17–26.31). In conclusion, PVP appears to be safe and effective for treating persistent painful osteoporotic fractures. Controlled studies with long-term follow-up are needed to evaluate the risk of vertebral fractures in the vicinity of a cemented vertebra. Abbreviations MGM McGill-Melzack scoring system - PVP Percutaneous vertebroplasty - VAS Visual analog scale  相似文献   

16.
OBJECTIVE: To assess the immediate and long-term efficacy and safety of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for the treatment of refractory pain resulting from osteoporotic vertebral fractures. METHODS: A retrospective, open study of percutaneous vertebroplasty (PV) was conducted with long-term follow-up. PV with PMMA was carried out between 1990 and 1996 in 40 patients with symptomatic osteoporotic vertebral fracture(s) that had not responded to maximum medical therapy. In 1997, each patient was asked to come back to our institution for a physical and spinal X-ray examination. Efficacy was assessed by changes over time in pain on Huskisson's visual analogue scale (VAS). RESULTS: Thirty-four vertebrae treated by PV in 25 patients were evaluated with long-term follow-up. The mean duration of follow-up was 48 months (range 12-84 months). Pain assessed by the VAS significantly (P<0.05) decreased from a mean of 80 mm+/-16 (S.D.) before PV to 37+/-24 mm after 1 month and 34+/-28 mm at the time of maximal follow-up. There was no severe complication related to this treatment, and no progression of vertebral deformity in any of the injected vertebrae. However, there was a slight but significantly increased risk of vertebral fracture in the vicinity of a cemented vertebra (odds ratio 2.27, 95% confidence interval 1.1-4.56). The odds ratio of a vertebral fracture in the vicinity of an uncemented fractured vertebra was 1.44 (0.82-2.55). CONCLUSION: PV appears to be a safe and useful procedure for the treatment of focal back pain secondary to osteoporotic vertebral fracture when conservative treatment has failed.  相似文献   

17.
Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.  相似文献   

18.
目的观察骨质疏松性椎体骨折(OVF)不同时期患者行经皮椎体成形术(PVP)治疗的临床效果。方法选择行PVP的OVF患者120例,根据损伤至手术时间不同分为损伤2周内手术(A组)65例、损伤第2~8周手术(B组)35例、损伤2个月后手术(C组)20例。比较三组患者术前、术后3 d、术后6个月时的疼痛视觉模拟评分(VAS)、欧洲骨质疏松症基金会生活质量问卷(QUALEFFO)评分;比较三组患者骨水泥分布情况、骨水泥注入量、骨水泥渗漏率。结果三组患者各组内比较,术后3 d的VAS均低于术前,术后6个月的VAS均低于术后3 d(P<0.05);术后6个月、术后3 d的QUALEFFO评分均低于术前(P<0.05)。三组同时点VAS、QUALEFFO评分差异均无统计学意义(P均>0.05)。三组骨水泥注入量、骨水泥渗漏率、骨水泥分布指数比较差异均有统计学意义(P均<0.05)。结论PVP在治疗不同时期OVF中均有良好效果。急性期骨水泥分布指数高,而在亚急性期、慢性期则分别存在骨水泥渗漏率较低、骨水泥注入量减少的情况。建议对于OVF患者应早期进行PVP治疗。  相似文献   

19.
目的 比较分析骨填充网袋椎体成形术和经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)的临床疗效。方法回顾性分析2018年12月至2020年7月经手术治疗的骨质疏松性椎体压缩骨折患者150例(单节段)的临床资料。根据手术方式的不同将其分为两组,网袋组73例,PKP组77例,术后随访12个月。分别记录评估两组患者术前和术后2 d和12个月视觉模拟评分(visual analogue scale, VAS)、伤椎前缘高度、Cobb角、Oswestry功能障碍指数(Oswestry disability index, ODI),并比较手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏及相邻椎体骨折情况。结果 150例患者均顺利完成手术,无严重并发症。两组患者一般资料比较差异无统计学意义(P>0.05)。网袋组73例患者手术时间为(27.1±1.9)min、术中透视次数为(14.3±1.4)次、骨水泥渗漏7例(9.6%)、相邻椎体骨折5例(6.8%),与PKP组比较差异有统计学意义[手术时间(32.4±4.3)min,术中透视次数(17.2±2.1)次,骨水泥渗漏19例(24.7%),相邻椎体再骨折16例(20.8%),均P<0.05];骨水泥注入量与PKP组比较差异无统计学意义(P>0.05)。网袋组术后2 d、12个月的VAS评分、Cobb角、伤椎前缘高度及ODI指数分别为(2.1±0.3)分、(11.4±3.7)°、(25.9±4.7)mm、(32.5±3.9)%和(0.4±0.3)分、(10.8±2.1)°、(24.2±1.7)mm、(26.8±2.5)%,各观察指标与术前比较明显改善(P<0.05),与PKP组比较差异无统计学意义[术后2 d分别为(2.3±0.4)分、(11.3±2.8)°、(26.7±4.1)mm、(32.6±3.7)%;术后12个月分别为(0.3±0.6)分、(10.9±1.7)°、(23.8±2.7)mm、(27.1±2.1)%,均P>0.05)]。结论 骨填充网袋椎体成形术和PKP治疗骨质疏松性椎体压缩骨折临床疗效基本相当,均可有效缓解患者疼痛症状、恢复椎体部分高度、纠正Cobb角及改善患者生活质量,而网袋组减少手术时间及术中透视次数、降低骨水泥渗漏率和相邻椎体再骨折发生率具有一定的优势。  相似文献   

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