经皮椎体成形术治疗骨质疏松性椎体骨折的疗效及并发症

骨质疏松性椎体骨折(OVCF)是一种临床常见的老年骨质疏松患者的并发症,常会引起胸、背、下腰部疼痛,严重影响患者的生活质量。如何应用安全有效的微创技术治疗OVCF成为临床研究的焦点问题。经皮椎体成形术(PVP)因其具有创伤小、安全性高等优点,被广泛应用于OVCF的治疗,但是PVP在临床应用过程中尚存在许多难点及不足〔1,2〕。本文拟分析PVP治疗后的恢复情况及并发症的发生情况。     

经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松脊柱压缩性骨折的临床对比分析

骨质疏松性骨折往往发生于老年人,造成持续性腰背部剧烈疼痛,椎体变形,脊柱后凸,如果引起神经症状可导致双下肢不全瘫、大小便失禁等,严重影响中老年人的生活质量[1].传统的保守治疗不但恢复时间长,而且易引起多种并发症.本研究拟比较分析经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗骨质疏松脊柱压缩性骨折的疗效.     

经皮椎体成形术及经皮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

随着我国人口老龄化的趋势,骨质疏松性椎体压缩骨折(OVCF)的患者逐渐增多。随着医学微创技术的发展,经皮椎体成形术(PVP)及经皮椎体后凸成形术(PKP)越来越多的用于临床,但PVP和PKP在OVCF治疗中的优缺点存在一定争议〔1～4〕。本研究探讨PVP和PKP治疗老年OVCF的效果。1资料与方法1.1研究对象入选2009年1月至2012年3月收治的采用     

经皮穿刺椎体成形术治疗骨质疏松性椎体压缩性骨折102例

既往在治疗上多采用保守疗法,但不少患者难以坚持长期卧床休养,导致治疗效果欠佳,并由于长期卧床导致骨质疏松程度加重、发现压力性溃疡、坠积性肺炎、血栓等并发症。经皮穿刺椎体成形术(PVP)是在影像监视下,经皮穿刺,通过椎弓根路径进入病变椎体,向内注入调配后的骨水泥〔主要成分为聚甲基丙烯酸甲酯(PMMA)〕的一种脊柱微创手术,达到稳定     

经皮椎体成形术治疗椎体压缩性骨折56例疗效观察

目的 探讨经皮椎体成形术（PVP）治疗椎体压缩性骨折的效果及安全性。方法 对56例椎体压缩性骨折患者于气管插管麻醉或局部麻醉行PVP,术后立即在C型臂透视下观察骨水泥在椎体内分布及渗漏情况,评估手术成功率;按照主诉疼痛分级法（VRS）对患者术前、术后疼痛情况进行分级并判定疗效;观察并发症发生情况及Cobb角、椎体前缘高度改善情况。结果 手术成功率为95．8％,术后疼痛总有效率为98．2％;除3个椎体骨水泥外渗外,无原椎体再发塌陷、神经受累现象;术后Cobb角及椎体前缘高度均显著改善。结论 PVP治疗椎体压缩性骨折疗效好、并发症发生率低,且可缩短患者长期卧床时间。     

经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效分析

目的探讨经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折的临床疗效。方法对120例(145个椎体)老年骨质疏松性椎体压缩性骨折患者行经皮椎体成形术治疗,观察术后疼痛缓解情况,术前和术后3 d、1个月、3个月应用10分制视觉模拟评分(VAS)对患者疼痛进行评价。结果所有患者均获3个月随访,100例患者疼痛完全缓解(CR.),15例患者部分缓解(PR),5例无缓解,有效率为95.83%(CR+PR/总例数)。术前与术后各时间段比较,视觉模拟评分差异均有统计学意义(P<0.05),但术后各时间段差异无统计学意义(P>0.05)。结论经皮椎体成形术具有显著的临床止痛效果和创伤小的优点,是治疗老年骨质疏松性椎体压缩性骨折安全有效的治疗方法。     

经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床效果分析

目的分析经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法选取该院2017-01~2018-01因OVCF行PVP治疗的患者158例(205椎),对比患者手术前后视觉模拟评分法(VAS)、Oswesty功能障碍指数(ODI)评分,伤椎前缘高度、Cobb角变化,以评价治疗效果;同时分析临床疗效与骨水泥注入量的关系。结果所有患者术后VAS评分、ODI评分均较术前明显降低,差异有统计学意义(P<0.05);术后伤椎前缘高度、Cobb角均较术前明显恢复,差异有统计学意义(P<0.05)。结论PVP治疗OVCF具有较好的临床效果,可尽早缓解疼痛,提高患者生活质量。     

