老年骨质疏松性胸腰椎压缩骨折治疗研究进展

Research progress of treatment of osteoporotic thoracolumbar vertebral compression fractures in the elderly

通过总结目前有关骨质疏松性椎体压缩骨折(OVCF)的治疗研究进展,包括非手术和手术治疗及数字化骨科技术的应用,比较不同治疗方法的利弊并加以探讨。非手术治疗包括卧床休息、药物、物理、中医药、运动康复、中医正骨手法的治疗方面,从改善临床症状、减少并发症、促进成骨、恢复椎体高度、减少邻近椎体的骨折等方面均有显著疗效。手术治疗方面经皮椎体成形术(PVP)是经典术式,镇痛效果好,但易发骨水泥渗漏且椎体高度恢复不理想;经皮球囊扩张椎体后凸成形术(PKP)椎体高度恢复较好,骨水泥注入量较大但渗漏率低;Sky骨扩张系统后凸成形术(SKP)矫形效果显著但较易破坏终板,且椎体高度的维持能力尚有待明确;Opti Mesh椎体成形术可优化填充材料,最大程度还原术后病椎内部的生理环境,但手术易损伤椎旁组织;Cortoss骨水泥毒性小、聚合温度低、可模拟椎体刚度,但实际临床疗效有待明确。随着新材料、新技术的不断完善与相互结合,在数字化骨科技术的深入应用中,保守与手术治疗OVCF将获得更安全、有效的临床治疗结果,并且能够揭示胸腰椎单纯压缩性骨折的作用机制与其对相邻椎体和椎间盘压应力的影响的差异性以及治疗后对脊柱功能的影响,为临床提供治疗依据。

To review the latest progress in minimally invasive treatment of osteoporotic vertebral compression fracture(OVCF).There are various technologies for treatment of OVCF to aim at analgesia, deformity correction, and vertebral stabilization, thus improving the patients' quality of life.Conservative treatment including bed rest, medicine, physics, medicine, sports rehabilitation and techniques of bone-setting manipulation, in the improve the clinical symptoms, reduce complications, promote osteogenesis, restore vertebral body height, reduce adjacent vertebral fracture have remarkable curative effect.Percutaneous vertebroplasty as the classical technology has a good effectiveness on analgesia, while percutaneous kyphoplasty has a better performance in vertebral height restoration and a lower complication of cement leakage.Obvious deformity correction can be achieved by skyphoplasty, with a risk of endplate damage and uncertain vertebral height maintenance.Opti Mesh vertebroplasty, physiological environment within the fractured vertebra is less likely to be disturbed, but paravertebral tissues are more vulnerable due to a bigger working cannal.Compared with traditional bone cement, Cortoss has advantages of less toxicity, less heat release, and proper stiff ness.With the constant improvement of new material, new technology and in combination with each other, the digitalization of orthopaedic technology applications, the conservative and surgical treatment of OVCF will obtain more safe and effective clinical treatment results, and to reveal the mechanism of action of thoracolumbar compression fractures alone and its influence on adjacent vertebral body and intervertebral disc pressure stress and the difference of the effect of treatment for spinal function, provides the treatment basis for the clinical.