经皮穿刺加压植入骨棒骨粉椎体成形治疗胸腰椎体压缩性骨折:恢复伤椎结构完整性和稳定性

背景:经皮穿刺椎体成形目前主要被应用于老年骨质疏松性压缩骨折的患者,而对于中青年椎体压缩骨折的患者,主要应用椎弓根螺钉内固定技术,但其存在创伤大、断钉、二次手术等问题。目的:观察经皮穿刺骨粉加压植入椎体成形修复胸腰椎体压缩性骨折的临床效果。方法:选取21例胸腰椎压缩性骨折患者,行经皮穿刺骨粉加压植入椎体成形,术前计算需植骨量,统计手术时间及出血量,观察患者治疗前后的疼痛程度、以及治疗前、后椎体高度比及Cobb角情况。结果与结论:(1)与治疗前比较,治疗后1 d及治疗后6个月疼痛目测类比评分显著降低(P<0.05);(2)与治疗前比较,治疗后1 d及治疗后6个月伤椎前缘高度比显著增大(P<0.05);(3)与治疗前比较,治疗后1 d及治疗后6个月椎体Cobb角度显著减小(P<0.05);(4)手术时间平均为(52.0±12.3)min,术中出血量平均为(11.5±1.5)m L;(5)结果说明,经皮穿刺骨粉加压植入椎体成形可以有效地恢复伤椎前缘高度,消除伤椎内的空腔,恢复伤椎的结构完整性和稳定性;最大程度的保留脊柱的运动功能,是一种治疗胸腰段椎体骨折的有效的微创手术方法。

老年骨质疏松性椎体非压缩性骨折采用PVP治疗效果探讨

目的探讨老年骨质疏松性椎体非压缩性骨折采用PVP 治疗效果,为临床应用提供参考.方法选择我院 2014年8 月至 2014 年 12月间 80例老年骨质疏松性椎体非压缩性骨折患者,按照简单随机法将其分成观察组及对照组,各40例,观察组患者采取PVP 进行治疗,对照组患者给予保守治疗,观察治疗结果.结果与对照组患者相比,观察组治疗后1周、治疗后1个月、治疗后6个月、治疗后12个月的LBOS分数分别为（48±5.9）分、（50±6.3）分、（59±8.4）分、（60±4.8）分,对比分析后,差异有统计学意义（t=6.394、7.094、7.203、8.039,P〈0.05）.观察组治疗后1周、治疗后1个月、治疗后6个月的LBOS分数分别为（4.1±1.7）mm、（4.4±1.1） mm、（4.7±1.3） mm,对比分析后,差异无统计学意义（t=1.034、1.053、1.201,P〉0.05）,治疗后12个月为（5.2±1.6）mm,对比分析后,差异有统计学意义（t=8.336,P〈0.05）.结论PVP治疗老年骨质疏松椎体非压缩性骨性折不仅可缓解疼痛,提高生活质量,防止椎体的塌陷,是一种有效的治疗方法.

经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床效果分析

目的分析经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法选取该院2017-01~2018-01因OVCF行PVP治疗的患者158例(205椎),对比患者手术前后视觉模拟评分法(VAS)、Oswesty功能障碍指数(ODI)评分,伤椎前缘高度、Cobb角变化,以评价治疗效果;同时分析临床疗效与骨水泥注入量的关系。结果所有患者术后VAS评分、ODI评分均较术前明显降低,差异有统计学意义(P<0.05);术后伤椎前缘高度、Cobb角均较术前明显恢复,差异有统计学意义(P<0.05)。结论PVP治疗OVCF具有较好的临床效果,可尽早缓解疼痛,提高患者生活质量。

C臂导向下椎体成形术治疗椎体压缩性骨折

目的:评估C臂导向下椎体成形术(PVP)治疗椎体压缩性骨折的疗效。方法:对近年来腰椎压缩性骨折适于PVP的32例椎体压缩性骨折患者共38个椎体在C臂导向下施行PVP治疗,术中采取小剂量、较低浓度骨水泥加压注入病变椎体,术后定期随访评价疗效。结果:32例全部顺利完成,其中27例术后疼痛次日减轻,1例3天后疼痛减轻,3例1周后疼痛缓解,1例症状改善不明显;均未发生严重并发症。结论:C臂导向下PVP治疗椎体压缩性骨折是比较安全的微创治疗技术,远期疗效均较肯定。

