经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩性骨折

目的探讨经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法对60例老年OVCF患者采用PKP治疗,手术在C臂机透视下进行。记录并比较术前、术后3 d、术后1年的视觉模拟疼痛评分(VAS)及病椎最大塌陷处的高度、Cobb角的变化。结果 60例均获得随访,时间1~3年,术后病椎疼痛症状均显著缓解。术后3 d和术后1年的VAS评分、病椎最大塌陷处的高度、Cobb角与术前比较差异均有统计学意义(P0.01)。结论 PKP治疗老年OVCF可以有效恢复椎体高度和矫正后凸畸形,迅速缓解疼痛,提高患者的生活质量。     

骨水泥遥控推注装置在PVP手术治疗骨质疏松性椎体压缩性骨折的运用价值

目的 探讨骨水泥遥控推注装置在PVP手术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的运用价值.方法 本研究对象为2017年2月～2020年6月于本院治疗的84例OVCF患者,随机数字法分为两组,均采用PVP手术治疗:对照组采用间断手动推...     

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。     

经皮椎体成形术磷酸钙骨水泥治疗老年骨质疏松性椎体压缩性骨折

目的探讨应用经皮椎体成形术(percutaneous vertebroplasty,PVP)自固化磷酸钙骨水泥(calcium phosphate cement,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 45例骨质疏松性胸腰椎压缩骨折患者病人共45个椎体,采用自固化磷酸钙骨水泥(calcium phosphatecement,CPC)治疗,平均充填量为2～4mL。手术前后应用国际通用术前疼痛目测分级(VAS)评分,脊柱侧位X线片测量椎体高度。结果 45例患者45个椎体操作全部成功,成功率100%。术后随访24个月,患者背部疼痛明显缓解或消失;术前VAS评分为6.5～8.8分,平均7.6±0.65分,术后1个月VAS评分平均2.02±0.87分,术后24个月VAS评分平均2.82±1.11分,手术前后有统计学意义(P0.05),术后1个月与术后24个月比较无显著差异(P0.05)。术后椎体高度无变化,随访椎体高度无丢失、无并发症。结论自固化磷酸钙骨水泥(calcium phosphate cement,CPC)充填治疗骨质疏松性胸腰椎压缩性骨折是一种微创、安全、有效的治疗手段。     

经皮椎体后凸成形术中不同黏度骨水泥对老年骨质疏松椎体压缩性骨折临床疗效观察

目的探讨经皮椎体后凸成形术(PKP)中不同黏度骨水泥对老年骨质疏松椎体压缩性骨折(OVCF)的临床疗效。方法我院2018年5月～2020年10月收治的OVCF病人60例,根据治疗方式不同分为对照组(28例)与实验组(32例)。对照组病人在PKP术中注入低黏度骨水泥,实验组病人在PKP术中注入高黏度骨水泥。统计围术期相关指标,并比较两组骨水泥渗漏情况。比较两组病人术前与术后椎体前缘高度及后凸Cobb角变化,计算椎体高度恢复率及后凸矫正率。随访3个月,比较视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)、健康调查简表(SF-36)评分。结果 60例病人均手术成功,手术时间平均(28.25±5.24)分钟,骨水泥用量平均(2.58±0.35)ml,实验组骨水泥总渗漏率较对照组低(P0.05),所有病人术中均无神经损伤;术后7天及术后3个月椎体前缘压缩高度及后凸Cobb角明显低于术前(P0.05),术后7天实验组显著低于对照组(P0.05),术后3个月两组比较差异无统计学意义(P0.05),术后实验组椎体高度恢复率及后凸矫正率较对照组高(P0.05);术后7天两组VAS、ODI评分均低于术前(P0.05),组间VAS及ODI评分相比,差异无统计学意义(P0.05),术后3个月两组SF-36评分均高于术前(P0.05),组间比较差异无统计学意义(P0.05)。结论老年OVCF病人PKP术中使用高黏度与低黏度骨水泥均疗效显著,二者对疼痛及腰椎功能改善作用相当,高黏度骨水泥可更好地恢复及矫正椎体结构,且水泥渗漏率低。     

