改良闭合复位联合经皮椎体成形术治疗骨质疏松性脊柱压缩骨折.DOCVIP

临床医学论文-改良闭合复位联合经皮椎体成形术治疗骨质疏松性脊柱压缩骨折 ?????????????? 作者：刘国强 白波 孙辉 廖壮文 【摘要】? 目的 探索改良闭合复位联合经皮椎体成形术(PVP)治疗骨质疏松性脊柱压缩骨折的效果。方法 患者俯卧于手术床，腹部悬空，升高手术床头、尾，于C型臂透视下先行手法闭合复位，再进行PVP治疗。在术前、术后3 d、术后12个月随访时进行疼痛视觉类比评分(VAS)、计算椎体前后缘高度比值(Beck值)和脊柱后凸畸形Cobb角。结果 28例34个椎体操作成功，骨水泥向椎体前方、侧方渗漏各1例，无椎体后方(椎管内)渗漏。VAS评分由术前8.5±1.2降低至2.5±1.4，Beck值由术前31.7±5.6升高至72.6±4.6，Cobb角由术前25.4°±7.3°改善至13.4°±5.2°。 结论 手术床俯卧位闭合复位联合PVP是治疗骨质疏松性脊柱压缩骨折的有效方法。 【关键词】? 闭合复位 经皮椎体成形术 骨质疏松 脊柱压缩骨折 ?????? 【Abstract】? Objective? To explore the effect of closed reduction in percutaneous vertebroplasty (PVP)? for the treatment of vertebral compression fractures. Methods? 28 patients with osteoporosis vertebral compression fractures were treated with closed reduction under carm xray monitoring by extending on the operating table, and then PVP was performed on the fractured vertebra. The results of preoperation, 3 days after and 12 monthes after the operation were quantitatively evaluated according to the concept of estimated vertebral height loss and vertebrotic angle of the vertebral compression fracture. Results? Operations on the 28 cases of 34 vertebraes are successful.Bone cement leakage happened in two cases including anterial and lateral without posterial. Pain scores，vertebral heights and Cobb angle improved significantly (P＜0.05) after the surgery. Conclusion? The modified closed reduction in PVP was effective in the treatment of? osteoporosis vertebral compression fractures. ??? 【Key words】? Closed reduction； Percutaneous vertebroplasty (PVP)； Osteoporosis； Vertebral compression fractures ??? 老年人中90%的脊柱骨折和髋部骨折与骨质疏松有关, 其中脊椎是骨质疏松性骨折最好发的一个部位［1］，骨质疏松性脊柱骨折已经成为危害老年人的重要疾病之一。新鲜骨质疏松性脊柱骨折的理想治疗方案是：能够迅速减轻因骨折引起的疼痛、能够矫正因骨折引起脊柱后凸畸形并能提高患者骨折后的生活质量。目前的治疗方法有：保守治疗、经皮椎体成形术(percutaneous vertebroplasty，PVP)、经皮椎体后凸成形术、经前路或后路切开内固定术。2004年2月～2006年2月我科运用改良闭合复位联合PVP治疗骨质疏松性胸、腰椎压缩骨折28例34个椎体，取得良好疗效。 ??? 1? 材料和方法 ??? 1.1? 一般资料? 本组28例(34个椎体)，男9例，女19例，年龄57～82岁，平均(67.4±1.8)岁；病程1～38 d,平均(16.2±2.8)d ,其中1个椎体压缩骨折23例，2个椎体压缩骨折4例，3个椎体压缩骨折1例；压缩程度小于1/3者26椎，压缩程度在1/3