经皮椎体后凸成形术治疗不同骨密度胸腰椎压缩性骨折

目的探讨经皮椎体后凸成形术(PKP)对骨密度正常、骨密度下降和骨质疏松性胸腰椎压缩性骨折的临床疗效。方法回顾性分析2016年6月—2017年1月采用PKP治疗的72例胸腰椎压缩性骨折患者的临床资料。根据术前患者腰椎平均骨密度T值,将患者分为骨密度正常组(T值-1,A组),骨密度下降组(-1≥T值≥-2.5,B组)和骨质疏松组(T值-2.5,C组)。采用疼痛视觉模拟量表(VAS)评分评价各组患者术前术后疼痛程度。以正侧位X线片为基础,以压缩椎体的楔形角表示椎体的几何学形状;以包含伤椎上下2个椎体的三节段后凸角评价脊柱后凸畸形程度。记录并比较各组术后骨水泥渗漏的发生率。结果所有患者术后VAS评分、楔形角和后凸角均较术前明显改善,差异均有统计学意义(P 0.05)。C组VAS评分及楔形角改善程度显著优于A和B组,差异均有统计学意义(P 0.05),但A、B组间相比差异无统计学意义(P 0.05)。3组间后凸角改变程度差异均无统计学意义(P 0.05)。A、B和C组的骨水泥渗漏率分别为12.5%(2/16)、7.4%(2/27)和17.2%(5/29),3组间差异无统计学意义(P 0.05)。结论对于不同骨密度胸腰椎压缩性骨折患者,PKP均能显著缓解其腰背痛,并能不同程度地纠正压缩椎体的几何学畸形,且对骨质疏松性椎体压缩性骨折临床疗效更好。     

加速康复外科理念在老年骨质疏松性腰椎压缩性骨折椎体成形术和后凸成形术后康复中的应用

目的：探讨按照加速康复外科（enhanced recovery after surgery,ERAS）理念指导术后规律性核心肌力训练对老年骨质疏松腰椎压缩性骨折椎体成形术（percutaneous vertebroplasty,PVP）和椎体后凸成形术（percutaneous kyphoplasty,PKP）术后康复的作用。方法：将2016年1月至2018年1月期间94例符合纳入、排除标准的因骨质疏松性腰椎压缩骨折而行PKP或PVP手术的老年患者分成观察组和对照组,术后均常规抗骨质疏松治疗。观察组47例,男18例,女29例,年龄（62.62±3.21）岁;对照组47例,男17例,女30例,年龄（62.38±2.84）岁。对照组按照传统的方式训练,观察组按ERAS理念指导患者规律性核心肌力训练。术后1、3、6个月随访,根据患者的Barthel量表、日本骨科协会（Japanese Orthopaedic Association,JOA）腰痛评分,Oswestry功能障碍指数对患者病情进行量化评估,统计分析。比较两组治疗效果的差异性。结果：94例完成随访,术后1、3个月观察组的Barthel量表、JOA腰痛评分、Oswestry功能障碍指数均优于对照组（P<0.05）。术后6个月观察组的Oswestry功能障碍指数优于对照组（P<0.05）,但两组JOA腰痛评分、Barthel量表差异无统计学意义（P>0.05）。两组患者术后1、3、6个月的Barthel量表、JOA腰痛评分、Oswestry功能障碍指数均明显好转（P<0.05）。结论：早期规律性核心力量训练在老年骨质疏松性腰椎压缩骨折PKP或PVP术后早期功能恢复及改善生活能力方面具有积极的作用,符合加速康复外科理念。     

经皮椎体后凸成形术治疗伴周壁破裂的骨质疏松性胸腰椎骨折

随着人口老龄化的加剧,骨质疏松症患者基数逐渐增大,因骨脆性增加及骨量流失,骨质疏松性椎体压缩性骨折(OVCF)的发生率呈逐年上升趋势.经皮后凸椎体成形术(PKP)是OVCF的主要治疗方式之一,穿刺后置入球囊,在骨折椎体内扩张,使椎体高度部分恢复,同时在椎体内形成一个空腔,在相对低压力下进行骨水泥灌注,恢复椎体高度与强度...     

