经皮椎体成形术治疗急性椎体骨折的临床分析

Clinical application of percutaneous vertebroplasty in treating acute vertebral fractures

目的探讨经皮椎体成形术(PVP)对治疗急性椎体骨折的临床应用价值。方法选择34例急性椎体骨折患者,骨折的部位为椎体的前部和(或)中部,患者均不伴有神经功能障碍。选择椎体骨折相对严重的一侧注入聚甲基丙烯酸甲酯(商品名骨水泥,PMMA),PMMA的剂量为2～6ml。分别在术前、术后48h记录疼痛分数和功能水平(巴塞尔指数)以评价治疗效果。结果34例患者中粉碎性骨折18例,41个骨折的椎体进行PVP治疗。术前的疼痛分数为18.09±1.50,术后48h为6.74±1.42,两者有显著性差异(P<0.001)。巴塞尔指数术前为53.78±16.66,术后48h为87.21±15.93,两者有显著性差异(P<0.001)。本组中8例在PMMA注射过程中进入椎体的两侧或前方,1例进入椎间盘和椎管,2例进入静脉,1例进入肺动脉,但患者均无临床症状。结论经皮椎体成形术能迅速缓解患者的临床症状和体征。

Objective To evaluate the efficacy and application of percutaneous vertebroplasty （PVP） in the treatment of acute vertebral fractures. Methods Thirty-four cases with acute vertebral fractures underwent PVP.The fracture segments included the anterior and/or tbe medial parts of the vertebral body.The nervous function of the patients was normal. Poly-methylmethacrylate（PMMA） was injected into the fractured vertebrae through the relatively severe side. The injection dose of PMMA ranged from 2ml to 6ml. The pain score and Barthel Index（BI） were evaluated pre-PVP and 48 hours post-PVP respectively. Results Thirty-four cases with 41 acute vertebral fractures underwent PVP, in which 18 cases with comminuted fracture were included. The mean values of pain score were 18.09±1.50 before pvP, and 6.74±1.42 after PVP. There was statistically significant difference （P〈0.001） between the two groups. The mean values of BI were 53.78±16.66 before PVP, and 87.21±15.93 after PVP. There was statistically significant difference（P〈0.001） between the two groups. Perivertebral PMMA leakage was found in 8 vertebrae, one leakage into the adjacent disc and vertebral canal 2 into the venous plexus, one into the pulmonary artery. All the patients had no clinical symptom. Conclusions PVP is an effective, safe and mini-invasive technique in treating patients with acute vertebral fractures, it can relieve the clinical symptoms and signs rapidly.