PVP治疗老年急性椎体骨折的临床应用

Clinical application of percutaneous vertebroplasty for treating acute vertebral fractures in aged patients

目的：探讨经皮椎体成形术（PVP）对治疗老年急性椎体骨折的临床应用价值。方法：36例老年急性压缩性和粉碎性椎体骨折的患者，骨折的部位为椎体的前部或／和中部，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骨水泥，骨水泥的剂量控制在2～6ml范围内。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：36例急性椎体骨折的患者，43个骨折的椎体进行PVP治疗。术前的疼痛分数为（17．99±1．45），术后48h为（6．04±1．32），两者比较差异有统计学意义（P〈0．001）。巴塞尔指数术前为（54．07±16．56），术后48h为（88．12±15．98），两者比较差异有统计学意义（P〈0．001）。其中9例在骨水泥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：经皮椎体成形术是一种治疗老年急性椎体骨折的微创、安全、有效的方法，能迅速缓解患者的临床症状和体征。

Objective To evaluate the efficacy and value of percutaneous vertebroplasty （PVP） for treating acute vertebral fractures in the aged patients. Method Thirty - six aged patients with compressed or comminuted vertebral fractures underwent PVP. The fracture seg- ments included the anterior and/or the medial parts of the vertebral body. The nervous function of the patients was normal. Polymethylmethacrylate（PMMA） was injected into the fractured vertebrae through the relatively serious side. The injection dose of PM- MA ranged from 2 to 6ml. The pain score and Barthel Index（BI） were evaluated pre - PVP and 48 hours post - PVP respectively. Results Thirty - six cases with 43 acute vertebral fractures underwent PVP. The mean values of pain score was （ 17. 99 ± 1.45 ） before PVP, （6.04 ± 1. 32） 48h after PVP,and there was statistically significance between the two groups（P 〈0. 001 ）. The mean values of BI was （54. 07 ± 16.56） before PVP, （ 88.12 ± 15.98 ） 48h after PVP, and there was statistically significance between the two groups（P 〈 0. 001 ）. Perivertebral PMMA leakage was found in 9 vertebrae,leakage to the adjacent disc and vertebral canal in 1 case,the venous plexus in 2 cases and the pulmonary artery in 1 case. All the patients had not clinical symptoms. Conclusion PVP is an effective,safe and mini -invasive technique for treating the aged patients with acute vertebral fractures, and it can relieve the clinical symptoms and signs rapidly.