PKP治疗老年骨质疏松性胸腰椎压缩骨折疗效分析

目的探讨经皮椎体后凸成形术(PKP)治疗老年骨质疏松性胸腰椎压缩骨折的临床疗效。方法回顾性分析2015-08—2018-10采用PKP治疗的71例老年骨质疏松性胸腰椎压缩骨折,比较术前及末次随访时疼痛VAS评分、椎体前缘高度、椎体中央高度、伤椎Cobb角。结果 71例均获得平均11(6~21)个月随访,1例发生骨水泥渗漏。末次随访时VAS评分较术前明显降低,椎体前缘高度较术前增加,椎体中央高度较术前增加,伤椎Cobb角较术前减小,差异有统计学意义(P <0.05)。结论 PKP治疗老年骨质疏松性胸腰椎压缩骨折切口小,术后疼痛缓解明显,椎体高度恢复良好,后凸畸形矫正满意。     

经皮椎体后凸成形术治疗骨质疏松性多椎体压缩骨折

[目的]分析经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性多椎体(≥3)压缩骨折的疗效。[方法]回顾分析2013年12月~2016年2月收治的45例(147个椎体)骨质疏松性多椎体压缩骨折的患者。均在全麻下行PKP治疗,术中应用多模式神经电生理监测,均顺利完成。术前、术后和末次随访时采用VAS评分评估疼痛程度和ODI评分评估患者日常生活功能;术前、术后及末次随访时测量伤椎前缘高度、伤椎中央高度和Cobb角及随访时的并发症。[结果]11例(15椎)发生骨水泥渗漏,但均无相关神经或脊髓症状。术后平均随访(16.80±3.51)个月(12~23个月)。患者的VAS评分由术前的(6.73±1.03)分降低到术后的(3.58±0.89)分,末次随访时为(1.16±0.85)分(P<0.05)。ODI评分由术前的(69.62±5.07)%降低到术后的(34.44±3.10)%,末次随访时为(16.27±2.79)%(P<0.05)。影像测量方面,伤椎前缘高度由术前的(16.24±1.46)mm恢复到术后的(19.38±1.37)mm,末次随访时为(19.36±1.36)mm;伤椎中央高度由术前的(18.01±1.67)mm恢复到术后的(21.10±1.41)mm,末次随访时为(21.09±1.67)mm;椎体后凸Cobb角由术前的(15.76±5.21)°矫正为术后的(9.23±3.95)°,末次随访时为(9.20±3.87)°;术前与术后影像测量相比差异均有统计学意义(P<0.05),但术后与末次随访时相比差异无统计学意义(P>0.05)。随访过程中有4例非手术椎体再发骨折。[结论]PKP治疗骨质疏松性多椎体压缩骨折,疗效可靠,可迅速缓解疼痛,部分恢复椎体高度。     

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。     

手法复位在骨质疏松性椎体压缩骨折经皮椎体后凸成形术中的应用

[目的]评价手法复位在骨质疏松性椎体压缩骨折经皮椎体后凸成形术中的临床应用.[方法] 2009年1月～2012年6月行经皮椎体后凸成形术的骨质疏松性椎体压缩骨折患者65例随机分为治疗组和对照组,分析比较两组骨水泥外漏发生率及术后2d、术后3个月、末次随访时疼痛恢复情况、椎体高度和脊柱后凸角(Cobb角)的变化.[结果]所有患者均获得6 ～21个月随访,平均11.3个月.于术后2 d、术后3个月及末次随访时进行测量,治疗组VAS评分较术前分别降低(4.32±1.01)、(4.97±0.70)、(5.45±1.95),椎体高度分别增加(6±1.12) mm、(6+1.12) mm、(5.97±1.13) mm,后凸cobb角分别减小(12.48+2.06)°、(12.35±1.96)°、(12.29±1.90)°,有6个椎体发生骨水泥外漏,对照组VAS评分较术前分别降低(4.74±1.24)、(5.21±1.01)、(5.38±0.89),椎体高度分别增加(3.18±0.87) mm、(3.18±0.87) mm、(3.15±O.86) mm,后凸Cobb角分别减小(5.85±1.81)°、(5.59±1.73)°、(5.29±1.45)°,有8个椎体发生骨水泥外漏.术后2d、术后3个月及末次随访时治疗组椎体高度恢复及脊柱后凸畸形矫正均明显优于对照组(P＜0.01),VAS评分变化及骨水泥泄漏率差异无统计学意义(P＞0.05).[结论]手法复位应用于骨质疏松性椎体压缩骨折经皮椎体后凸成形术是安全有效的,可以更好的恢复椎体高度和纠正脊柱后凸畸形,不增加骨水泥泄露的发生率,也不影响术后疼痛的改善.     