微创椎体后凸成形术治疗12例高龄椎体压缩性骨折

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骨折的临床效果。方法采用山东龙冠球囊扩张系列骨水泥充填对12例骨质疏松性椎体骨折患者（共13个椎体）,在C型臂X光机透视下行经皮椎弓根椎体后凸成形术,平均随访3个月。结果所有患者腰背痛症状均在术后2-24h缓解,第3天能下地行走,随访3个月后病情稳定。结论采用椎体后凸成形术治疗骨质疏松性椎体骨折较安全且能使椎体复张,缓解疼痛,早期下地行走。     

单球囊双侧序贯扩张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 探讨单球囊双侧序贯扩张经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效.方法 2017年1月—2018年6月,采用PKP治疗OVCF患者80例,其中40例行单球囊双侧序贯扩张(观察组),40例行单球囊单侧扩张(对照组).记录2组手术时间、骨水泥注入量、骨水泥弥散系数;术前、术后7 d、末次随访时采用疼痛视觉模拟量表(VAS)评分评估患者疼痛程度,拍摄X线片并测量Cobb角、椎体前缘高度,评价患者畸形矫正及椎体高度恢复效果;观察2组患者椎体再塌陷、骨水泥渗漏发生情况.结果 所有手术顺利完成.所有患者随访超过2年.观察组手术时间长于对照组,骨水泥注入量多于对照组,骨水泥弥散系数高于对照组,差异均有统计学意义(P<0.05);2组患者住院时间差异无统计学意义(P>0.05).术后7 d和末次随访时2组患者VAS评分较术前下降,椎体前缘高度较术前增加,Cobb角较术前减小,差异均有统计学意义(P<0.05);末次随访时观察组Cobb角小于对照组,椎体前缘高度高于对照组,差异均有统计学意义(P<0.05).2组患者椎体再塌陷、骨水泥渗漏发生率差异均无统计学意义(P>0.05).结论 单球囊双侧序贯扩张PKP治疗OVCF能够提升骨水泥注入量和弥散效果,减轻术后矫正效果的丢失,且不增加骨水泥渗漏风险.     

经皮椎体后凸成形术中采用椎体支架系统治疗骨质疏松性椎体压缩性骨折

目的 比较传统经皮椎体后凸成形术（PKP）与PKP术中采用椎体支架（VBS）系统治疗骨质疏松性椎体压缩性骨折（OVCF）的近期疗效。方法 2019年7月—2020年12月,大连市第二人民医院收治老年单节段OVCF患者83例,其中47例采用传统PKP治疗（PKP组）,36例在PKP术中采用VBS系统治疗（VBS组）。记录并比较2组患者手术时间、术中出血量、透视时间、球囊压力、骨水泥注入量、骨水泥渗漏情况、住院时间和住院费用,以及手术前后疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）、Beck指数、伤椎前缘高度、伤椎中部高度、伤椎前缘高度比、伤椎Cobb角、局部Cobb角。结果 所有手术顺利完成,所有患者随访时间> 1年。2组患者术后VAS评分、ODI、Beck指数、伤椎前缘高度、伤椎中部高度、伤椎前缘高度比、局部Cobb角均较术前有所改善,差异有统计学意义（P < 0.05）。与PKP组比较,VBS组手术时间更长,术中透视时间更长,球囊压力更高,骨水泥注入量更多,骨水泥渗漏率更低,住院费用更高,伤椎Cobb角恢复更好,差异均有统计学意义（P < 0.05）。结论 2种术式均能缓解OVCF患者疼痛,PKP术中采用VBS系统能更好地纠正伤椎畸形,且骨水泥渗漏率低,但其手术时间、术中透视时间较长,住院费用较高。     

