经皮椎体成形术治疗骨质疏松疼痛性椎体压缩骨折的临床疗效分析

Percutaneous vertebroplasty for treatment of painful osteoporotic vertebral compression fractures： a retrospective analysis of clinical efficacy

目的 探讨经皮椎体成形（PVP）治疗疼痛性骨质疏松椎体压缩骨折（OVCFs）的临床疗效和影像学变化.方法 回顾性分析2007年5月至2012年6月东南大学附属中大医院应用PVP治疗OVCFs随访1年以上并有完整CT影像资料142例患者195节椎体.PVP前后定期评价VAS,术后3 dCT复查观察骨水泥分布和渗漏情况,在CT二维重建正中矢状面上分别测量术前、术后3d及术后1年椎体高度和Cobb角.比较各随访点VAS、椎体高度和Cobb角变化差异,椎旁骨水泥渗漏是否影响疗效.结果 所有PVP操作均成功,平均注入骨水泥量胸椎（4.5±1.1）ml,腰椎（6.0±1.2）ml,平均随访（17±6）个月.术后3 dCT显示椎旁骨水泥渗漏共38例43节椎体（22.1％）,均无症状.142例术后24 h VAS平均下降了5.25,术后1个月进一步下降了1.12,均有显著变化,余各随访点间差异无统计学意义.PVP后3d椎体前缘、中央高度及Cobb角分别恢复了1.55、1.38 mm及2.37°,差异有统计学意义,但术后3d和随访1年以上比较差异均无统计学意义.骨水泥椎旁渗漏组与无渗漏组的VAS评分、椎体前缘、中央高度和Cobb角的变化在各随访点差异均无统计学意义.结论 PVP可迅速缓解OVCFs患者的疼痛及提高多数椎体的高度并保持长期稳定;椎旁少量骨水泥渗漏对临床疗效和椎体稳定性无影响.

Objective To evaluate the clinical efficacy and radiological changes in patients with painful osteoporotic vertebral compression fractures （OVCFs） after percutaneous vertebroplasty （PVP）.Methods Retrospective analysis was conducted on 195 vertebrae in 142 patients with painful OVCFs treated with vertebroplasty in our hospital from May 2007 to June 2012.The scores of visual analogue scale （VAS） were recorded and the heights of vertebral bodies and Cobb angles were measured in the mid-sagittal plane of the reformatted images at 64-detector row CT during the period of follow-up.Polymethylmethacrylate （PMMA） distribution in vertebrae and whether leakage was observed on CT within 3 days after PVP.The changes in VAS,heights of vertebral bodies and Cobb angles were compared between the cases with and without leakages.Results The successful rate of technique of PVP was 100％.The mean volume of PMMA injected in each vertebra was （4.5 ± 1.1） ml and （6.0 ± 1.2） ml respectively in thoracic and lumbar.The mean follow-up was （17 ±6）months.Asymptomatic leakages of PMMA were demonstrated by CT in 38 patients with 43 vertebrae （22.1％）.The average decrease in VAS was 5.25 and 1.12 respectively in 24 hours and a month after PVP.The changes in VAS respectively at 1 month,3 months,6 months and more than 1 year after procedure were not significantly different.In postoperative 3 days,the average increase in height of vertebral body was 1.55 mm anteriorly and 1.38 mm centrally,the average reduction in Cobb angle were 2.37°.The heights and Cobb angles of vertebral bodies between in 3 days and in more than 1 year after PVP were not significantly different.The scores of VAS and the changes in vertebral body heights and Cobb angles between the patients with or without cement leakages were not significantly different during the period of follow-up.Conclusion PVP is an effective treatment for patients with painful OVCFs that provides immediate and sustained pain relief,increases in the heights of vertebral bodies injected in cement and keeps stable radiological progression within at least 1 year after PVP.Asymptomatic cement leakages around vertebrae have no influence on pain relief and vertebral stability in this group of patients.