老年骨质疏松性椎体压缩骨折的早期经皮椎体后凸成形术治疗

目的观察早期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的临床效果。方法对45例老年骨质疏松性椎体压缩骨折患者在骨折后48 h内给予PKP治疗。对比手术前后VAS评分、ODI、伤椎高度及Cobb角。结果患者均获得随访,时间4~14周。有1例1椎体出现骨水泥渗漏,但未出现神经症状。术后24 h与末次随访时VAS评分、ODI、伤椎高度、Cobb角与术前比较差异均有统计学意义(P0.05),末次随访时各项指标与术后24 h比较差异均无统计学意义(P0.05)。结论早期应用PKP治疗老年骨质疏松性椎体压缩骨折具有迅速缓解疼痛、创伤小、安全、并发症少、可早期下地活动等优点。     

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。     

经皮椎体后凸成形术治疗老年骨质疏松性压缩骨折的效果

目的探讨经皮椎体后凸成形术(PKP)治疗老年骨质疏松性脊柱压缩骨折的效果。方法选取2016-09—2018-03间收治的72例老年骨质疏松性脊柱压缩骨折患者,根据手术方法不同分为2组。对照组(32例)实施经皮椎体成形术(PVP),观察组(40例)行PKP。比较2组的疗效。结果 2组患者术后均获10～12个月随访,术前2组患者的VAS评分、伤椎前缘高度及Cobb角差异无统计学意义(P0.05)。术后1周和末次随访时2组的上述指标均较术前明显改善,其中观察组改善效果优于对照组,差异有统计学意义(P0.05)。观察组骨水泥渗漏率归于对照组,差异有统计学意义(P0.05)。结论 PKP治疗老年骨质疏松性脊柱压缩骨折,能有效恢复伤椎前缘高度和矫正后凸畸形,减少骨水泥渗漏发生率。     

单侧经皮后凸成形术治疗老年骨质疏松性椎体压缩骨折

目的探讨单侧经皮后凸成形术（percutaneous kyphoplasty,PKP）治疗老年骨质疏松性椎体压缩骨折的临床效果。方法对16例老年骨质疏松性新鲜椎体压缩骨折采用单侧PKP治疗。结果随访8～15个月,平均11．6个月。16例患者术后疼痛均有不同程度缓解,术前病椎平均高度为（17．8±2．5）mm、Cobb角（23．8±2．0）°,术后病椎平均高度为（26．2±3．4）mm、Cobb角（9．5±1．8）°。单个椎体手术时间平均为30．3min,仅1例骨水泥轻度渗漏但无神经受累。结论单侧PKP具有手术时间短、创伤小、术后疼痛缓解明显、有效改善后凸畸形等优点,在规范操作下手术并发症较少,是治疗骨质疏松性椎体压缩骨折的良好方法。     

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

目的观察球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折的临床疗效。方法采用PKP治疗60例骨质疏松性椎体压缩性骨折患者(共77椎),比较手术前后VAS评分、椎体前缘高度、Cobb角变化情况,分析疗效。结果 VAS评分术后低于术前,椎体前缘高度术后高于术前,Cobb角术后小于术前,差异均有统计学意义(P<0.05)。患者均获随访,时间6～12(8.2±1.7)个月。随访期间均未发生疼痛加重情况。结论 PKP治疗骨质疏松性椎体压缩性骨折临床疗效良好,有效恢复并保持脊柱功能,并发症少,患者接受程度较高。     