高黏度骨水泥经皮椎体成形术对骨质疏松性椎体压缩性骨折患者术后VAS及ODI评分的影响

目的探讨高黏度骨水泥经皮椎体成形术对骨质疏松性椎体压缩性骨折(OVCF)患者术后VAS及ODI评分的影响。方法选取2017-02—2019-03间遂平县仁安医院行经皮椎体成形术的64例OVCF患者,随机将其分为2组,每组32例。对照组术中应用低黏度骨水泥,观察组术中注入高黏度骨水泥。比较分析不同黏度骨水泥的临床效果。结果(1)观察组术后第1天的骨水泥渗漏率及术后3个月的VAS、ODI评分均低于对照组,差异均有统计学意义(P<0.05)。结论应用高黏度骨水泥行经皮椎体成形术治疗OVCF,骨水泥渗漏率低,有利于缓解患者术后疼痛和改善脊柱功能。     

不同黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折

目的 比较采用高黏度骨水泥和低黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效差异.方法 回顾性分析2013年9月至2014年11月我科治疗的83例骨质疏松性椎体压缩性骨折病人的病例资料.根据手术所用不同黏度骨水泥分组:采用低黏度骨水泥椎体成形术治疗的病人43例(低黏度组);采用高黏度骨水泥椎体成形术治疗的病人40例(高黏度组).记录单个椎体手术时间、骨水泥渗漏发生率,术后并发症发生率.采用疼痛视觉模拟量表(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)对两组进行术前及术后1 d、术后3个月疼痛及功能进行评价.通过X线检查对术前、术后椎体各部进行测量,统计椎体高度变化.结果 83例病人术后均得到3个月随访.两组术前VAS评分和骨折压缩率上无差异.高黏度组的手术时间较低黏度组明显缩短(t=22.32,P=0.000).术后1 d、术后3个月,两组组内VAS评分、ODI较术前明显降低(均P=0.000),但术后组间比较无明显差异(均P>0.05).高黏度组骨水泥渗漏率较低黏度组低,差异有统计学意义(P=0.0494).椎体成形术后高黏度组椎体高度恢复优于低黏度组,差异有统计学意义(P=0.000).结论 椎体成形术中使用不同类型的骨水泥均能有效地缓解病人疼痛,改善生活质量.与低黏度骨水泥相比,高黏度骨水泥有着较低的骨水泥渗漏率,同时缩短了手术时间和降低了术中放射性的暴露.     

经皮椎体成形术治疗胸腰椎压缩性骨折

胸腰椎骨折为骨科常见多发病,在临床上有许多治疗方法,我科从2001年开始尝试应用经皮椎体成形术治疗胸腰椎骨折取得良好效果,现报道如下。     

高黏度骨水泥与普通骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩骨折效果观察

目的 探讨高黏度骨水泥与普通骨水泥经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCF)的效果.方法 前瞻性纳入2019-01—2021-01于南阳市第一人民医院骨科行PVP治疗的OVCF患者.依据骨水泥粘度分为普通骨水泥组和高黏度骨水泥组.比较2组患者的基线资料.手术前后采用视觉模拟评分(VAS)法评估患者的...     

椎体成形术治疗压缩性骨折并发骨水泥渗漏的预防

目的探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗骨质疏松性椎体压缩性骨折并发骨水泥渗漏的预防。方法 2007年5月至2011年11月,我科采用PVP治疗骨质疏松性胸腰椎压缩性骨折患者75例85椎,其中有7例患者出现骨水泥渗漏。本文对骨水泥渗漏的原因、处理方法、预防措施进行总结。结果 78例患者术后疼痛症状消失或缓解,优良率达97.48%。7例出现骨水泥渗漏现象,其中有4例位于椎旁软组织,1例呈现拖尾现象,2例通过椎板漏入相邻椎间盘。结论虽然经皮椎体成形术治疗椎体压缩性骨折在操作过程中会出现骨水泥渗漏等并发症,给患者造成身心伤害,甚至危及患者生命,但只要合理掌握手术适应证,提高技术水平,掌握手术技巧,骨水泥渗漏的并发症是可以避免的。     