经皮椎体成形术治疗骨质疏松性压缩性骨折的有限元力学分析

目的建立胸腰段骨质疏松性椎体压缩性骨折的病理三维有限元模型,分析手术前后病椎及邻近椎体应力变化情况。方法取CT三维重建资料通过软件MIMICS10.0建立椎体的三维实体模型,以三维有限元分析软件ANSYS12.0模拟经皮椎体成形术(PVP)过程在腰1(L1)椎体中置入不同容量骨水泥(2、4、6、8 ml),分析轴向压缩直立、前屈、后伸、侧弯、旋转5种加载状态下手术前后相邻椎体的应力变化。结果小剂量骨水泥注入(2、4 ml),病椎所受应力逐渐增加,而较大治疗量骨水泥注射入(6、8 ml),随着病椎硬度及刚度加强,其所受应力逐渐下降;而临近椎体在骨水泥注入量逐渐增加过程中,所受应力未见明显改变。结论对于老年骨质疏松性压缩性骨折的力学研究,三维有限元力学分析具有良好的应用前景及临床价值;在能够避免大治疗剂量骨水泥注入所带来并发症(如渗漏)前提下,4⁸ ml骨水泥注入量更加有效,且不增加邻近椎体骨折的风险。     

经皮椎体成形术治疗骨质疏松性椎体骨折32例疗效观察

经皮椎体成形骨水泥填充术（PVP）有恢复椎体高度、增加椎体强度、止痛效果明显等作用。2004～2007年,我们应用PVP治疗骨质疏松性椎体压缩骨折12例,疗效满意。现报告如下。     

经皮椎体成形术与经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效比较

目的对比经皮椎体成形术(PVP)与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(OVCF)的临床疗效。方法回顾分析自2013年6月至2014年12月该院单纯行PVP或PKP的OVCF患者92例(共128个椎体),根据手术方式分成PVP组和PKP组,统计两组患者手术的有效率、后凸矫正率及骨水泥渗漏率,并比较患者手术前及术后1个月的疼痛视觉模拟评分(VAS)及伤椎高度变化情况。结果 PVP组有效率为90.00%,PKP组有效率为92.86%,两组无统计学差异(P0.05);两组患者术后VAS均明显低于手术前,其中PKP组VAS评分显著低于PVP组(P0.05);两组患者间后凸矫正率比较无统计学差异(P0.05);PKP组发生骨水泥渗漏率为16.67%,明显低于PVP组的36.00%(P0.05);两组患者术后伤椎高度明显高于手术前,其中PVP组伤椎高度显著高于PKP组(P0.05)。结论 PVP和PKP治疗OVCF均具有良好的临床疗效,PKP可以更好地降低患者的VAS评分,且骨水泥渗漏率更低,而PVP可以更有效地提高伤椎的高度。两种方式各有特点,临床应根据患者的实际情况进行选择。     

经皮椎体成形术及经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折再发骨折危险因素研究

目的 探讨骨质疏松性椎体压缩骨折（OVCFs）经皮椎体成形术（PVP）及经皮椎体后凸成形术（PKP）后非手术椎体骨折的危险因素。方法回顾性研究2009年2月～2010年3月于河北医科大学第三医院脊柱外科门诊及病房共收治OVCFs患者76例,男11例,女65例,年龄56~87岁,平均（66．7±7-3）岁,随访时间6～22个月,平均13．6个月。44例患者行PVP手术,32例患者行PKP手术。记录两组患者年龄、性别、病程、体质量指数、骨密度、水泥注入量、水泥渗漏率、平均后凸角矫形,分析引起非手术椎体骨折的危险因素。结果PVP组患者水泥注入量及平均后凸角矫形均低于PKP组患者,经两样本t检验,差异有统计学意义（P〈0．05）;水泥渗漏率和新发椎体骨折两组间差异无统计学意义（P〉0．05）;logistic回归分析结果显示,骨密度T值≤-2．5SD是与非手术椎体骨折相关的危险因素,后凸角矫形≥5．0。组患者新发骨折与首次手术间隔时间明显短于对照组,经秩和检验显示差异有统计学意义（P〈O．05）。结论骨密度T值≤-2．5SD是与非手术椎体骨折相关的危险因素,在骨密度T值严重降低的骨质疏松患者中,过多的矫正后凸畸形可能缩短了再发骨折的发病周期。     

