经皮椎体成形术治疗严重椎体压缩性骨折的临床价值

The clinical value of percutaneous vertebroplasty in treating severe vertebral compression fractures

目的探讨经皮椎体成形术(PVP)对严重椎体压缩性骨折治疗的临床价值。方法回顾性分析2012年6月—2013年3月行PVP治疗严重椎体压缩性骨折30例患者、累及30节病变椎体的临床资料。根据椎体压缩形态分为楔形、双凹型以及长方形3种,楔形骨折采取健侧椎弓根入路,双凹形骨折采取单侧椎弓根入路,长方形压缩性骨折根据骨水泥填充情况采取单侧或双侧椎弓根入路。采用视觉模拟评分法(VAS)和WHO疼痛标准分级程度评价效果,测量压缩椎体术前高度及术后恢复高度。所有患者术后均通过门诊随访或电话随访6个月。结果 30节病变椎体穿刺成功率为100%。VAS评分术前平均6.9±0.9,术后1 d、1个月、3个月、6个月分别为5.0±0.9、3.5±0.7、2.5±0.8、1.6±0.7。依据WHO标准完全缓解(CR)25例、部分缓解(PR)3例;无效2例;临床有效率(CR+PR)为93.3%;术前压缩椎体高度为(5.77±1.09)mm;术后平均恢复高度为(14.33±2.03)mm。结论单纯PVP治疗严重椎体压缩性骨折方法可行,短期临床效果肯定。

Objective To discuss the clinical value of percutaneous vertebroplasty （PVP） in treating severe vertebral compression fracture. Methods During the period from June 2012 to March 2013, PVP was carried out in 30 patients with severe vertebral compression fracture （30 diseased vertebrae in total）. The clinical data were respectively analyzed. According to the shape of compressed vertebra , the fractures were divided into three types： wedge-shaped, double concave and oblong-shaped. For wedge-shaped fracture, PVP was performed via the pedicle access of the healthy side. For double concave type , unilateral pedicle access was used, while for oblong-shaped type unilateral or bilateral access was adopted to conduct PVP according to the distribution of the injected PMMA. The therapeutic results were evaluated by using VAS and pain degree classification standard of WHO. The preoperative and postoperative vertebral height was estimated on the lateral projection. All patients were followed up for six months at out-patient clinic or by telephone. Results The success rate of puncturing was 100%. The preoperative mean VAS was 6.9 ± 0.9. The postoperative VAS at one day, one, 3 and 6 months after the procedure was 5.0 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.8 and 1.6 ± 0.7 respectively. Based on WHO pain degree classification standard, complete remission （CR） was obtained in 25 cases, partial remission （PR） in 3 cases, and invalid in 2 cases. The effective rate （CR ＋PR） was 93.33%. The mean preoperative height of the compressed vertebrae was （5.77 ± 1.09） mm and the mean postoperative height of the compressed vertebrae was （14.33 ± 2.03） mm. Conclusion For the treatment of severe vertebral compression fractures, percutaneous vertebroplasty is clinically feasible with reliable short-term effect.