比较经皮椎体成形术与保守治疗治疗骨质疏松性椎体压缩骨折的系统评价

目的 比较经皮椎体成形术(PVP)与保守治疗治疗骨质疏松性椎体压缩骨折的疗效.方法 收集所有PVP与保守治疗治疗骨质疏松性椎体压缩骨折的随机对照研究(RCT),前瞻性临床队列研究(CCT),对其逐个进行质量评价,作系统评价分析.结果 共纳入3篇研究:1篇RCT,2篇CCT,共计288例患者.3个研究均对PVP与保守治疗进行疗效比较.在减轻疼痛方面,PVP组在术后1 d及至少2 w内优于保守组,但在远期效果上是否优于保守治疗缺乏证据.在相邻椎体新发压缩骨折方面,两种方法没有差别.在总体治疗效果上,由于使用了不同的评分方法,尚无法得出何种技术更为有效的结果.在止痛药物的使用上,也无法得出PVP组少于保守治疗组的结论.结论 PVP与保守治疗均是治疗骨质疏松性椎体压缩骨折的有效治疗方法,但近期疼痛缓解PVP组优于保守组.在评价其他结局指标方面,缺乏足够的证据,尚需更多设计严格的研究以增加证据的强度.     

胸腰段重度楔形骨质疏松性椎体压缩骨折的经皮椎体成形术治疗与保守治疗的近期疗效和并发症的比较

目的 比较经皮椎体成形术(PVP)和保守治疗胸腰段重度楔形骨质疏松性椎体压缩骨折(OVCF)的近期疗效及并发症.方法 对2007年1月至2010年1月收治的43例胸腰段重度楔形OVCF患者进行前瞻性非随机对照研究,根据患者意愿分别行PVP治疗(19例)和保守治疗(24例).两组患者治疗前一般资料比较差异均无统计学意义,具有可比性.治疗前、后以视觉模拟评分(VAS)评估疼痛程度,用SF-36健康调查简表(SF-36)评估患者生理功能(PCS)及心理功能(MCS);并比较两组患者治疗前、后VAS评分、PCS评分、MCS评分、椎体高度、后凸角度及渗漏情况. 结果 所有患者均完成1年随访,PVP组VAS评分、疼痛缓解率、PCS评分、椎体前中壁高度、后凸角度在治疗后各时间点均优于保守治疗组,差异均有统计学意义(P＜ 0.05);PVP组MCS评分在治疗后1个月高于保守治疗组,其他时间点两组MCS评分差异均无统计学意义(P＞0.05);两组椎体后壁高度及新发椎体骨折发生率差异均无统计学意义(P＞0.05);但PVP组新发椎体骨折时间比保守治疗组提前约53 d,差异有统计学意义(P＜0.05).PVP组骨水泥渗漏率达52.6％(10/19),椎间盘渗漏占70.0％(7/10),均未引起严重临床并发症. 结论 PVP治疗胸腰段重度楔形椎体压缩骨折在技术上是可行的,其临床疗效优于保守治疗,且并不增加术后新发椎体骨折的风险.     

Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review

Percutaneous vertebroplasty has been performed for more than ten years to treat painful osteoporotic vertebral compression fractures. Clinical results have been encouraging, but little is known about the efficacy and safety of this minimally invasive procedure. We therefore performed a systematic review to assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures. A search was conducted using Medline, Embase and The Cochrane Controlled Trials Register. The search yielded fifteen studies, eleven prospective, three retrospective and one controlled trial. Totally 1,136 interventions were performed on 793 patients. Mean pain scores, measured using a 0 to 10 VAS score, improved significantly from 7.8 to 3.1 (−60.3%) immediately after percutaneous vertebroplasty. The short-term complication rate varied between 0.4 and 75.6%. Leakage of cement outside the vertebral body was markedly common, ranging from 3.3 to 75.6%. Although the majority was asymptomatic, a few devastating clinical adverse effects were reported (mean 2.4%). Although percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral fractures, we revealed only a single controlled trial. We conclude that there are insufficient data available to reliably assess efficacy of percutaneous vertebroplasty. The procedure has a low rate of clinical complications, but potential complications can be devastating. In the future, assessing the efficacy of percutaneous vertebroplasty requires controlled trials with long-term follow-up.     

保守疗法和椎体成形术治疗骨质疏松性椎体压缩骨折的系统评价

[目的]评价保守疗法和经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效.[方法]全面收集保守疗法和PVP治疗骨质疏松性椎体压缩骨折的随机对照研究,在严格文献质量评价的基础上,进行系统评价.[结果]共纳入4篇RCT,共计285例患者.在减轻疼痛方面,经皮椎体成形术组在术后ld、2周均优于保守组.在再骨折和邻椎骨折方面,尚不能得出确切结论.[结论]经皮椎体成形术和保守疗法均是治疗骨质疏松性椎体压缩骨折的有效治疗方法,近期疼痛缓解情况经皮椎体成形术组优于保守组,再骨折的评价缺乏足够的证据,尚需更多设计严谨的临床试验证实.     

