初学者应用椎体成形术治疗急性原发性骨质疏松性骨折的体会

The Beginner Experience of PVP Operation in Treatment of Acute Primary Osteoporosis Fractures

目的：总结作者最初学习应用椎体成形术（PVP）治疗原发性骨质疏松骨折的经历体会,启发初学者.方法：对作者在学习曲线早期采用PVP治疗原发性骨质疏松性椎体骨折病例过程中出现的问题和处理措施进行回顾性分析.结果：本组共有47例55椎体;男性16例,女性31例;年龄在61～89岁,平均74.6±6.9岁;单纯胸椎18例19椎,单纯腰椎25例28椎体,合并胸腰椎4例8椎体;术中并发症包括椎体多次穿刺（21.8％,12/55）、椎体节段误穿（3.6％,2/55）、血气胸（1.8％,1/55,经保守治疗后自愈）、椎体骨水泥渗漏（12.7％,7/55）;VAS疼痛评分术前24小时内5.4±1.9分,术后24小时内1.9±1.0分,P〈0.01,差异有统计学意义;根据VAS疼痛评分计算优良率为87.2％（41/47）;术后病人随访5～24个月,邻近椎体骨折发生率7.3％（4/47）.结论：PVP微创技术对原发性骨质疏松性骨折引起的疼痛改善效果好,初学者能较快掌握并独立实施,主要问题是初学者在早期学习使用发生多次穿刺率和骨水泥渗漏率较高,以及存在误穿椎体节段和伤及周围重要组织等风险.因此,初学者应当选择易于操作的病例、清晰辨别标志性解剖结构、关键步骤透视、注射骨水泥量宁少勿多、可单侧穿刺不双侧穿刺、不追求影像学完美等,这些是快速掌握PVP技术,同时又能减少手术风险的必要措施.

Objective： ： To summarize the percutaneous -vertebroplasty （PVP） experience for new operator to treat primary osteoporo- sis spinal fracture. Methods： Retrospectively summarized therapeutic effect on primary osteoporosis vertebral fracture with PVP, and ana- lyzed the operation related complications in the early stage of the learning curve in the course of PVP operation. Results： There were total 47 cases of 55 vertebrates. Of them, 16 cases in males, 31 cases in females; age from 61 -89 years, average 74.6 _＋ 6.9; 19 thoracic vertebrae from18 cases, 22 lumbar vertebrae from 22 cases, 14 thoracic/lumbar vertebrae from 7 cases ; the surgical complications includ- ed intraoperative vertebral multiple puncture （21.8%, 12/55 ）, puncture in error segment （3.6%, 2/55 ）, pneumothorax and blood chest （1.8%, 1/55 ） but without treatments; vertebral leakage rate of bone cement （12.7%, 7/55 ） , VAS score value in 24 hours be- fore and after PVP are statistically 5.4 ± 1.9, 1.9 ± 1.0, respectively （ P 〈 0.01 ）. The good and perfect rate of therapeutic effect calcu- lated according to the VAS value was 87.2% （41/47）. Postoperative patients with incidence of adjacent vertebral fractures were 7.3% （4/47） within 5 ± 24 months follow - up. Conclusion： Minimally invasive PVP is a good surgical technical for perfect improvement of pain caused by primary osteoporosis fracture. Beginners can quickly master and independently implemented. Mainly complications in the early learning curve are high rate of multiple puncture and leakage of bone cement, and rarely pneumothorax and blood chest, puncture in error segment. Thus, before PVP operation, mastering certain skills such as identification of anatomical structure, key site for X - ray per- spective, less injection amount of bone cement being better than more cement and so on is quickly grasp the technology and good to reduce the risk of operation.