后凸成形术对老年多椎体骨质疏松压缩骨折选择治疗21例观察.docVIP

后凸成形术对老年多椎体骨质疏松压缩骨折选择治疗21例观察 　 作者：王林，陶惠人，罗卓荆，李新奎，马真胜，李明全，杨旻 【摘要】 ［目的］探讨依据术前MRI检查结果对老年多椎体骨质疏松压缩骨折行选择性椎体后凸成形术的疗效。［方法］自2003年6月～2006年12月老年多椎体骨质疏松压缩骨折21例57椎，采用根据术前MRI信号改变判断疼痛性椎体和陈旧骨折椎体，行选择性球囊扩张后凸成形术的治疗方法。对疼痛性椎体采用正常球囊扩张压力和足量骨水泥充填；对陈旧性骨折椎体采用较低球囊扩张压力和少量骨水泥充填，不追求恢复椎体高度。观察术后症状改善、骨折复位情况及有无并发症发生。［结果］21例手术均顺利完成，术后24 h内疼痛均明显缓解。椎体前缘、中部、后缘平均高度术前分别为（1.7±0.9）cm，（1.7±0.7）cm，（2.5±0.9）cm，术后分别为（2.2±0.4）cm，（2.4±0.6）cm，（2.6±0.3）cm，椎体前缘、中部平均高度手术前后差异有统计学意义（P＜0.01）。Cobb′s角由术前33.7°±10.9°矫正至术后25.9°±9.3°，手术前后差异有统计学意义（P＜0.01）。术后平均随访26.3个月，患者疼痛症状均较术前明显改善或消失，未出现严重并发症。［结论］依据术前MRI结果对多椎体压缩骨折采用选择性后凸成形术治疗，临床效果满意，能够缩短手术时间、减少手术并发症、减少射线损害和手术费用，更适于老年多椎体骨质疏松压缩骨折的治疗。 【关键词】 骨质疏松； 脊柱； 骨折； 后凸成形术 Abstract：［Objective］To evaluate the effect of selective kyphoplasty in treatment of osteoporotic thoracolumbar multi-vertebral compressive fractures based on preoperative magnetic resonance imaging (MRI).［Method］Twenty-one cases (fifty-seven vertebral bodies) of osteoporotic thoracolumbar multi-vertebral compressive fractures were treated from June 2003 to December 2006. The signal changes in different sequences were confirmed by preoperative MRI. Based on the MRI signal changes,57 vertebral bodies were treated by selective kyphoplasty. Normal balloon pressure and cement volume were performed for the painful vertebral bodies and lower pressure and cement volume were preferred for the vertebral bodies with old fracture.［Result］All patients tolerated the operation well with immediate relief of their back pain in 24 hours.The mean height of the anterior, media and posterior vertebral bodies were (1.7±0.9)cm, (1.7±0.7)cm, (2.5±0.9)cm preoperatively and (2.2±0.4)cm, (2.4±0.6)cm, (2.6±0.3)cm postoperatively. The mean kyphosis was improved from (33.7±10.9) degrees to (25.9±9.3) degrees (P＜0.01). No complication occurred. There was not back pain and deformed.Correction was maintained well after 26.3 months follow up.［Conclusion］The selective transpedicular balloon kyphoplasty for thoracolumbar osteoporotic multi-vertebral frac