经皮椎体成形术治疗骨质疏松型胸腰椎压缩性骨折的临床评价

摘要

Objective To evaluate the efficacy and safety of the percutaneous vertebroplasty (PVP) for osteoporotic thoracolumbar vertebral compression fractures, and to summary measures to avoid complications of the surgery. Methods A retrospective analysis of the patients with steoporotic thoracolumbar vertebral com-pression fractures treated by PVP from Mar. 2010 to Jan. 2014 was done, with a total number of 45 patients and 60 vertebral lesions. The outcomes were assessed by visual analogue score ( VAS) and Oswestry disability index ( ODI) before and after the operation. T-test was done using the SAS software. Results Forty-five pa-tients with osteoporotic compression fractures were treated with PVP. After the treatment, the VAS scores were decreased by 5. 87±1. 00 (at the 3rd day) and 4. 25±1. 28 (in 1 year), meanwhile the ODI scores decreased by 54. 97±4. 92 (at the 3rd day) and 41. 47±5. 88 (in 1 year). There was no statistically significant difference between thoracic vertebra fractures and lumbar vertebra fractures after the surgery. Bone cement leakage oc-curred in 5 patients after the surgery, but there was no nerve dysfunction or pulmonary embolism. Conclusion PVP is a safe and effective measure for osteoporotic thoracolumbar compression fractures. PVP has the same efficacy to thoracic vertebra fractures and lumbar vertebra fractures caused by osteoporosis. The new PVP mate-rials need further study to support their safety. At present, strict indications, a grasp of injecting bone cement quantity and speed, and standard operation are effective methods to prevent complications.%目的：评价经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松型胸腰椎压缩性骨折的效果及安全性,探讨避免手术并发症的措施。方法回顾性分析2010年3月至2014年1月我院采用经椎弓根入路双侧PVP治疗骨质疏松型胸腰椎压缩性骨折的患者45例,按病变部位分为胸椎组,腰椎组和合并胸腰椎骨折组,分别于术后3 d、术后1年随访患者,以视觉模拟评分法( visual analogue score,VAS)和Oswestry功能障碍指数( Oswestry disability index,ODI)为评价指标,应用SAS软件进行t检验分析,比较治疗前后VAS和ODI评分的差异。结果45例骨质疏松型压缩性骨折患者行PVP治疗后3 d、1年VAS评分分别降低了(5.87±1.00)分、(4.25±1.28)分,ODI评分分别下降了(54.97±4.92)分、(41.47±5.88)分,术后3 d、1年胸椎组、腰椎组VAS评分和ODI评分,差异均无统计学意义(均P>0.05)。 PVP治疗过程中5例患者发生骨水泥渗漏,但无神经损坏、肺栓塞等并发症。结论PVP是治疗骨质疏松型胸腰椎压缩性骨折的一种安全、有效的治疗方式。 PVP对骨质疏松引起的胸椎、腰椎骨折疗效相当。 PVP新型材料的安全性还需进一步研究探讨。严格掌握适应证、规范的操作、把握好推注骨水泥量和速度是目前预防并发症的有效方法。