经横突-椎弓根单侧穿刺椎体后凸成形术治疗胸腰椎骨质疏松性压缩骨折

目的:探讨经横突-椎弓根单侧穿刺椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗胸腰椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的手术技巧及临床疗效。方法:2009年1月～2011年3月,共对26例胸腰椎OVCF患者经横突-椎弓根单侧穿刺行PKP治疗,其中男9例,女17例;年龄56～78岁,平均66岁。共有伤椎35个。术前疼痛视觉模拟评分(visual analogue scale,VAS)为7.96±0.95分,后凸Cobb角为18.42°±5.98°,骨折椎体前缘高度为19.08±2.28mm,中部高度为17.02±1.72mm。术后2d及末次随访时行VAS评分,并摄X线片测量后凸Cobb角和伤椎前、中柱高度,评价患者临床疗效。结果:患者均顺利完成PKP手术,手术时间15～75min,平均34min;每个椎体注入骨水泥3～6ml,平均4.8ml。未出现神经损伤、骨水泥椎管内渗漏等并发症,伤椎内骨水泥分布良好。23例患者获得随访,随访时间12～36个月,平均29个月。术后2d及末次随访时的VAS评分分别为2.42±0.39分和2.01±0.37分,Cobb角分别为7.77°±0.77°、8.71°±0.81°;伤椎前缘高度分别为22.00±1.73mm、21.28±1.24mm,中部高度分别为20.80±0.75mm、19.64±1.12mm,与术前比较差异均有统计学意义(P<0.05),术后2d与末次随访时比较VAS评分差异有统计学意义(P<0.05),Cobb角、伤椎体前缘和中部高度差异均无统计学意义(P>0.05)。结论:经横突-椎弓根单侧穿刺椎体后凸成形术是治疗胸腰椎骨质疏松性压缩骨折的一种有效方法。     

经后路椎间盘镜椎间盘切除术

本院于２０００年３月至２００１年１１月，采用经后路椎间盘镜施行腰椎间盘手术（MED组）６６例，与１９９８年１月至２０００年４月采用传统开放手术（传统组）５８例进行了比较观察，MED组恢复良好。报告如下。１资料与方法１．１一般资料：MED组中男４４例，女２２例，年龄３０～６５岁，平均４８岁；病程１个月～６年，平均２年５个月；其中多间隙突出８例，巨大中央型突出５例，突出髓核伴钙化１１例，明显小关节内聚伴侧隐窝狭窄１０例，腰椎间盘侧后方突出或或脱出２９例，伴黄韧带肥厚３例，其中６例合并以上两种病变。传统组…     

相隔单椎体跳跃性椎体结核的手术治疗

目的探讨前路病灶清除植骨融合内固定治疗相隔单椎体跳跃性椎体结核的临床疗效。方法2002年3月至2005年3月,对21例相隔一个正常椎体的跳跃性胸腰椎椎体结核患者施行前路病灶清除植骨融合椎体钉棒内固定治疗,植骨采用自体髂骨-肋骨或钛网-肋骨植骨。男14例,女7例;年龄22～67岁,平均43岁。病变范围：T4～L3,胸椎12例,胸腰段6例,腰椎3例。两处跳跃病变破坏2个椎体1例、3个椎体7例、4个椎体10例;三处跳跃病变破坏5个椎体2例,6个椎体1例。病变节段后凸角：胸椎30°～50°,胸腰段15°～30°,腰椎10°～20°。4例伴不完全截瘫。术前强化抗痨2～4周,术后规则抗痨1年。结果21例患者随访2.1～5.1年,平均3.4年。切口均一期愈合,术后早期肺不张2例,腹胀1例,经保守治疗1周内恢复。术后1～3个月红细胞沉降率、C-反应蛋白逐渐恢复正常。手术矫正后凸畸形10°～30°,末次随访畸形矫正角度丢失≤5.1°。植骨于术后3个月开始出现融合,随访期间无植骨块移位和内固定松动、折断。4例不完全截瘫患者术后6个月神经功能基本恢复正常。结论前路病灶清除植骨融合内固定治疗相隔单椎体跳跃性椎体结核可彻底清除病灶、矫正后凸畸形、重建和维持脊柱稳定性。     

Cervical vertebral erosion due to tortuous vertebral artery

A case of cervical vertebral erosion due to tortuous vertebral artery is presented. This entity is rare and only 11 cases have been reported in the literature. The present case is the first to be demonstrated by magnetic resonance imaging. The importance of considering this vascular anomaly in the differential diagnosis of cervical spinal tumors is discussed.     

