骨水泥充填治疗多节段骨质疏松性压缩性骨折的病例分析

Bone cement is required for multi-segment osteoporotic compression fractures

背景:椎体骨质疏松性压缩骨折多发生于骨质钙丢失严重的老年人群,轻微的外力就可以引起椎体骨折,近年来发展起来的经皮椎体成形治疗骨质疏松性压缩性骨折效果较好。目的:探讨骨水泥充填治疗多节段骨质疏松性压缩性骨折的疗效及材料的特性。方法:采用骨水泥充填材料经皮椎体成形治疗多椎体骨质疏松性压缩骨折患者32例,共158个椎体。治疗后复查X射线、CT等辅助检查,了解骨折椎体复位情况、椎体的容量变化、骨水泥分布及外漏情况,用CT容量分析法检测治疗前后椎体的容积变化,观察疼痛强度评价的目测类比评分变化,分析发生骨水泥渗漏的原因。结果与结论:纳入结果分析32例,158个椎体。注射骨水泥后无神经根及脊髓损伤,无肺栓塞及心脑血管系统急性反应。①治疗后随访6-16个月,平均随访10个月,无严重并发症和椎体塌陷。②治疗前椎体体积为(22.2±8.6)cm3,治疗后增至(24.8±6.9)cm3,体积变化差异有统计学意义(P<0.05)。③6个椎体发生骨水泥渗漏,分别为椎管内硬膜外2个、椎旁静脉4个,可能与椎体后缘爆裂、骨水泥黏度过低以及注射速度过快有关。④治疗后48h目测类比评分为(2.2±3.7)分,较治疗前(8.3±1.6)分显著下降(t=25.2,P<0.05)。作者认为,对于多节段骨质疏松性压缩性骨折,采用充分的治疗前准备和恰当的方法,选择合适的骨水泥充填材料,一期行经皮椎体成形治疗是安全可行的,可明显缓解患者的疼痛症状,治疗中操作要注意防止骨水泥渗漏。

BACKGROUND： Vertebral osteoporotic compression fractures often occur in the elderly with serious bonecalcium loss, and light external forces can cause vertebral fractures. The percutaneous vertebroplasty developed recently has better effect for the treatment of osteoporotic compression fractures. OBJECTIVE： To explore the effect and material characteristics of bone cement for the treatment of multi-segment osteoporotic compression fractures. METHODS： Thirty-two patients （158 vertebral bodies） with osteoporotic compression fractures were treated with bone cement through percutaneous vertebroplasty. Review X-ray and CT scanning were performed after treatment to understand the fracture vertebra reduction, changes of vertebral capacity, bone cement distribution and leakage situation. The change of the volume of vertebral body before and after treatment was detected with CT volumetric analysis, the change of Visual analog scale was observed and the reason for bone cement leakage was analyzed. RESULTS AND CONCLUSION： All the 32 patients （158 vertebral bodies） were included in the final analysis. There were no nerve root and spinal cord injuries, no pulmonary embolism and no cardiovascular system acute response after injection of bone cement;All the patients were followed-up for 6-16 months after treatment, averaged in 10 months, and there were no serious complications or vertebral collapse. The vertebral volume before treatment was （22.2±＋8.6） cm^3 and increased to （24.8±6.9） cm^3 after treatment, and the difference was significant （P 〈 0.05）. Six vertebral bodieS appeared bone cement leakage, including two bone cement leakage in spinal epidural and four bone cement leakage in paravertebral vein, and the leakage may related to the posterior margin burst, low bone cement viscosity and fast nject on speed. The visual analog scale score （2.2±3.7） at 48 hours after treatment was significantly lower than （8.3±1.6） before treatment （t=25.2, P 〈 0.05）. The adequate pre-treatment preparation, proper method, suitable bone cement materials combined with percutaneous vertebroplasty is safe and feasible for the treatment of multi-segment osteoporotic compression fractures, which can significantly alleviate pain in the patients, and we should pay attention to prevent the leakage of bone cement during operation.