老年骨质疏松症患者经皮椎体后凸成形手术的治疗效果

目的分析研究经皮椎体后凸成形术对老年骨质疏松症椎体压缩性骨折患者的临床治疗效果。方法对我院2013年6月至2016年3月收治的87例老年骨质疏松症椎体压缩性骨折患行随机分为对照组和观察组，42例患者采用经皮椎体成形术治疗为对照组，45例患者采用经皮椎体后凸成形术治疗，为观察组，对比分析两组患者治疗前后的临床疗效。结果观察组和对照组患者VAS许分治疗前[（8．56±2．98）分、（8．49±2．86）分，t=0．11，P〉0．05]，治疗后1周[（2．58±1．34）分、（3．34±2．01）分，t=2．09，P〈o．05]、4周[（2．06±0．97）分、（3．87±1．96）分，t=5．51，P〈0.05]和12周[（1．09±0．89）分、（2．37±1．29）分，t=5．42，P〈0．05]均低于治疗的。观察绀患者的Cobb角（棒体后凸角）、ODI指数（功能障碍指数）以及患者术后下床活动时间[（2．7±1．2）d、（4．7±2．4）d，t=4．96．P〈0．05]、术后平均住院时间[（7．7±2．2）d、00．9±4．3）d，t=4．49，P〈0．05]均低于对照组（均P〈0．05），患者术后骨水泥并发症的发生牢观察组（6．7％）低于对照组（21．4％）（x2=3．98，P〈0．05）。结论经皮椎体后凸成形术用于老年骨质疏松症椎体压缩性骨折患者的临床治疗效果礁著，可以有效缓解患者疼痛，改善机体功能性障碍，提高患者生活质量，具有较高的临床使用价值。

Comparison of therapeutic effect between percutaneous vertebroplasty and kyphoplasty on vertebral compression fracture

Objective： To compare the clinical efficacy of percutaneous vertebroplasty （PVP） with percutaneous kyphoplasty （PKP） in the treatment of vertebral compression fracture （VCF）. Methods： Ninety-eight patients with VCF were treated by PVP （n = 42 ） or PKP （n = 56 ）. The anterior midline and posterior heights of vertebrae body, preoperative and postoperative visual analogue scale （VAS）, operation time and amount of blood loss were compared between 2 groups. Results： There was statistical difference in vertebral height between two groups （ P 〈 0. 01 ）. No significant difference was seen in VAS, operation time and blood loss between two groups （ P 〈 0.05 ）. Conclusions： PKP and PVP have the similar therapeutic efficacy in treatment of VCF with minimal invasion, less operation time and blood loss. However, PKP is superior in the recovery of vertebral height.

Treatment of osteoporotic compression fracture of thoracic/lumbar vertebrae by kyphoplasty with SKY bone expander system

Objective： To investigate prospectively the effectiveness ofkyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/ lumbar vertebrae and correction of the deformity. Methods： Twenty-five patients with thoracic/lumbar vertebral osteoporotic compression fracture were admitted to our hospital between March 2007 and March 2008, and treated by kyphoplasty with SKY bone expander system. Patient＇s pain status was rated with Visual Analogue Scale （VAS） score system 1 day before and 1 hour, 48 hours, 6 months, 12 months after surgery. In addition, Rolland-Mor- ris and Oswestry disability questionnaires （RDQ and ODI） were used for survey 1 day before and 1, 6, 12 months after surgery. Pre- and post-operative vertebral heights and Cobb＇s angles were measured based on the X-ray films and statistically analyzed. Results： There were 27 fractured vertebrae in these 25 patients. After SKY kyphoplasty, the Cobb＇s angles （9.8°±9.76°） were significantly reduced compared with preoperative angles （17.18°±9.35°, P〈0.05）, and the average improve- ment rate was 39%. Patients＇ pain VAS scores were also greatly improved after operation （P〈0.05）. Moreover, postoperative RDQ and ODI scores were significantly smaller than preoperative values （P〈0.05）. Conclusions： Kyphoplasty with SKY bone expander system provides an effective method for treating thoracic/ lumbar vertebral osteoporotic compression fracture, with the advantages of small surgical wound and short duration. It can effectively recover the anterior and medial heights of fractured vertebrae （33% and 50%, respectively）, reduce the Cobb＇s angle, quickly alleviate pain and improve patients＇ quality of life in a relatively short time period.