Predicting human vertebral bone strength by vertebral static histomorphometry

The study investigates the relationship between static histomorphometry and bone strength of human lumbar vertebral bone. The ability of vertebral histomorphometry to predict vertebral bone strength was compared with that of vertebral densitometry, and also with histomorphometry and bone strength of iliac crest bone biopsies. The material comprised matched sets of second lumbar vertebrae, third lumbar vertebrae, and two iliac crest bone biopsies from each of 21 women (19--96 years) and 24 men (23--95 years). One of the iliac crest biopsies and 9-mm-thick mediolateral slices of half of each of the entire vertebral bodies (L-2) were used for histomorphometry. The other iliac crest biopsies and the L-3 were destructively tested by compression. High correlation was found between BV/TV or Tb.Sp and vertebral bone strength (absolute value of r = 0.86 in both cases). Addition of Tb.Th significantly improved the correlation between BV/TV and bone strength, and the addition of bone space star volume significantly improved the correlation between Tb.Sp and bone strength (from absolute value of r = 0.86 to absolute value of r = 0.89 in both cases). Bone structure (connectivity density) was not capable of improving the prediction of bone strength of the vertebral body. The correlations between BV/TV of L-2 and bone strength of L-3 were comparable with the correlation obtained by quantitative computed tomography (QCT), peripheral QCT (pQCT), and dual-energy X-ray absorptrometry (DEXA) of L-3 and bone strength of L-3. The iliac crest was found to have low predictive power of vertebral bone strength (iliac BV/TV: r = 0.62; iliac bone strength: r = 0.67). No gender-related differences were found in any of the relationships. It was shown that trabecular bone volume BV/TV and mean trabecular plate separation Tb.Sp are good predictors of vertebral bone strength. The ability of histomorphometry to predict vertebral bone strength was comparable to that of densitometry. Bone structure assessed by connectivity density did not improve the correlation between static histomorphometric measures and vertebral bone strength. No gender-related differences were found in any of the relationships. Neither static histomorphometry nor biomechanical testing of iliac crest bone biopsies is a good predictor of vertebral bone strength.     

Diagnosis of vertebral fractures by vertebral fracture assessment.

Vertebral fractures are independent risk factors for both vertebral and peripheral fractures and only one-third of these fractures come to clinical attention. Vertebral fracture assessment (VFA) is a radiographic method using dual X-ray absorptiometry (DXA) to assess vertebral deformities during bone density measurement. We performed VFA of the spine from T4 to L5 on a Delphi W device (Hologic, Bedford, MA) in 136 postmenopausal patients (69+/-10 yr). These patients also had X-rays of the thoracic and lumbar spine. VFA was independently compared with X-rays by two rheumatologists, for the diagnosis of vertebral fractures at both the patient and vertebral levels. Using X-rays, 61 patients (45%) had at least one vertebral fracture. The percentage of unreadable vertebrae was 1% and 12.4% on X-rays and VFA, respectively (p<0.0001). At the patient level, VFA allowed to diagnose if the patient had no fracture or had at least one fracture in 74% of patients. In 11.2% of cases, VFA misclassified the patients. At the vertebral level, diagnostic efficacy of VFA as compared with X-rays was 97%. Concordance between both observers was good (kappa-score=0.69). We designed an algorithm for decision of performing X-rays in postmenopausal women: Using results of VFA would avoid X-rays in 32% of our patients. VFA is a reliable technique with low radiation, and is easily and rapidly applicable during bone density measurement by DXA, which could improve management of osteoporotic patients.     

