单侧分次椎体成形治疗急性老年性椎体压缩性骨折的临床分析

摘要

目的：探讨单侧分次法椎体成形术对急性老年性椎体压缩性骨折的治疗效果。方法：选取2010年11月-2012年5月本院收治的46例（共82椎）急性椎体压缩性骨折的老年患者，所有患者均给予单侧椎体成形治疗，即利用球囊式椎体扩张器，采取单侧分次经皮穿刺的方法，对病椎进行扩张，并于扩张后行骨水泥填充；观察比较手术前后患者的疼痛视觉模拟评分（VAS）及下腰痛（JOA）评分水平，并比较病锥的前、后缘及中央高度的变化。结果：46例患者的椎体手术均顺利结束，所有患者均未表现出严重并发症。所有患者术后3 d的VAS评分（3.21±0.36）分与术后6个月的（3.78±0.83）分均明显低于术前的（6.83±0.34）分，术后3 d的下腰痛JOA评分（21.58±0.39）分与术后6个月的（20.64±0.95）分均明显高于术前的（16.13±0.46）分，且术后3 d和术后6个月的病椎的前、后缘及中央高度均明显高于术前，差异均有统计学意义（P<0.05），而术后3 d与术后6个月上述各观察指标均无统计学意义（P>0.05）。术后“靶椎”高度再丢失不明显。结论：应用单侧分次椎体成形术治疗急性期老年性椎体压缩性骨折能有效缓解疼痛，提高骨水泥弥散程度及减少椎管内骨水泥渗漏，值得临床推广。%Objective:To investigate the treatment effect of unilateral and fractionated percutaneous kyphoplasty in treatment of acute senile vertebral compression fractures.Method:46 elderly patients(a total of 82 vertebral)with acute vertebral compression fractures in our hospital from November 2010 to May 2012 were selected,all patients were given unilateral vertebral plasty,the balloon expander vertebral dilator was used and unilateral points of percutaneous puncture method was taken,the disease of vertebral were expanded,and then filled with bone cement.The visual analogue scale (VAS)and low back pain score(JOA),front,rear and central height change of the disease cone before and after surgery in patients were observed and compared.Result:46 patients with vertebral surgery ended smoothly,all patients showed no severe complications.The VAS average score after surgery 3 days was(3.21±0.36)score and the 6 month postoperatively was(3.78±0.83)score,they were significantly lower than(6.83±0.34)score preoperatively,and the lumbago JOA average score after surgery 3 days was(21.58±0.39)score and the 6 month postoperatively was(20.64±0.95) score,they were significantly higher than(16.13±0.46)score preoperatively,and the front,rear and central height change of the disease cone after 3 days and the 6 months postoperatively were significantly higher than before surgery, the differences were statistically significant(P<0.05),while there were no significant differences in the observation of indexes between after 3 days and the 6 months postoperatively(P>0.05).Postoperative"target vertebral”height loss was not obvious.Conclusion:Application unilateral and fractionated percutaneous kyphoplasty in treatment of acute senile vertebral compression fractures can effectively relieve pain,increase bone cement dispersion degree and reduce spinal canal leakage of bone cement,is worthy of clinical promotion.