Warm needling moxibustion plus PKP for vertebral compression fracture due to kidney deficiency and blood stasis:a randomized controlled trial

Objective:To explore the efficacy and mechanism of warm needling moxibustion plus percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fracture(OVCF)due to kidney deficiency and blood stasis.Methods:A total of 70 OVCF patients were randomized into a control group and an observation group,with 35 cases in each group.The control group was given PKP treatment,and the observation group was treated with warm needling moxibustion on the basis of the treatment in the control group.The visual analog scale(VAS)and Oswestry disability index(ODI)were scored and the Cobb angle of fractured vertebrae was measured before and after treatment.The re-fracture rate of the adjacent vertebrae was recorded at 1-year follow-up.The serum levels of transforming growth factor(TGF)-β1 and omentin-1 were measured before and after treatment.Results:After treatment,the VAS and ODI scores in both groups decreased(all P<0.05),and all the scores in the observation group were lower than those in the control group(both P<0.05).After treatment,the Cobb angle of fractured vertebrae in both groups decreased(both P<0.05),and the Cobb angle in the observation group was smaller than that in the control group(P<0.05).At 1-year follow-up,the re-fracture rate of the adjacent vertebrae in the observation group was lower than that in the control group(P<0.05).After treatment,the serum levels of TGF-β1 and omentin-1 in both groups increased significantly(all P<0.05),and the serum levels of TGF-β1 and omentin-1 in the observation group were higher than those in the control group(both P<0.05).Conclusion:The treatment of warm needling moxibustion plus PKP can relieve pain,improve dysfunction,promote healing of the injured vertebrae,and reduce the re-fracture rate of the adjacent vertebrae in patients with OVCF due to kidney deficiency and blood stasis,which may be related to the increase of serum TGF-β1 and omentin-1 levels.

Therapeutic observation on point-toward-point needling at points on the low back regions for residual back pain after percutaneous kyphoplasty

Objective: To observe the effect of point-toward-point needling at points on the low back regions on residual back pain after percutaneous kyphoplasty (PKP), thoracolumbar function and quality of life (QOL) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: A total of 72 patie nts with OVCF and residual back pain after PKP were in eluded and allocated into a treatme nt group (n=36) and a control group (n=36) by the random number table. Cases in the control group received salmon calcitonin injection (miacalcic), for 1 mL each time, once a day, and oral intake of calcium carbonate D3 pill, 600 mg each time, once a day, whereas cases in the treatment group received point-toward-point needling at points on the low back regions and electroacupuneture (EA) for 30 min each time, once a day and 6 times a week on the basis of the treatment in the control group. Treatment in both groups lasted for 2 weeks. Therapeutic efficacy indicators including visual analog scale (VAS), Oswestry disability index (ODI) and Barthel index (Bl) were evaluated before and after treatment and at follow-up visit (1 month after treatment). Results: The total effective rate was 94.4% and 88.9% in the treatment group after treatment and at the follow-up visit, respectively, higher than 77.8% and 69.4% in the control group, and the between-group differences were statistically significant (both P<0.05). After treatment and at the follow-up visit, the VAS and ODI scores decreased, and Bl scores in creased in both groups, and the in tra-group differe nces were statistically sign ifica nt (all P<0.05). After treatme nt and at the follow-up visit, between-group differences of VAS, ODI and Bl scores were statistically significant (all P<0.05). Conclusion: On the basis of conventional medication treatment, point-toward-point needling at points on the low back regions has a good therapeutic effect in relieving residual back pain after PKR improving thoracolumbar function and QOL, better than conventional medication treatment alone.

Treatment of osteoporotic vertebral compressive fractures with percutaneous kyphoplasty and oral Zishengukang

OBJECTIVE:To observe the therapeutic effect of percutaneous kyphoplasty(PKP) and oral Zishengukang(ZSGK) for the treatment of osteoporotic vertebral compression fractures(OVCFs).METHODS:Seventy patients were randomly divided into a control group(PKP group) and an experimental group(PKP plus ZSGK group).The 35 patients in the experimental group were prescribed 6 g oral ZSGK three times a day for 90 days after PKP.Visual analog pain scale(VAS),Oswestry functional score,vertebral height and Cobb's angle were recorded and compared before treatment and at one week,one month and three months after treatment.RESULTS:Vertebral height and Cobb's angle significantly improved and VAS and Oswestry functional score were significantly lower in both groups after PKP than pre-operatively(P<0.01).Three months after treatment,VAS and Oswestry functional score in the experimental group were lower than controls(P<0.05),even though vertebral height and Cobb's angle were comparable(P>0.05).CONCLUSION:PKP combined with oral ZSGK provide superior short-term and long-term symptom control after OVCF than PKP alone.