经皮椎体后凸成形术治疗椎体裂隙周围硬化的Kümmell病

目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗椎体裂隙周围硬化的Kümmell病的安全性与疗效。方法 2011年1月~2013年6月,20例骨质疏松性椎体裂隙周围硬化的Kümmell病患者在本院接受PKP治疗。术前、术后2 d及末次随访时采用疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)评估患者疼痛缓解和生活质量改善情况。测量并记录伤椎前缘相对高度和局部后凸Cobb角的矫正情况。结果本组病例随访12~36个月,平均16个月;无脊髓神经根损伤、肺栓塞等并发症发生。术前VAS评分、ODI、伤椎前缘相对高度和后凸角分别为(8.9±0.4)分、(87.5±3.5)%、(41.3±5.2)%、22.1°±1.8°,术后2 d分别为(2.2±0.6)分、(31.8±4.1)%、(71.2±4.9)%、12.6°±1.4°,末次随访时为(2.0±0.3)分、(26.1±1.3)%、(70.7±4.8)%、13.2°±1.8°,术后2 d与术前相比差异具有统计学意义(P0.05),末次随访与术后2 d相比差异无统计学意义(P0.05)。结论 PKP用于治疗椎体裂隙周围硬化的Kümmell病安全、有效,能缓解疼痛、恢复椎体高度、纠正脊柱后凸畸形,可改善患者生活质量。     

Sky骨扩张器在经皮椎体后凸成形术中的临床应用

目的:探讨应用Sky骨扩张器行经皮椎体后凸成形术治疗椎体压缩性骨折的临床疗效。方法:应用Sky骨扩张器行经皮椎体后凸成形术治疗8例共9个椎体的压缩性骨折,其中骨质疏松性椎体压缩性骨折6例7个椎体,脊柱转移瘤1例(T7),椎体血管瘤1例(L1)。术前术后行VAS评分,测量手术前后各病椎椎体前缘、中线、后缘高度并进行比较和统计学分析。结果:全组均安全完成手术,平均每个椎体手术时间为42min;失血量平均每例约为20ml;平均每个椎体注入PMMA3.2ml,术前的VAS评分平均为7.8分,术后第1天平均为3.1分,术后1周为2.6分,术后1个月平均2.5分,手术前后差异有显著性(P<0.05)。术前骨折椎体前缘的平均高度为18.21mm,术后为20.52mm(P<0.01);术前骨折椎体中线的平均高度为14.23mm,术后为19.43mm(P<0.01);术前骨折椎体后缘的平均高度为23.98mm,术后为24.59mm(P>0.05)。术后CT检查发现椎体后缘少量渗漏和椎间隙骨水泥渗漏各1例,均无临床症状;1例患者出现椎体后缘渗漏,术后出现大小便功能障碍,经保守治疗后于术后5d大便功能恢复,术后1周小便功能改善。结论:应用Sky骨扩张器行经皮椎体后凸成形术治疗椎体压缩性骨折创伤小、较安全,近期疗效较好,但仍有一定的并发症发生。     

椎基静脉孔与椎体内裂隙相通可能是后凸成形术骨水泥渗漏的危险因素

 目的 通过对伴与不伴椎内裂隙征的椎体行经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）后不同类型骨水泥渗漏的发生率的评估,探讨椎基静脉孔和椎内裂隙相通是否为骨水泥渗漏的危险因素。方法 回顾性分析2009年1月至2013年1月我科行PKP手术的224例患者的270个手术椎体术前与术后X线片、CT及MRI。所有病例依据是否存在椎体内裂隙分为裂隙组和骨小梁组。将骨水泥渗漏分为五型：通过骨皮质缺损进入椎旁软组织（A型）,通过椎基静脉孔（B型）,通过进针管道（C型）,通过骨皮质缺损进入椎间盘区域（D型）,以及通过椎旁静脉（E型）。分别统计两组各类型的骨水泥渗漏的发生率并分析差异是否有统计学意义。结果 裂隙组72例,骨小梁组198例。B型骨水泥渗漏最为常见,占总手术椎体的15.5%（42例）,其次为D型骨水泥渗漏（7.8%,21例）。裂隙组B型骨水泥渗漏发生率为23.6%,高于骨小梁组的12.6%,且两者之间差异有统计学意义（P=0.028）。其余各型骨水泥渗漏之间差异无统计学意义。结论 B型骨水泥渗漏在伴椎内裂隙征的椎体中更为常见,说明椎内裂隙征和椎基静脉孔之间存在通道。因此,在伴椎内裂隙征的椎体行PKP手术时,需特别小心避免骨水泥通过椎基静脉孔漏入椎管。     

