单针骨水泥技术治疗老年椎体压缩骨折的临床分析

目的探讨单针经单侧椎弓根经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗老年人新鲜胸腰椎骨折的方法及临床疗效。方法将2010年3月～2011年9月治疗胸腰椎骨折100例110椎，分为两组，A组50例60椎行单针经单侧椎弓根PVP术，B组50例50椎行经双侧椎弓根PVP术。两组均行术前及术后进行疼痛视觉模拟评分（visual analoguescale，VAS）、活动能力评分（locomotor activityscale，LAS）、椎体前后缘高度比及两组间骨水泥注入量、骨水泥渗漏及手术时间进行比较。结果两组术前与术后2天VAS评分、LAS评分及椎体前后缘高度比均有显著差异，症状改善明显（P〈0．01）；两组平均随访时间6．5个月，患者术后骨折椎体无疼痛，复查X线片显示术后6月与术后2天椎体前后缘高度比无明显差异（P〉0．05）。A组平均单椎体手术时间20．1min，注入骨水泥2．8ml（2-4．5m1）；B组手术时间35．2min，注入骨水泥3．7ml（2．5～6ml）。两组间平均单椎体手术时间及平均骨水泥注入量均有明显差异（P〈0．05）。两组发生骨水泥渗漏情况为椎间盘渗漏A组5例、B组6例，椎旁渗漏A组7例、B组7例，无严重并发症发生，两组骨水泥渗漏发生率无显著差异（P〉0．05）。结论单针骨水泥技术可即刻缓解疼痛，恢复伤椎高度，提高患者的活动能力，明显缩短手术时间，降低住院费用及X线暴露时间，是一种微创、安全、有效的治疗老年人新鲜胸腰椎骨折的技术。

Clinical investigation on the treatment of the aged patients with spinal compressive fracture by unipedicular percutaneous vertebroplasty

Objective To study the clinical effects ofunipedicular percutaneous vertebroplasty in the treatment of fresh thoracolumbar fractures in the elderly. Methods From March 2010 to September 2011, among 100 patients （110 vertebras） with thoracolumbar fractures, 50 patients （60 vertebras） were treated with unipedicular percutaneous vertebroplasty （PVP） in the A group and 50 patients （50vertebras） were treated with bipedicular PVP in the B group. The visual analogue scale （VAS）, locomotor activity scale （LAS）, spinal height, operation time and bone cement volume were evaluated before and after operation. Complications such as bone cement leakage were analyzed. Results The VAS and LAS decreased at the second day after operation significantly; the vertebral height increased significantly after operation （P〈0.01）; During an average of 6.5 months follow up, no patients reported vertebral pain. Review of X ray films showed no significant loss of vertebral height （P〉0.05）. The average operation time was 20.1 minutes every vertebral body and 2.8ml （2-4.5 ml） bone cement was injected in the A group. The average operation time was 35.2 minutes and an average of 3.7 ml （2.5-6ml） bone cement was injected in the B group. Intervertebral leakage of bone cement was found in 5 patients in the A group and in 6 patients in theBgroup. Paravertebral leakage of bone cement was also found in 7 patients in every group. No serious complications occurred. Conclusion Unipedicular PVP can be used to instantly reinforce vertebral injury, relieve pain, and improve the patient＇s mobility. For elder people with fresh thoracolumbar fractures, when health conditions are allowed, unipedicular PVP surgery is the right treatment.