闭合复位经皮椎体成型术治疗胸腰椎压缩性骨折24例.docVIP

闭合复位经皮椎体成型术治疗胸腰椎压缩性骨折24例 作者：蒋守海，王业华，赵德勇，龚维成 【摘要】 目的 探讨闭合复位经皮椎体成型术（PVP）治疗新鲜胸腰椎压缩性骨折的近期疗效。方法 24例新鲜胸腰椎压缩性骨折患者，利用手术床过伸复位，然后经皮穿刺行椎体成型术。根据术前、术后侧位X线片测量椎体高度压缩率、后突畸形角度，并计算椎体高度恢复率和后凸畸形矫正率。结果 利用过伸闭合复位后，再行椎体成型术，可以使椎体前壁高度恢复(46.1±22.6)%，后凸畸形角度矫正（43.5±26.3）%。结论 新鲜胸腰椎压缩性骨折经过伸体位闭合复位后再行椎体成型术，可有效恢复椎体高度和矫正后凸畸形。 【关键词】 胸腰椎；压缩性骨折；闭合复位；经皮椎体成型术 Abstract:Objective To assess the immediate effect of closed reduction in percutaneous vertebroplasty (PVP) in the treatment of new vertebral compression fracture.Methods 24 patients with new vertebral compression fracture were subjected first to closed reduction by extending the operating table, and then to percutaneous vetebroplasty performed on the fractured vertebra. The results were evaluated according to the vertebral height loss and kyphotic angle of the vertebral compression fractures estimated from the plain lateral radiographs.Results The vertebral compression fractures could be reduced by overextension before percutaneous vertebroplasty. The restoration rate of anterior vertebral height was (46.1±22.6) %, the rate of kyphotic angle correction was（43.5±26.3）%.Conclusion Closed reduction percutaneous vertebroplasty is an efficacious method in the treatment of new vertebral compression fractures, able to well restore the vertebral height and kyphotic angle. Key words: thoracolumbar spine; vertebral compression fracture; closed reduction; percutaneous vertebroplasty 经皮椎体成型术（PVP）已广泛应用于椎体肿瘤、骨质疏松性椎体压缩骨折的治疗，疗效满意，但PVP应用于新鲜胸腰椎压缩性骨折（vertebral compression fracture, VCF）的治疗报道较少。自2005年3月至2006年8月，我们采用闭合复位经皮椎体成型术治疗新鲜胸腰椎压缩性骨折24例，取得较好疗效。现报道如下。 　　1 资料和方法 　　1.1 一般资料 　　本组采用PVP治疗胸腰椎压缩性骨折24例；男7例，女17例；年龄20岁至68岁,平均50.6岁。创伤原因：高处坠落伤9例，车祸伤3例，骑车摔伤7例，行走摔伤5例。其中胸11椎3例，胸12椎8例，腰1椎6例，腰2椎5例，腰3椎2例。结合影像学检查均为单纯椎体楔形压缩骨折，无合并神经损伤。 　　1.2 手术方法 　　患者均于伤后5天内手术。采用气管插管麻醉或连续硬膜外麻醉。患者俯卧于骨科手术台上，牵引双下肢，使骨盆离开床面约15 cm，在C形臂X线机透视下，使腰椎过伸闭合复位，示复位满意后，常规消毒铺巾。C形臂X线机透视定位，采用13G骨穿针经伤椎椎弓根钻孔达椎体前侧1/3，调制骨水泥（聚甲基丙烯酸甲酯， PMMA）达拉丝期时，用1 ml注射器分别于两侧椎弓根向椎体内缓