过伸位经皮椎体成形术与球囊扩张椎体后凸成形术治疗老年性骨质疏松椎体骨折的疗效观察

目的：比较过伸位经皮椎体成形术（hyperextension reduction percutaneous vertebroplasty, HRPVP）与球囊扩张椎体后凸成形术（percutaneous kyphoplasty, PKP）治疗老年骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture, OVCF）的临床效果。方法选择2012年10月至2014年6月湖北医药学院附属人民医院脊柱外科收治的OVCF患者97例（119椎）,其中男25例,女72例;平均年龄为（73.40±5.16）岁。本组患者随机分为两组,HRPVP组52例,采用HRPVP治疗;PKP组45例,采用PKP治疗。分别于术前1 d、术后2 d及术后第3、6个月采用疼痛视觉模拟量表（visual analogue scales, VAS）评分、Oswestry功能障碍指数（Oswestry disability index, ODI）、椎体高度、Cobb角等临床和影像学指标评价两组患者的治疗效果。结果两组患者术后腰背部疼痛症状均明显缓解。术后2 d,术后3、6个月的腰背痛VAS评分、ODI、椎体高度、Cobb角等均优于术前,差异均有统计学意义（均P＜0.05）,但同一时间点两组间比较差异均无统计学意义（均P＞0.05）。结论 HRPVP与PKP治疗OVCF,两种方法都能够迅速缓解腰背部疼痛、很好地矫正后凸畸形,而HRPVP操作简单易行,实用性强,值得推广。     

椎体内裂隙样变对经皮椎体后凸成形术疗效的影响

 目的 探讨椎体内裂隙样变对经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)疗效的影响。方法 回顾性分析2009年12月至2011年12月,采用PKP治疗183例骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者资料,根据影像学表现,将患者分为裂隙组和无裂隙组。裂隙组44例,男5例,女39例;年龄56～89岁,平均71.6岁。无裂隙组139例,男22例,女117例;年龄51～91岁,平均70.2岁。比较两组患者骨折椎体分布情况、骨水泥注入量、骨水泥渗漏发生率、渗漏类型、骨折椎体高度恢复情况等。采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index, ODI)评价疗效。结果裂隙组与无裂隙组在骨折椎体的分 布存在差异,裂隙组骨折椎体主要分布在T₁₁～L₂椎体,无裂隙组主要分布在T₁₁～L₅及T₇～₉。裂隙组和无裂隙组骨水泥注入量及渗漏率分别为3.4～5.6 ml和3.5～5.1 ml, 45.3%(24/53)和41.9%(72/172),两项指标比较差异无统计学意义;但两组骨水泥渗漏类型存在差异,裂隙组主要在椎体周 围软组织渗漏,无裂隙组主要沿血管渗漏。两组术后骨折椎体高度均明显恢复,裂隙组较无裂隙组椎体前缘高度恢复明显。裂隙 组和无裂隙组术后VAS评分及ODI指数分别为(2.8±1.1)分和(2.4±0.7)分,29.3%±6.8%和27.6%±6.9%,两项指标比较差异 无统计学意义。结论 伴椎体内裂隙样变的OVCFs的骨折椎体主要分布在活动度较大的T₁₁～L₂椎体。采用 PKP治疗伴椎体内裂隙样变的OVCFs可获得满意的临床疗效,术后椎体前缘高度恢复明显。     

Outcome of percutaneous balloon kyphoplasty in vertebral compression fractures

Background:Incidence of vertebral compression fractures (VCFs) is increasing due to increase in human life expectancy and prevalence of osteoporosis. Vertebroplasty had been traditional treatment for pain, but it neither attempts to restore vertebral body height nor eliminates spinal deformity and is associated with a high rate of cement leakage. Balloon kyphoplasty involves introduction of inflatable balloon into the fractured body of vertebra for elevation of the end-plates prior to fixation of the fracture with bone cement. This study evaluates short term functional and radiological outcomes of balloon kyphoplasty. The secondary aim is to explore short-term complications of the procedure.Results:Statistically significant improvements in SF-36 (from 34.29 to 48.53, an improvement of 14.24, standard deviation (SD) - 20.08 P < 0.0001), VAS (drop of 4.49, from 6.74 to 2.24, SD - 1.44, P < 0.0001), percentage restoration of lost vertebral height (from 30.62% to 16.19%, improvement of 14.43%, SD - 15.37, P < 0.0001) and kyphotic angle correction (from 17.41° to 10.59°, improvement of 6.82, SD - 7.26°, P < 0.0001) were noted postoperatively. Six patients had cement embolism, 65 had cement leak and three had adjacent level fracture which required repeat kyphoplasty later. One patient with history of ischemic heart disease had cardiac arrest during the procedure. No patients had neurological deterioration in the followup period.Conclusions:Kyphoplasty is a safe and effective treatment for VCFs. It improves physical function, reduces pain and corrects kyphotic deformity.     

