经皮穿刺椎体成形术治疗高龄骨质疏松性胸腰椎压缩性骨折的疗效观察

Curative effect observation of percutaneous vertebroplasty （PVP） on elderly osteoporotic thoracolumbar vertebral compression fractures

目的：探讨高龄（≥80岁）骨质疏松性胸腰椎压缩性骨折患者应用经皮穿刺椎体成形术（ PVP）治疗的疗效与安全性。方法：分析高龄骨质疏松性胸腰椎压缩性骨折患者28例，共35个椎体。全部患者术前常规行胸或腰椎正侧位片、骨密度检测、磁共振成像（ magnetic resonance imaging ， MRI）及计算机断层扫描（ computed tomography，CT）检查。行术前手术风险评估。全部在“C”型臂X线机引导下行单侧入路经皮穿刺椎体成形术（ PVP）。术前、术后行视觉模拟评分（ VAS）及止痛药使用评分。结果：全部患者在术后生命征平稳，胸背痛疼痛明显缓解，无1例神经系统并发症发生，未出现严重手术并发症，早期便可下床活动。术后患者视觉模拟评分（visual analogue sale，VAS）[1]及止痛药使用评分均较术前明显降低，差异有统计学意义（P＜0．01）。结论：高龄（≥80岁）骨质疏松胸腰椎压缩性骨折患者应用经皮穿刺椎体成形术（ PVP）治疗，可安全有效地缓解患者疼痛，减少止痛药的使用，使患者能早期下床活动，减少因长期卧床所导致的并发症，提高高龄患者的生活质量，降低病死率。术前严格掌握手术适应证、充分术前准备、术中准确定位及穿刺、关键步骤中严密X线透视检测、术中密切注意患者症状及生命征等，可有效避免严重手术并发症的发生，提高手术成功率。

Objective：To explore the efficacy and safety of the application of percutaneous vertebroplasty （ PVP） on elderly （≥80 years） patients with osteoporotic thoracolumbar vertebral compression fractures.Methods：Analyzing elderly patients with osteoporotic tho-racolumbar vertebral compression fracture 28 cases, a total of 35 vertebrae.All patients did routine thoracic or lumbar spine radiographs, bone density testing, MRI （ magnetic resonance imaging, MRI） and computed tomography （ computed tomography, CT） examination be-fore surgery.And did preoperative risk assessment.All did percutaneous vertebroplasty （ PVP） by trans-single-pedicular approach guided by the＆quot;C＆quot;type arm X-ray machine.Preoperative and postoperative visual analog scale （ VAS） and analgesics use score were performed .Results：After surgery all patients were with stable vital signs , the pain in their chest and back relieved obviously, none of them with neurological complications ,or appeared severe complications, they could get out of bed in the early stage.Postoperative the vis-ual analog scale （ visual analogue sale, VAS） [1] and the score of analgesics use significantly reduced obviously than preoperative, and the difference was statistically significant （P ＆lt;0.01）.Conclusion：Using Percutaneous vertebroplasty （PVP） on elderly patients with osteo-porotic thoracolumbar vertebral compression fracture could safely and effectively relieve the pain in them, reduce the use of painkillers, so that the patients could early ambulation, reduce the complications which caused by long-term bedridden, improve the quality of life of the elderly patients and reduce the mortality.Preoperative strictly grasping the surgical indications, and making the preoperative prepara-tion adequate, intraoperative accurately positioning and puncturing, tightly X-ray detecting in the key step, and paying close attention to the patient＆#39;s symptoms and vital signs, etc.which could effectively prevent the occurrence of serious complications and raise the successful rate of operation.