体位复位法结合PVP治疗老年骨质疏松性胸腰椎压缩性骨折临床观察

Clinical Observation of Postural Reduction Combined with PVP for Senile Osteoporotic Vertebral Compression Fractures

目的:观察利用体位复位结合经皮椎体成形术(PVP)治疗老年骨质疏松性胸腰椎压缩性骨折(OVCF)的临床疗效。方法:选取初诊OVCF患者50例,术前采用体位复位后行PVP治疗。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度(Cobb's),进行视觉模拟疼痛(VAS)功能评分。结果:术前1天与术后3月的椎体前缘高度、Cobb's角、VAS评分比较,差异均有统计学意义(P<0.05)。单节椎体手术时间30~60 min,平均40 min。每个椎体注入骨水泥量3~7 mL,平均3.5 mL。下地时间12~48 h,平均24 h。术中发生骨水泥渗漏6例(椎体前方漏2例,椎体侧方漏2例,椎体后方漏1例,椎间盘漏1例),未出现明显神经损害体征。41例在术后即感疼痛减轻或消失,6例出现一过性沉痛,1~3天后消失,3例患者术后仍有轻微疼痛,经过口服消炎止痛药及理疗等治疗后缓解。结论:体位复位法结合PVP治疗老年骨质疏松性胸腰椎压缩性骨折,在止痛和纠正脊柱后凸畸形方面具有肯定的效果,是一种比较微创、简单、安全的有效方法。

Objective：To observe the clinical effect of postural reduction combined with percutaneous vertebroplasty（PVP）in treating senile osteoporotic vertebral compression fractures（OVCF）.Methods：Fifty cases of OVCF patients were selected as study objects.The treatment of postural reduction combined with PVP was applied before the operation.According to the preoperative and postoperative lateral X-ray films,the height of the centrum and the kyphosis angle were measured,and visual analogue scale（VAS） was scored.Results：Compared the anterior height of the centrum,Cobb＇s angle and VAS scores one day before the operation and three months after the operation,significant difference were found（P〈0.05）.The operation time of single-section centrum was 30-60 min,with an average of 40 min.The amount of bone cement injected into each vertebral body was 3-7mL,with an average of 3.5mL.The ambulation time was 12-48 h,with an average of 24 h.Six cases of leakage of bone cement were found during the operation（2 cases of leakage of anterior centrum,2 cases of leakage of lateral centrum,1 case of leakage of rear centrum,1 case of leakage of intervertebral disc）,but no obvious signs of nerve damage were found.The sense of pain in 41 cases was relieved or disappeared after the operation.Six cases of transient pain were found and disappeared after 1-3 days.Three cases of patients still felt a little painful after the operation,but the pain was relieved by receiving treatment such as anti-inflammatory analgesics and physical therapy.Conclusion：The application of postural reduction combined with PVP for senile OVCF has positive effect on analgesia and kyphosis correction,which is a more minimally invasive,simple,safe and effective therapy.