椎体成形术结合体位复位治疗多椎体骨质疏松性骨折疗效分析

Efficacy of percutaneous vertebroplasty and manipulative reduce for the treatment of multi-vertebral osteoporotic compression fracture

目的探讨椎体成形术结合体位复位技术治疗脊柱多椎体骨质疏松性骨折的疗效和安全性。方法 2004年4月至2008年4月采用椎体成形术结合体位复位技术治疗脊柱多椎体(2个椎体以上)骨质疏松性骨折33例77椎,男9例,女24例;年龄59-87岁,平均69岁。利用俯卧位双髂及上胸部垫高,腹部悬空形成腰桥,按压骨折部位复位。在"C"型臂X线机引导下,经皮穿刺,注入医用胶原蛋白海绵和骨水泥完成手术。观察术后疼痛(翻身疼和扣击疼)症状改善、骨折复位及后凸矫正情况,并分析并发症发生情况。结果 33例患者手术顺利完成,术后平均随访12个月。骨折局部起床时疼痛和局部扣击疼程度,用视觉模拟数字法VAS评分由术前8分降低为术后2.7分,椎体前缘、中部高度分别由术前1.9cm、1.7cm增至术后2.2cm和2.1cm,差异有统计学意义,椎体后缘高度术前、术后和随访期间无明显变化。脊柱后凸总矫正16°。随访过程矫正度无丢失(统计学无意义)。33例中骨水泥渗漏4例,1例气胸,均未出现临床症状。结论椎体成形术结合体位复位技术是治疗脊柱多椎体骨质疏松性骨折经济、安全、有效的方法。

Objective To evaluate the efficacy and safety of PVP and manipulative reduce in the treatment of multi-vertebral osteoporotic compression fracture. Methods From April 2004 to April 2008, 33 patients （77 vertebraes） with painful mutil-vertebral osteopomtic compression fracture underwent PVP and manipulative reduce. The group included 9 men and 24 women with an average age of 59 years （range 59 - 87 years）. Each procedure included insertion and fracture reduce and cement and collagen sponge filling under ＂C＂ -arm monitoring. Preoperative and postoperative pain level, vertebal height resorption, spine kyphosis correction and complication were recorded and analysed. Results All 33 patients tolerated the operation well and were followed up for above average 12 months. Awake pain and strike pain of spina fracture local was observed. The mean VAS （ visual analog scale） pain score decreased singnifcantly from 8 preoperatively to 2. 7 postoperatively. No singnificant change of posterior vertebral height was recorded postoperatively. The total correction of spine kyphosis was 16°. Complications were found in 4 cases with cement leakage with no clinical symptoms. Conclusion PVP and manipulative reduce is effective, relatively safe and economical treatment for multivertebral osteoporotic compression fracture.