椎体后凸成形术治疗90岁及以上椎体压缩骨折患者疗效和安全性

摘要

目的 评估椎体成形术治疗90岁及以上椎体压缩骨折患者临床疗效及安全性. 方法 回顾性分析北京医院骨科56例行后凸成形术治疗的90岁以上椎体压缩骨折患者临床资料.对患者的疼痛、止痛药物、骨水泥外溢及是否发生椎体再次骨折等进行评估.记录术前、术后3d及末次随访期间疼痛评分、镇痛药物用量、活动能力及术后骨水泥渗漏、再次骨折等并发症发生情况.结果 56例患者平均随访时间18.6个月(6～32个月).术前、术后3d及末次随访,视觉模拟评分法(VAS)评分依次为(7.1±2.1)分,(2.6±1.1)分和(1.8±0.7)分(F=455.794,P＜0.001);镇痛药物评分依次为(2.0±1.7)分、(1.4±0.5)分和(1.1±0.7)分(F=9.631,P＜0.001);活动能力评分依次为(2.5±0.6)、(1.2±0.5)和(1.0±0.3)分(F=63.254,P＜0.001).并发症方面:骨水泥渗漏10例(17.9％);椎体再次骨折6例(10.7％),脑脊液漏3例(5.3％),神经根刺激症状2例(3.6％),均为一过性,对症治疗后缓解,末次随访时恢复良好. 结论 后凸成形术治疗90岁及以上骨质疏松脊柱压缩骨折患者可降低患者骨折带来疼痛,减少镇痛药物使用,改善脊柱活动能力.可作为一种安全、有效的微创治疗手段.%Objective To evaluate efficacy,safety and complication of percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) in≥90 years patients.Methods Clinical data of 56 cases aged ≥ 90 years with osteoporotic vertebral compression fracture undergoing percutaneous kyphoplasty were retrospectively analyzed.Visual analog scale (VAS) score,analgesics administration score,locomotor activity score,bone cement leakage and incidence of refracture were evaluated before and 3 days after treatment,and at the last follow-up.Results The mean follow-up was 18.6 months (6-32 months) in all patients.The mean VAS score was (7.1 ±2.1) before treatment,(2.6±1.1) at 3 days after the procedure,and (1.8±0.7) at last follow-up,respectively (F=455.794,P＜0.001).Analgesics administration score were (2.0±1.7),(1.4±0.5) and (1.1±0.7) respectively before and 3 days after treatment,and at the last follow-up (F=9.631,P＜0.001).Locomotor activity score were (2.5±0.6),(1.2±0.5) and (1.0±0.3)before and 3 days after treatment,and at the last follow-up (F=63.254,P＜ 0.001) respectively.Bone cement leakage occurred in 10 cases(17.9％),recurrent fracture in 6 cases(10.7％),cerebrospinal leak in 3 cases (5.3％),and nerve root stimulation in2 cases(3.6％).Total complication rate was 33.9％(19/56),and all complications were transient and well tolerated.Conclusions Kyphoplasty for osteoporotic vertebral compression fracture in the very elderly is effective and safe.It alleviates fracture-induced pain,reduces analgesic drug use and improves spinal activity,and provides a better choice for minimal invasive treatment for nonagenarian OVCF patients.