A meta-analysis of the secondary fractures for osteoporotic vertebral compression fractures after percutaneous vertebroplasty

To identify the risk factors of the secondary fractures for osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).We conducted a search of relevant articles using Cochrane Library, PubMed, Medline, Science Direct, Embase, the Web of Science and other databases. The time range we retrieved from establishment of the electronic database to November 2017. Gray studies were found in the references of included literature reports. STATA version 11.0 (Stata Corporation, College Station, Texas) was used to analyze the pooled data.Fourteen studies involving 1910 patients, 395 of whom had fracture secondary to the surgery were included in this meta-analysis. The result of meta-analyses showed the risk factors of the secondary fractures for OVCFs after PVP was related to bone mineral density (BMD) [95%CI (−0.650, −0.164), SMD=−0.407, P=.001], cement leakage ((RR=0.596, 95%CI (0.444,0.798), P = .001)), and kyphosis after primary operation ((SMD=0.741, 95%CI (0.449,1.032), P = .000)), but not to gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.Bone mineral density, cement leakage, and kyphosis after primary operation are the risk factors closely correlative to the secondary fracture after PVP. There have not been enough evidences to support the association between the secondary fracture and gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.     

个体化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的临床疗效

目的探讨个体化单侧穿刺椎体后凸成形术(UI-PKP)治疗胸腰段椎体骨质疏松性压缩骨折(OVCF)的安全性和临床疗效。方法采用UI-PKP术治疗单节段胸腰椎OVCF患者187例,男63例,女124例;年龄60～89岁,平均73.5岁。骨折椎体分布,胸椎(T)10 27例,T11 40例,T12 49例,腰椎(L)1 43例,L2 28例;PKP术后再骨折18例。患者术前常规行X线、全脊柱MRI及压缩椎体三维重建,针对不同患者影像资料进行穿刺钉道设计,指导术中穿刺。观察骨水泥灌注量、骨水泥在骨折椎体的填充情况、骨水泥渗漏及并发症;比较手术前与术后3 d、3个月、1年时间点疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及压缩椎体前缘、中线高度。结果所有患者顺利完成手术,骨水泥注入量(4.3±1.7)ml。术后3 d、3个月、1年,VAS、ODI较术前明显改善,骨折椎体前缘、中线高度较术前明显增加,差异有统计学意义(P0.05)。骨水泥在骨折椎体充分填充166例(88.8%),不充分填充21例(11.2%)。23例(12.3%)发生骨水泥渗漏(硬膜外渗漏3例,椎间隙渗漏12例,椎旁软组织渗漏8例);2例椎旁渗漏致肋间神经压迫,术后出现放射性疼痛和麻木,予非甾体类抗炎药物、封闭等治疗好转;其余渗漏均未引起临床症状,未行翻修手术。未出现气胸、血管神经损伤、脊髓损伤、脑脊液漏、感染等相关并发症。结论 UI-PKP治疗胸腰段椎体OVCF,骨水泥在骨折椎体弥散良好,临床疗效满意。     

A review of vertebroplasty for osteoporotic and malignant vertebral compression fractures

Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.     

Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty

The aim of this study was:to assess the long-term efficacy and safety of percutaneous vertebroplasty (PVP) for treating painful vertebral osteoporotic fractures, and to estimate the risk of vertebral fracture in the vicinity of a cemented vertebra. A prospective open study was conducted. PVP were carried out between July 1995 and September 2000 for 16 patients with symptomatic osteoporotic vertebral fracture that had not responded to extensive conservative medical therapy. All the patients were followed-up for more than 1 year. The efficacy of the PVP was assessed by the changes over time in pain on Huskissons visual analog scale (VAS) and on the McGill-Melzack scoring system (MGM). The efficacy of the procedure was also assessed by measuring the changes over time in quality of life assessed by the Nottingham Health Profile (NHP instrument): twenty-one vertebrae treated by PVP in 16 patients were evaluated. The mean duration of follow-up was 35 months. Pain assessed by the VAS significantly decreased from a mean of 71.4 mm±13 before PVP to 36 mm±30 after 6 months, and to 39 mm±33 at the time of maximal follow-up (p<0.05 for both comparisons). The results were also significant for the MGM: 3.00±0.57 before PVP to 1.6±1.4 at the long-term follow-up (p<0.05). The solely statistically significant decrease for quality of life was noted for pain. A slight but not significant improvement was noted for 3/6 dimensions of the NHP scores. A slight but significant increase in social isolation was also found. No severe complication occurred immediately after PVP. At the long term follow-up (35 months) there was a slight but not significantly increased risk of vertebral fracture in the vicinity of a cemented vertebra: odds ratio 3.18 (95% confidence interval (CI) 0.51–19.64). The odds ratio of a vertebral fracture in the vicinity of an uncemented fractured vertebra was 2.14 (95% CI: 0.17–26.31). In conclusion, PVP appears to be safe and effective for treating persistent painful osteoporotic fractures. Controlled studies with long-term follow-up are needed to evaluate the risk of vertebral fractures in the vicinity of a cemented vertebra. Abbreviations MGM McGill-Melzack scoring system - PVP Percutaneous vertebroplasty - VAS Visual analog scale     

Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty

OBJECTIVE: To assess the immediate and long-term efficacy and safety of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for the treatment of refractory pain resulting from osteoporotic vertebral fractures. METHODS: A retrospective, open study of percutaneous vertebroplasty (PV) was conducted with long-term follow-up. PV with PMMA was carried out between 1990 and 1996 in 40 patients with symptomatic osteoporotic vertebral fracture(s) that had not responded to maximum medical therapy. In 1997, each patient was asked to come back to our institution for a physical and spinal X-ray examination. Efficacy was assessed by changes over time in pain on Huskisson's visual analogue scale (VAS). RESULTS: Thirty-four vertebrae treated by PV in 25 patients were evaluated with long-term follow-up. The mean duration of follow-up was 48 months (range 12-84 months). Pain assessed by the VAS significantly (P<0.05) decreased from a mean of 80 mm+/-16 (S.D.) before PV to 37+/-24 mm after 1 month and 34+/-28 mm at the time of maximal follow-up. There was no severe complication related to this treatment, and no progression of vertebral deformity in any of the injected vertebrae. However, there was a slight but significantly increased risk of vertebral fracture in the vicinity of a cemented vertebra (odds ratio 2.27, 95% confidence interval 1.1-4.56). The odds ratio of a vertebral fracture in the vicinity of an uncemented fractured vertebra was 1.44 (0.82-2.55). CONCLUSION: PV appears to be a safe and useful procedure for the treatment of focal back pain secondary to osteoporotic vertebral fracture when conservative treatment has failed.     

骨质疏松性椎体骨折不同时期行经皮椎体成形术疗效比较

目的观察骨质疏松性椎体骨折(OVF)不同时期患者行经皮椎体成形术(PVP)治疗的临床效果。方法选择行PVP的OVF患者120例,根据损伤至手术时间不同分为损伤2周内手术(A组)65例、损伤第2~8周手术(B组)35例、损伤2个月后手术(C组)20例。比较三组患者术前、术后3 d、术后6个月时的疼痛视觉模拟评分(VAS)、欧洲骨质疏松症基金会生活质量问卷(QUALEFFO)评分;比较三组患者骨水泥分布情况、骨水泥注入量、骨水泥渗漏率。结果三组患者各组内比较,术后3 d的VAS均低于术前,术后6个月的VAS均低于术后3 d(P<0.05);术后6个月、术后3 d的QUALEFFO评分均低于术前(P<0.05)。三组同时点VAS、QUALEFFO评分差异均无统计学意义(P均>0.05)。三组骨水泥注入量、骨水泥渗漏率、骨水泥分布指数比较差异均有统计学意义(P均<0.05)。结论PVP在治疗不同时期OVF中均有良好效果。急性期骨水泥分布指数高,而在亚急性期、慢性期则分别存在骨水泥渗漏率较低、骨水泥注入量减少的情况。建议对于OVF患者应早期进行PVP治疗。     

Vertebroplasty for osteoporotic vertebral compression fractures

Vertebroplasty for osteoporotic vertebral compression fractures is a minimally invasive procedure which could provide immediate pain relief by injecting PMMA into the vertebral body percutaneously. Kyphoplasty, which is designed to restore the vertebral height by inflating balloon, has recently been developed and the excellent early clinical results were reported. Calcium phosphate cement may have potential advantages over the PMMA for the use in vertebroplasty or kyphoplasty.