Short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures

Objective： To evaluate the short-term outcomes of short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures. Methods： Twenty patients who suffered from nonadjacent thoracolumbar fractures were treated by short segmental pedicle screw fixation for burst fracture and by percutaneous vertebroplasty for compression fracture. X-rays, CT and MRI scans were conducted using the same protocol before and after surgery and during follow-up. Pre- and postoperative American Spinal Injury Association （ASIA） grades, fusion of fracture sites, visual analog scale （VAS） of back pain, and Oswestry disability index （ODD were accessed. Results： All patients were followed up for an average period of 12 months. The sagittal profile of the thoracolumbar spine was restored satisfactorily. No patient had neurologic deterioration after surgery, and 9 patients with incom- plete lesions improved postoperatively by at least one ASIA grade. The fusion rate was 100%. The average VAS of back pain was 7.6 preoperatively and 3.2 postoperatively. The average ODI was 72.5 preoperatively and 35.5 postoperatively. Conclusions： Short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures exhibits such advantages as preserving functional segment units, reliable fixation, good neurologic recovery and early mobilization and, therefore, is suitable for treating nonadjacent thoracolumbar fractures.

Clinical study on abdominal acupuncture for osteoporotic vertebral compression fracture

Objective： To explore the efficacy of abdominal acupuncture in treating patients with osteoporotic vertebral compression fracture （OVCF）. Methods： Forty-five eligible OVCF patients were randomized into an abdominal acupuncture （AA） group, a body acupuncture （BA） group and a medication group according to the random numbers generated by the SPSS 22.5 version software, 15 subjects in each group. Patients in the medication group were intervened by Ossotide injection （intravenous injection）, Caltrate （oral administration）, Alfacalcidol （oral administration）, and Salcatonin injection （muscular injection）. In addition to the intervention given to the medication group, patients in the AA group additionally received acupuncture at Zhongwan （CV 22）, Xiawan （CV 20）, Qihai （CV 6）, Guanyuan （CV 4）, Shuifen （CV 9）, and Huaroumen （ST 24）; while patients in the BA group additionally received acupuncture at Jiaji （EX-B 2, superior and inferior to the affected area） points, Ashi points, Weizhong （BL 40） and Chengshan （BI. 57）. For the AA and BA groups, the acupuncture treatment was given once a day, 6 d per week, for 3 weeks in total. Prior to the intervention, and respectively after 1-week treatment, 2-week treatment and 3-week treatment, visual analogue scale （VAS） and Barthel index （BI） were adopted to evaluate pain degree and activities of daily living （ADL）. Results： After intervention, the VAS and BI scores were significantly changed in the three groups （P〈0.05）. Respectively after 2-week, 2-week and 3-week treatment, the VAS and BI scores in the two acupuncture groups were significantly different from those in the medication group at the same time point （P〈0.02）. After 2-week and 2-week treatment, the improvements of VAS and BI scores in the AA group were more significant than those in the BA group（P〈0.05）; after 3-week treatment, there was no significant difference in comparing the VAS score between the two acupuncture groups （P〉0.05）, but a significant difference was found in comparing the BI score （P〈0.05）. Conclusion： Abdominal acupuncture can produce a more significant effect in improving VAS and BI scores in OVCF patients than body acupuncture and pure medication treatment, and it＇s efficient and causes few sufferings.

Clinical observation on electroacupuncture plus hydro-acupuncture for low back pain caused by compression fractures

Objective： To observe the effect of electroacupuncture （EA） at Jiaji （EX-B 2） points plus hydro-acupuncture with sinomenine hydrochloride for low back pain caused by compression fractures in the elderly. Methods： Ninety-five elderly in-patients with low back pain caused by compression fractures were randomly divided into an observation group and an EA group according to the visit sequence. Both groups received the same basic treatment. In the EA group, 48 cases were treated with EA at Jiaji （EX-B 2） points plus the basic therapy; 47 cases in the observation group received the basic treatment plus EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji （EX-B 2） points. The levels of osteoprotegerin （OPG） and interleukin-1β（IL-1β） in peripheral blood were measured by enzyme-linked immunosorbent assay （ELISA） before and at the 21st day of treatment in both groups. Oswestry disability index （ODI） and visual analog scale （VAS） scores were used to analyze the clinical efficacy. Results： After treatment, the OPG content in the observation group was higher with statistical significance compared with that before treatment in the observation group and after the treatment in the EA group, respectively （both P〈0.05）; the content of IL-1β, ODI and VAS scores were lower than those before treatment in the observation group and after treatment in the EA group with statistical significances （all P〈0.05）. Conclusion： The combination of EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji （EX-B 2） points is effective for low back pain caused by compression fractures in the elderly, and is superior to EA at Jiaji （EX-B 2） points alone.