Age-related changes in vertebral height ratios and vertebral fracture

Because no gold standard for the definition of vertebral fracture exists, there has been controversy about whether mild vertebral deformities are truly fractures or simply normal variation in vertebral size and shape. The aim of this study was to assess the associations of mild variations of vertebral height ratios to definite vertebral fractures. In 479 Japanese women (age 53.9±9.1 years) who visited our institute for a medical checkup, we performed lateral lumbar radiographs and morphometric parameters were derived by measuring the anterior (Ha), middle (Hm) and posterior (Hp) height of each vertebral body from T12 to L4. Vertebral height ratios, Ha/Hp, Hm/Hp or Hp/Hp of adjacent vertebrae that were more than 3 SD different from vertebra-specific means of normative data were considered to indicate fractures. Forty-five women were diagnosed with at least one fracture. After excluding the subjects with vertebral fracture, we examined the associations of the variations in vertebral height ratios with age, anthropometric parameters and lumbar bone mineral density (BMD) measured by dual-energy X-ray absorptiometry. Vertebral height ratios, especially Hm/Hp in postmenopausal women, tended to decrease with age and were positively associated with BMD. No significant correlation was observed between anthropometric parameters and vertebral height ratios. Age-related decrease in vertebral height ratios (Ha/Hp and Hm/Hp, each averaged from T12 to L4) was significant even after the correction for BMD. Mean values of height ratios of non-fractured vertebrae adjusted for age and BMD were significantly lower in postmenopausal women with vertebral fracture than in those without vertebral fracture. Logistic regression analysis showed that BMD and height ratios of non-fractured vertebrae were independent predictors of vertebral fracture risk. The results suggest that older women, and women with at least one obvious (3 SD) fracture, tend to have mild deformities which do not qualify using the 3 SD definition. These mild deformities may represent real consequences of osteoporosis, because they are more pronounced among women with obvious fracture.     

骨质疏松性椎体压缩骨折经皮椎体强化术后椎体高度再丢失的研究进展

正经皮椎体强化术包括经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP),两者通过微创手术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF),可有效缓解疼痛、恢复压缩椎体高度和脊柱稳定性。但近年来观察到PVP和PKP术后恢复的椎体高度存在再丢失现象(没有创伤的情况下),术后椎体高度的再丢     

椎动脉三维CT血管成像对椎动脉型颈椎病的诊断价值

目的:探讨椎动脉三维CT血管成像(CTA)在椎动脉型颈椎病(CSA)诊断中的应用价值。方法:2007年7月～2008年4月临床上诊断为CSA的患者共21例(CSA组),对其CTA上显示的椎动脉、横突孔及钩椎关节增生情况进行观测,并与21例非CSA患者(对照组)的CTA观测结果进行比较分析。结果:CSA组中椎动脉正常者4例,管腔变细者7例,走行异常者1例,椎动脉硬化者2例,管腔局限性狭窄者4例,血管走行迂曲者3例,无血管闭塞的患者。对照组中14例椎动脉表现正常,管腔变细者4例,走行迂曲者3例。两组中血管正常、局限性狭窄出现比率间均有显著性差异(P0.05,χ2分别为9.72、1.21)。CSA组中11例(52.4%)患者共有36个钩椎关节增生,以C4～C7增生(28个,77.8%)最为常见,32个(88.9%)为轻度增生,3个(8.3%)为中度增生,1个(2.8%)为重度增生。对照组中,6例(28.6%)患者共有19个钩椎关节增生,只有1个(5.3%)表现为中度增生,其余均为轻度增生。结论:CTA可以较好地显示椎动脉异常、局限性狭窄及钩椎关节的增生情况,在CSA中具有一定的诊断价值。     

Multiple vertebral osteonecrosis

Vertebral osteonecrosis classically presents with an intravertebral vacuum cleft phenomenon or a fluid-filled cleft on MR images. These clefts are usually found in older patients presenting with more severe fractures, more significant collapse and instability. Therefore, although considered for a long time as pathognomonic for vertebral osteonecrosis, vertebral clefts are now considered to represent fracture non-union. The double-line sign is classically described for osteonecrosis of long bones, but has been reported in one case of concurrent spinal cord and vertebral bone marrow radionecrosis. We present a case of a histologically confirmed multilevel vertebral osteonecrosis manifesting as a double-line sign in the absence of an associated vertebral collapse and unrelated to radiotherapy.