南方医科大学学报

南方医科大学学报 ›› 2006, Vol. 26 ›› Issue (05): 640-643.

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不同方式的椎体成形术治疗骨质疏松性椎体严重压缩性骨折

曾明； 赵新建； 张健平； 谭健韶；   

  1. 广东省佛山市第一人民院骨科； 广东省佛山市第一人民院骨科 广东佛山528000； 广东佛山528000；
  • 出版日期:2006-05-20 发布日期:2006-05-20

Different approaches of vertebroplasty for management of severe osteoporotic vertebral compression fractures

ZENG Ming,ZHAO Xin-jian,ZHANG Jian-ping,TAN Jian-shao Department of Orthopedics,First People’s Hospital of Foshan,Foshan 528000,China   

  1. 广东省佛山市第一人民院骨科； 广东省佛山市第一人民院骨科 广东佛山528000； 广东佛山528000；
  • Online:2006-05-20 Published:2006-05-20

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摘要： 目的探讨根据Rao不同分型的骨折采用不同方式的椎体成形术治疗椎体重度压缩性骨折的穿刺技术与临床效果。方法观察我院骨科收治的椎体重度压缩性骨折25例,平均年龄72岁,平均骨折压缩程度74%,平均病程22d。采用Rao骨折分型分3组:A组楔型12例、B组双凹型7例、C组粉碎型6例。A组采用单侧经椎弓根入路,B组经外侧双侧椎弓根入路,C组后路减压经椎体后壁椎体成形椎弓根钉内固定。平均随访1年。术前、术后第3天(C组术后7d)、术后6个月分别进行采用疼痛强度视觉类比评分(VAS)及O’Brein:止痛药使用情况、活动能力评分,并观察其穿刺成功率、并发症等。结果25例全部穿刺成功。平均手术时间:A组35min,B组50min,C组120min。平均骨水泥注入量2.0ml。平均出血量A、B组各30ml,C组600ml。术后3dA组VAS平均下降4.8,B组6.2,C组(术后7d)5.4;配对样本t检验VAS、止痛药使用、活动能力,术后与随访时均较术前显著下降(P<0.001),随访时维持原水平或仍有进步。9例骨水泥外渗,2例椎管内少许内溢,有一过性神经刺激症状,5例椎间盘外渗,2例椎体前外渗,无神经损伤并发症。结论不同类型的重度椎体压缩性骨折应采用不同方式的椎体成形术可取得椎体内较好的骨水泥分布与止痛效果并拓宽其手术适应证,术前体位训练对提高手术耐受力实用有效。

Abstract: Objective To compare the clinical efficacy of 3 approaches of vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures.Methods Twenty-five patients with severe osteoporotic vertebral compression fractures were observed,whose average age was 72 years with average disease history of 12 days and average compression of the affected vertebral bodies of 73%.The patients were divided into 3 groups for 3 different fracture types according to Rao’s classification of osteoporotic vertebral structure and deformity,namely wedge type(group A,n= 12),biconcave type(group B,n= 7)and crush type(group C,n=6).Unipedicular approach was adopted in group A,far lateral bipedicular approach in group B,and posterior wall vertebroplasty and pedicle screw fixation in group C.The average follow-up time was 1 year.Visual analog scale(VAS),analgesic use and the mobility were measured in the patients preoperatively and 3 days(7 days in group C)and 6 months after the operation,respectively,and the success rates and complications were observed.Results All the surgical procedures were successful.The average operation time was 35 min in group A,50 min in group B,and 2 h in group C.The average volume of cement injected into each vertebral body was 2.0 ml.The average blood loss was 30 ml in groups A and B,and 600 ml in group C.The procedure increased mobility and decreased analgesic use.VAS was decreased by a mean of 4.8 in Group A,6.2 in group B 3 days after the operation and 5.4 in group C 7 days postoperatively,and remained stable till 6 months after the operation(P<0.01).Cement extravasation occurred in 9 cases,cement in the vertebral canal in 2 cases with transient neurological symptoms,and cement extravasation in the intervertebral space and the anterior space of the vertebral bodies took place in 5 and 2 cases,respectively.No neurological complications were observed.Conclusion Different types of severe osteoporotic vertebral compression fractures require management with different approaches of vertebroplasty for adequate filling of the remaining vertebral body,which provides significant pain relief with wider indications.

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