骨质疏松性椎体压缩性骨折椎体后凸成形术后隐性失血及其影响

目的：探讨骨质疏松性椎体压缩性骨折在椎体后凸成形术后隐性失血及相关危险因素。方法：对2015年3月至2017年12月收治的153例骨质疏松性椎体压缩性骨折并接受椎体后凸成形术患者的临床资料进行回顾性分析,其中男55例,女98例;年龄68~87（78.6±11.4）岁。收集患者手术前后红细胞比容用于计算隐性失血量,通过多元线性回归模型分析患者的性别、年龄、体重指数、骨密度、是否合并糖尿病和高血压、手术方式（单侧或双侧）、手术时间、手术节段及数量、椎体丢失高度及恢复高度比因素对于隐性失血的影响。结果：术后隐性失血量为（287.7±68.5）ml。多元线性回归分析显示糖尿病病史（β=2.405,P=0.012）,手术方式（β=3.042,P<0.001）,手术时间（β=2.043,P=0.038）,手术节段（β=1.993,P=0.043）及数量（β=0.374,P<0.001）,椎体高度丢失（β=2.785,P=0.003）及恢复比例（β=7.301,P<0.001）与隐性失血相关。结论：骨质疏松性椎体压缩性骨折椎体后凸成形术存在一定程度的隐性失血,糖尿病病史、手术方式、手术时间、手术节段及数量、椎体高度丢失及恢复比例为隐性失血的危险因素。     

Transcostovertebral kyphoplasty of the mid and high thoracic spine

While Kyphoplasty is increasingly becoming a recognised minimally invasive treatment option for osteoporotic vertebral fractures and neoplastic vertebral collapse, the experience in the treatment of vertebrae of the mid (T5-8)- and high (T1-4) thoracic levels is limited. The slender pedicle morphology restricts the transpedicular approach at these levels, necessitating extrapedicular placement techniques. Fifty five vertebrae of 32 consecutive patients were treated with kyphoplasty at levels ranging from T2-T8 for vertebral fractures (27 patients) or osteolytic collapse (5 patients). All procedures were performed through the transcostovertebral approach under fluoroscopic guidance. The radioanatomical landmarks of this minimally invasive approach were consistently identified and strictly adhered to. One fracture required open instrumentation due to posterior column injury in addition to kyphoplasty. Identification of specific radioanatomical landmarks allowed precise tool introduction in all cases without intraspinal or paravertebral malplacement. Average operating time for patients with osteoporotic fractures was 30 min per level (range 13–60 min) and 52 min per level (range 35–95 min) in neoplastic cases. Biopsy yield in patients with known or suspected malignancies was 100%. Epidural cement leakage was detected in one patient with pedicular osteolysis. Perforation of the lateral vertebral cortex during balloon inflation occurred in another patient. Both intraoperative complications were without clinical significance. Kyphoplasty in mid- to -high thoracic levels is possible via the transcostovertebral route under fluoroscopic guidance. Strict adherence to a stepwise protocol of tool introduction following defined radioanatomical landmarks is mandatory for the safe completion of this minimally invasive technique.     

Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis

This systematic review updates the understanding of the evidence base for balloon kyphoplasty (BKP) in the management of vertebral compression fractures. Detailed searches of a number of electronic databases were performed from March to April 2006. Citation searches of included studies were undertaken and no language restrictions were applied. All controlled and uncontrolled studies were included with the exception of case reports. Prognostic factors responsible for pain relief and cement leakage were examined using meta-regression. Combined with previous evidence, a total of eight comparative studies (three against conventional medical therapy and five against vertebroplasty) and 35 case series were identified. The majority of studies were undertaken in older women with osteoporotic vertebral compression fractures with long-term pain that was refractory to medical treatment. In direct comparison to conventional medical management, patients undergoing BKP experienced superior improvements in pain, functionality, vertebral height and kyphotic angle at least up to 3-years postprocedure. Reductions in pain with BKP appeared to be greatest in patients with newer fractures. Uncontrolled studies suggest gains in health-related quality of life at 6 and 12-months following BKP. Although associated with a finite level of cement leakage, serious adverse events appear to be rare. Osteoporotic vertebral compression fractures appear to be associated with a higher level of cement leakage following BKP than non-osteoporotic vertebral compression fractures. In conclusion, there are now prospective studies of low bias, with follow-up of 12 months or more, which demonstrate balloon kyphoplasty to be more effective than medical management of osteoporotic vertebral compression fractures and as least as effective as vertebroplasty. Results from ongoing RCTs will provide further information in the near future. This report has been undertaken through unrestricted funding by Kyphon Inc. The planning, conduct and conclusions of this report are made independently from the company.     

经皮椎体后凸成形术后骨水泥用量对骨质疏松性五联椎体模型生物力学的影响

目的研究行单侧椎弓根穿刺椎体后凸成形术(PKP)后,骨水泥用量对中间椎体压缩骨折的骨质疏松性五联椎体模型的生物力学影响。方法采用新鲜成年猪脊柱胸腰段五联椎体制作中间椎体骨质疏松并Ⅱ度压缩骨折模型,分为A、B、C、D 4组,每组15个标本。A组不行PKP术,B、C、D组行经单侧(右侧)穿刺PKP术,注入骨水泥量分别为伤椎体积的15%、25%、35%,记录骨水泥渗漏情况。手术24 h后应用电子力学实验机测试各脊柱单元的极限抗压强度及刚度;B、C、D组继续加压直至出现两处新发椎体骨折(伤椎除外),并记录新发骨折椎体的位置。结果 B、C、D组脊柱单元强化后的刚度分别为(234±8)N/mm、(259±12)N/mm、(294±13)N/mm,均优于A组的(204±12)N/mm,差异有统计学意义(P0.05)。B、C、D组强化后的脊柱单元极限抗压强度分别为(3 428±96)N、(3 134±86)N、(2 615±90)N,均大于A组的(1 758±55)N,差异有统计学意义(P0.05);B、C、D组分别有17、21、27个新发椎体骨折位于强化椎相邻位置,且分别有1、3、11个脊柱单元发生骨水泥渗漏,组间差异均具有统计学意义(P0.05)。结论 PKP可有效恢复骨折椎体的力学性能,使其刚度及极限抗压强度得到明显改善;但强化椎邻近椎体的应力在PKP术后较术前有明显增加,使椎体极限抗压强度下降,骨水泥用量是导致强化椎邻近椎体骨折的因素之一。     

椎体骨折2周与4周内行椎体后凸成形术后疗效的比较研究

 目的 比较骨质疏松性椎体压缩骨折后2周内(接受手术时病程≤14d)与2～4周(14 d＜接受手术时病程≤ 28d)行椎体后凸成形术后椎体高度及骨水泥渗漏的情况。方法 回顾性分析2010年1月至2011年1月,采用椎体后凸 成形术治疗48例骨质疏松性椎体压缩骨折患者资料,根据患者受伤至手术时间分为2周内和2～4周手术组,2周内手术 组22例,男4例,女18例;年龄54～85岁,平均71.17岁。2～4周手术组26例,男5例,女21例;年龄56～88岁,平均73.12 岁。两组患者骨折椎体均位于T₇～L₄。比较两组患者年龄、性别、骨密度T值、术前椎体高度丢失率、 术中注入骨水泥量、 术后椎体高度恢复率、术后1年椎体高度丢失率、骨水泥渗漏率。结果 2周内和2～4周手术组术前椎体压缩程度、骨水泥注入量、骨密度T值、椎体高度恢复率分别为47%±21%和48%±19%、(3.69±1.03)ml和(3.66±0.71)ml、-2.79±0.57和- 2.87±0.95、25%±8.3%和23%±7.7%,两组上述四项指标比较,差异均无统计学意义。2周内手术组1年椎体高度丢失率为 9%±2.8%,2～4周手术组为11%±2.9%,两组比较差异有统计学意义。2周内和2～4周手术组骨水泥渗漏率分别为22.2% (6/27)和11.8%(4/34),两组比较差异无统计学意义。结论 骨质疏松性椎体压缩骨折后,2周内与2～4周行椎体后凸成 形术均能较好恢复椎体高度,且骨水泥渗漏率相似,但2周内手术的患者术后1年椎体高度丢失率较小。     

