小剂量骨水泥PVP治疗多节段椎体压缩性骨折

目的 探讨采用小剂量骨水泥椎体成形术治疗多节段骨质疏松伴椎体压缩性骨折的临床效果。方法 回顾性研究自2006年９月至2011年８月我院采用小剂量骨水泥椎体成形术治疗46例多节段骨质疏松伴椎体压缩性骨折的病例。其中，男11例，女35例，年龄56～83岁，平均67.3岁。所有患者术前均行骨密度测定Ｔ值≤-2.5，提示骨质疏松，并行Ｘ线片、CT及MRI检查明确责任椎体及后壁完整情况。本组治疗的病例均为多节段椎体压缩性骨折，责任椎体分别分布在：胸６椎（１个）、胸７椎（１个）、胸８椎（２个）、胸９椎（２个）、胸10椎（５个）、胸11椎（11个）、胸12椎（31个）、腰１椎（36个）、腰２椎（８个），腰３椎（９个）、腰４椎（13个）、腰５椎（14个）等，本组治疗的病变椎体最少２个，最多４个，平均2.32个。所有患者均经单侧椎弓根穿刺椎体，１次对２个或２个以上责任椎体行小剂量骨水泥椎体成形术。术前、术后３天、１周、术后６个月随访时进行疼痛视觉类比评分（VAS），评价临床治疗效果。结果 46例患者共行108个椎体成形术，平均１次2.32个椎体，单个椎体内骨水泥注射剂量约1.2～2.1 ml，平均（1.8±0.38）ml。所有患者定期随访，随访时间6～18个月（平均12.6个月），术前患者VAS评分为7.95±0.82，术后３天VAS评分为4.48±0.80，随访时VAS评分为2.38±0.55，采用配对 t 检验对术前、术后随访时VAS评分进行统计学分析，差异有统计学意义（P＜0.001，α＝0.05）。结论 小剂量骨水泥椎体成形术作为一种微创手术，可有效地缓解多节段骨质疏松伴椎体压缩性骨折引起的疼痛症状，是一种有效的治疗方法。

Minidosal bone cement in percutaneous vertebroplasty in the treatment of multi-segmental vertebral compression fractures

Objective To investigate the clinical efficiency of minidosal bone cement in percutaneous vertebroplasty （PVP） in the treatment of multi-segmental osteoporosis with vertebral compression fractures. Metheds 46 patients with multi-segmental osteoporosis with vertebral compression fractures were treated by minidosal bone cement in PVP in our hospital from September 2006 to August 2011, whose data were retrospectively analyzed. There were 11 males and 35 females, with an average age of 67.3 years old （range; 56-83 years）. All patients displayed osteoporosis by bone density measurement （T≤-2.5） preoperatively. All patients were checked to identify the vertebral body in responsibility and the completeness of the posterior wall by X-ray, CT and MRI. All patients had multi-segmental vertebral compression fractures, among whom 1 vertebral body in responsibility was in T6, 1 in T7, 2 in T8, 2 in T9, 5 in T10, 11 in T11, 31 in T12, 36 in L1, 8 in L2, 9 in L3, 13 in L4, 14 in L5 and so on. There were at least 2 vertebral bodies with lesions and 4 ones at most, with an average of 2.32 ones. All patients underwent unilateral pedicular approach piercing the vertebral body, and were treated by minidosal bone cement in PVP for 2 or more vertebral bodies in responsibility at once. All patients were followed up preoperatively and 3 days, 1 week and 6 months postoperatively. Visual Analogue Scale （VAS） scores were measured to evaluate the clinical efficiency. Results PVP was performed on 46 patients for 108 times, with an average of 2.32 vertebral bodies at once. The injected cement volume into a single vertebral body was about 1.2-2.1 ml, with an average of （1.8±0.38）ml. All patients were followed up regularly, and the mean duration was 12.6 months （range; 6-18 months）. Preoperatively the VAS score was 7.95±0.82 points, and was 4.48±0.80 and 2.38±0.55 points respectively 3 days postoperatively and in the follow-up. The paired T-test was used to compare the VAS scores preoperatively and in the follow-up, and the statistical differences were significant （P〈0.001, α=0.05）. Conclusions PVP with minidosal bone cement as a minimally invasive surgery can effectively relieve the pain caused by multi-segmental osteoporosis with vertebral compression fractures.