骨质疏松性骨折椎体成形术后再骨折的临床治疗

目的 探讨骨质疏松性骨折椎体成形术后再骨折的治疗方法.方法 选取2010年1月至2011年1月收治的骨质疏松性骨折患者120例（140个椎体）,将术后12个月内再次骨折的15例（20个椎体）患者作为研究对象,其中11例给予骨水泥强化治疗,术后抗感染,恢复期给予积极的康复锻炼指导;4例给予抗骨质疏松治疗.随访10个月,观察有无骨水泥外漏及抗骨质疏松的治疗恢复情况.结果 11例再次骨折的患者在注射骨水泥过程中均无椎前静脉渗漏及椎间盘渗漏,术后所有患者均未出现骨水泥渗漏,其中3例注射后出现背部疼痛,主要考虑为手术影响到局部神经功能,给予镇痛药治疗后疼痛明显减轻;4例抗骨质疏松治疗恢复可,无疼痛和不适症状发生.术后3d所有患者均可下床活动,均于术后1周内出院.所有患者均未出现充填剂不良性宿主反应,无再次骨折发生.通过疼痛视觉模拟量表（VAS）进行评分,治疗后3d和终末期随访时VAS评分均明显低于治疗前（3.05±0.55）,（0.05±0.15）分比（6.95±0.65）分],且终末期随访时VAS评分低于治疗后3d,差异均有统计学意义（P＜0.05）.结论 骨水泥强化治疗辅以抗感染及康复锻炼指导及抗骨质疏松治疗对骨质疏松性骨折椎体成形术后再骨折的临床疗效确切,安全可靠,值得临床推广应用.

Clinical treatment of osteoporotic refracture after vertebroplasty

Objective To investigate the treatment method of osteoporotic refracture after vertebroplasty. Methods One hundred and twenty patients （140 vertebraes） with osteoporotic fractures from January 2010 to January 2011 were selected, 12 months after operation, 15 cases of refracture （20 vertebraes） patients as the research object, ll cases were given bone cement to strengthen treatment, postoperative anti-infection, recovery given a positive rehabilitation exercise instruction;4 cases were given anti-osteoporosis treatment. Follow-up of 10 months,whether leakage of bone cement and the recovery of anti-osteoporosis treatment were observed. Results Eleven patients with refracture in the process of bone cement injection had no prevertebral venous leakage and disc leakage, none of the patients had bone cement leakage after operation ;including 3 cases occurred back pain after injection,the main consideration was surgery influenced the local nerve functions and given analgesic treatment, then pain significantly reduced; 4 cases with anti-osteoporosis therapy and recoverd better,no pain and other unsuitable symptom occurred. Postoperative 3 d all of the patients could get out of bed,were discharged on 1 week after operation. All patients were not appear the adverse host reaction of fillers, with no occurrence of refracture. Through visual analog pain scale（ VAS ） score, VAS score in the 3 d after treatment and end-stage follow-up were significantly lower than before treatment （3.05±0.55 ）, （0.05 ±0.15 ） scores vs. （6.95 ±0.65 ） scores ], and VAS score at the time of end-stage follow-up was lower than 3 d after treatment,there was significant difference （P 〈 0.05 ）. Conclusion Bone cement to strengthen with anti-infection and rehabilitation exercise instruction and anti-osteoporosis in the treatment of osteoporotic refracture after vertebroplasty curative effect,safe and reliable effect, worthy of clinical popularization and application.