胸腰椎压缩性骨折脊柱后凸成形术的临床分析

目的探讨胸腰椎压缩性骨折脊柱后凸成形术的优势及并发症。方法选取2009年1月～2011年5月52例接受脊柱后凸成形术的胸腰椎压缩性骨折患者。结果 52例患者均完成脊柱后凸成形术,1例术后发生脊柱前骨水泥渗漏,1例术后发生脊柱后骨水泥＂尾巴＂,未造成脊髓硬膜囊受压、疼痛等后遗症,52例患者随访1～18个月,平均6个月,无复发。结论脊柱后凸成形术不仅具有椎体成形术的优点,还恢复压缩椎体的强度和刚度,又可部分恢复压缩椎体的高度,矫正后凸畸形。但脊柱后凸成形术又存在骨水泥渗漏、肺栓塞、脊髓损伤、局部出血和血肿、疼痛加重、一过性发热等并发症。     

单侧与双侧PKP治疗骨质疏松性椎体压缩骨折的对比研究

目的通过对行PKP治疗骨质疏松性椎体压缩骨折（OVCFs）病例的单、双侧经椎弓根手术人路的对比,探讨单、双侧经椎弓根手术人路对术后疗效是否存在影响。方法选择自2009-03—2012—04采用单侧（单侧组）或双侧（双侧组）经椎弓根行经皮椎体后凸成形术（PKP）治疗的OVCFs,其中单侧组46例,双侧组50例,统计2组围手术期及术后随访的临床资料,对比分析2组间各项指标之间的差异是否具有统计学意义。结果96例均获得随访,时间12—48个月,平均34．6个月,在住院天数、下地活动、VAS评分等方面,2组间差异无统计学意义（P〉0．05）;关于椎体高度和Cobb角,末次随访与术后1周数据比较,双侧组差异无统计学意义（P〉0．05）,而单侧组差异有统计学意义（P〈0．05）。结论采用单侧或双侧经椎弓根行PKP治疗OVCFs均可取得良好的疗效．但是随着时间的延长,在维持椎体高度及矫正后凸畸形方面．经双侧人路方法的疗效要优于单侧。     

Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study

Summary  To better understand the risk of secondary vertebral compression fracture (VCF) following a vertebroplasty or kyphoplasty, we compared patients treated with those procedures to patients with a previous VCF. The risk of subsequent fracture was significantly greater among treatment patients, especially within 90 days of the procedure. Introduction  Predominantly uncontrolled studies suggest a greater risk of subsequent vertebral compression fractures (VCFs) associated with vertebroplasty/kyphoplasty. To further understand this risk, we conducted a population-based retrospective cohort study using data from a large regional health insurer. Methods  Administrative claims procedure codes were used to identify patients receiving either a vertebroplasty or kyphoplasty (treatment group) and a comparison group of patients with a primary diagnosis of VCF who did not receive treatment during the same time period. The main outcomes of interest, validated by two independent medical record reviewers, were any new VCFs within (1) 90 days, (2) 360 days, and (3) at adjacent vertebral levels. Multivariable logistic regression examined the association of vertebroplasty/kyphoplasty with new VCFs. Results  Among 48 treatment (51% vertebroplasty, 49% kyphoplasty) and 164 comparison patients, treated patients had a significantly greater risk of secondary VCFs than comparison patients for fractures within 90 days of the procedure or comparison group time point [adjusted odds ratio (OR) = 6.8; 95% confidence interval (CI) 1.7–26.9] and within 360 days (adjusted OR = 2.9; 95% CI 1.1–7.9). Conclusions  Patients who had undergone vertebroplasty/kyphoplasty had a greater risk of new VCFs compared to patients with prior VCFs who did not undergo either procedure.