经皮支柱块治疗胸腰椎压缩骨折

目的观察经皮支柱块治疗单纯胸腰椎压缩骨折疗效。方法采用经皮穿刺经双侧椎弓根支柱块置入术治疗33例胸腰椎压缩性骨折患者。结果 33例患者共植入支柱块66枚,术后无神经并发症发生。手术时间35~57(40.8±6.3)min,手术切口长度1.5~2.0(1.7±0.3)cm,术中失血量18~40(25.7±8.3)ml。患者均获随访,时间10~22(15.4±2.3)个月。VAS评分:术前7~10(8.0±1.6)分,术后1~3(2.4±0.8)分;Cobb角:术前20°~35°(25.2°±6.1°),术后6°~13°(9.7°±2.5°);伤椎前缘高度:术前45%~60%(49.6%±6.3%),术后75%~91%(82.7%±5.3%)。VAS评分、Cobb角、伤椎前缘高度术前术后比较差异均有统计学意义(P0.05)。结论经皮支柱块治疗胸腰椎压缩性骨折的短期疗效满意,创伤小,并发症少。     

椎体成形术与非手术治疗骨质疏松性椎体压缩骨折的系统评价

目的 系统评价椎体成形术和非手术治疗骨质疏松椎体压缩性骨折的治疗效果.方法 应用Cochrane系统评价方法计算机检索Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库和维普数据库,并手工检索相关领域杂志.检索不受语种限制,时间均从建库至2011年11月.收集以椎体成形术和非手术治疗骨质疏松性椎体压缩骨折的所有随机对照试验(RCTs).进行资料提取和质量评价,用RevMan 5.0软件进行统计学分析.结果 最终纳入7个RCTs,共614例患者.研究结果显示:与保守治疗相比,随访1、4、12、24、48w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,两种治疗方法无统计学意义.与安慰剂相比,随访4w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显优势.结论 与保守治疗相比,椎体成形术在缓解疼痛方面具有一定的优势,但是远期疗效还需更大量的高质量文献提供科学的证据.由于纳入研究质量和病例数量的局限,上述结论尚需要更多高质量的随机对照试验进一步验证.     

Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: a systematic review of randomized, controlled trials

Vertebral collapse is one of the most common fractures associated with osteoporosis. The subsequent back pain is severe and often requires medications, bed rest and hospitalization to control pain and improve mobilization. The purpose of this systematic review was to assess the effects of calcitonin versus placebo for the treatment of acute pain in patients sustaining stable, recent, osteoporotic vertebral compression fractures. MEDLINE (1966–2003), EMBASE (1980–2003), Cochrane Controlled Trial Registry (2003, volume 3), other databases, and conference proceedings were searched for relevant research. Primary study authors and the pharmaceutical manufacturer were contacted, and bibliographies of relevant papers were hand-searched. Randomized, double-blind, placebo-controlled trials comparing calcitonin versus placebo for the acute pain of recent osteoporotic vertebral compression fractures were included. Two reviewers extracted data, performed numeric calculations and extrapolated graphical data independently. The combined results from five randomized controlled trials, involving 246 patients, determined that calcitonin significantly reduced the severity of pain using a visual analogue scale following diagnosis. Pain at rest was reduced as early as 1 week into treatment (weighted mean difference [WMD] =3.08; 95% confidence interval [CI]: 2.64, 3.52) and this effect continued weekly to 4 weeks (WMD =4.03; 95% CI: 3.70, 4.35). A similar pattern was seen for pain scores associated with sitting, standing, and walking. Side effects were gastrointestinal, minor and often self-limited. Calcitonin appears to be effective in the management of acute pain associated with acute osteoporotic vertebral compression fractures by shortening time to mobilization.Dr. Lyritis was the principal investigator of three of the included trials. He has not received research funding nor speakers fees from Novartis. None of the other study authors have received funding from any company that manufactures salmon calcitonin. Grant support was provided by the Emergency Medicine Research Group (EMeRG). Dr. Rowe is funded through the Canada Research Chairs Program of the Canadian Institute of Health Research (CIHR)     

