椎体成形术治疗老年胸腰椎爆裂性骨折

摘要

Objective To explore the feasibility and clinical effect of percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar burst fractures . Methods From January 2010 to October 2012, a series of 25 senile patients with osteoporotic thoracolumbar burst fractures without neurological signs were enrolled .Percutaneous vertebroplasty was performed in these patients.After position reduction before operation , individualized puncture and injection of bone cement were carried out based on the characteristics of fractures during the operation .The vertebral body was effectively strengthened , the vertebral body height recovered , and the convex angle corrected.Postoperative visual analog scales (VAS), height of fractured vertebra, and the Cobb’s angle on sagittal plane were measured at 1, 6, and 12 months after surgery, respectively. Results Stable vertebral body was obtained in all the patients.The VAS was significantly decreased after operation (2.5 ±0.9 vs.9.2 ±0.8, P=0.000).The height of the fractured vertebra was restored (85.2%±4.4%vs.80.3%±4.1%, P=0.000) and the Cobb’s angle was significantly improved (8.1°± 2.1°vs.11.4°±2.4°, P=0.000).A total of 23 patients were followed up.At 12 months postoperatively, the VAS was further decreased , and the vertebral height and the Cobb ’ s angle were kept unchanged . Conclusions Percutaneous vertebroplasty is an effective treatment for thoracolumbar burst fractures .However, the surgical indications should be strictly followed and the operation plan should be personalized .%目的：探讨经皮椎体成形术治疗老年骨质疏松引起的胸腰椎爆裂性骨折的临床效果。方法2010年1月～2012年10月，对25例不伴有明显神经症状的胸腰椎爆裂性骨折的老年患者行经皮椎体成形术。术前结合体位复位，术中根据骨折特点个体化穿刺及注入骨水泥，有效固化椎体、恢复椎体高度、纠正后凸成角。术后1、6、12个月随访疼痛视觉模拟评分（ VAS）、伤椎高度恢复率、伤椎后凸Cobb角。结果所有患者术后即可获得椎体稳定，腰痛VAS评分较术前明显降低（2．5±0．9 vs．9．2±0．8，P＝0．000），椎体高度恢复（85．2％±4．4％ vs．80．3％±4．1％，P＝0．000），后凸Cobb 角减小（8．1°±2．1°vs．11．4°±2．4°，P＝0．000），23例获得随访，术后12个月疼痛VAS评分进一步降低，术后6、12个月椎体高度、后凸Cobb角无明显丢失。结论经皮椎体成形术可用于治疗老年骨质疏松爆裂性骨折，安全有效，但需要谨慎选择适应证及个体化制定手术方案。