经皮可扩张椎体支柱块置入术治疗胸腰椎压缩骨折

目的 探讨经皮可扩张椎体支柱块(IVEP)置入并植骨治疗胸腰椎压缩性骨折的手术技巧和短期疗效.方法 自2009年1月～2011年2月采用经皮穿刺经双侧椎弓根IVEP置入术治疗胸腰椎压缩性骨折42例(44椎),共置入支柱块88枚.结果 术后疼痛显著缓解,VAS评分及ODI评分均较术前明显降低.平均手术时间(38.8±5.3)min/椎.术后椎体高度平均恢复至正常椎体高度的(89.6±6.5)％,术后Cobb角明显变小.至末次随访,骨折愈合良好,无复位丢失和支柱块移位.结论 经皮可扩张IVEP置入并植骨治疗胸腰椎压缩性骨折的短期疗效满意,具有创伤小、手术操作简便、并发症少、并且可保留脊柱生理活动度的优点,是治疗该类骨折较为理想的选择.     

Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs)

Summary

The study investigated whether kyphoplasty (KP) was superior to vertebroplasty (VP) in treating patients with osteoporotic vertebral compression fractures (OVCFs). KP may be superior to VP for treating patients with OVCFs based on long-term VAS and ODI but not short-term VAS. Further large-scale trials are needed to verify these findings due to potential risk of selection bias.

Introduction

This study aimed to assess whether KP was superior to VP in treating patients with OVCFs.

Methods

The Medline, Embase, and Cochrane databases and references within articles and proceedings of major meetings were systematically searched. Eligible studies included patients with OVCFs who received either KP or VP. Standard mean differences (SMDs) and relative risks (RRs) were used as measures of efficacy and safety in a random-effects model.

Results

Eleven studies enrolling 869 patients with OVCFs were identified as eligible for final analysis. Compared with VP, KP was associated with significant improvements in long-term (SMD, ?0.70; 95 % confidence interval [CI]: ?1.30, ?0.10; P?=?0.023) visual analog scale (VAS); short-term (SMD, ?1.50; 95 % CI: ?2.94, ?0.07; P?=?0.040) and long-term (SMD, ?1.03; 95 % CI: ?1.88, ?0.18; P?=?0.017) Oswestry Disability Indexes (ODIs); short-term (SMD, ?0.74; 95 % CI: ?1.42, ?0.06; P?=?0.032) and long-term (SMD, ?0.71; 95 % CI: ?1.19, ?0.23; P?=?0.004) kyphosis angles; and vertebral body height (SMD, 1.56; 95 % CI: 0.62, 2.49; P?=?0.001) and anterior vertebral body height (SMD, 3.04; 95 % CI: 0.53, 5.56; P?=?0.018). KP was also associated with a significantly longer operation time (SMD, 0.73; 95 % CI: 0.26, 1.19; P?=?0.002) and a lower risk of cement extravasation (RR, 0.68; 95 % CI: 0.48, 0.96; P?=?0.030) compared with VP. No significant differences were found in the short-term VAS, posterior vertebral body height, and adjacent-level fractures.

Conclusion

Acknowledging some risk of selection bias, KP displayed a significantly better performance compared with VP only in one of the two primary endpoints, that is, for ODI but not for short-term VAS. Further randomized studies are required to confirm these results.

     

Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review

The aim of this study is to evaluate the efficacy and safety of balloon kyphoplasty (BK) in the management of vertebral compression fractures (VCFs). This study is based on a systematic review of the literature (until October 2004) and meta-analysis of clinical studies assessing the efficacy and safety of BK in the treatment of VCFs. Estimates of effect were based on a random effects model. Meta-regression analyses were carried out where required. A total of 26 studies met the inclusion criteria. Although studies displayed considerable methodological limitations, the results of the clinical series indicate significant improvements in pain intensity, vertebral height, sagittal alignment, functional capacity, and quality of life. Compared with conventional medical management, BK afforded significant improvement in pain intensity and mobility. Likewise, a significant reduction was observed in vertebral collapse, kyphotic deformity, the development of new vertebral fractures, and hospital stay. Compared with vertebroplasty, the technique reduced the loss of height and the degree of kyphotic deformity, and afforded a significantly lower leakage rate—with no differences in relation to other variables. Regarding adverse effects, leakage affected 7% of all levels treated, while complications were recorded in 2% of the patients, and new vertebral fractures in 16%. The available evidence suggests that BK can be effective and safe in application to VCFs. However, existing studies evince substantial methodological limitations and relatively short follow-up periods. Better clinical research is required to determine the capacity of BK to avoid the functional and physiological sequelae of VCFs and to define the true role of the technique among the existing therapeutic options.