椎体成形术治疗严重型老年性胸腰椎压缩骨折临床疗效分析(1)
[摘要] 目的 探討经皮椎体成形术(PVP)在治疗严重型老年性胸腰椎压缩骨折临床疗效。 方法 整群选取2013年4月—2015年8月在该院接受治疗58例严重型老年性胸腰椎压缩骨折患者，按照随机数字表法将其分为两组各29例(各69个椎体病变)，对照组行保守治疗，观察组行PVP治疗，其中2节段20例，3节段7例，4节段2例，35个椎体塌陷程度大于75%，20个椎体合并椎弓根和椎体后缘骨质破坏，骨质疏松压缩性骨折20例，轻微外伤史的5例及不明原因压缩性骨折4例。PVP在C形臂X线机或C形臂X线机+CT组合机监视下进行，骨水泥(PMMA)粉：液：对比剂比例为3：2：1，按椎体计算骨水泥用量为1～3 mL。观察两组患者治疗效果及随访结果差异。 结果 对照组、观察组治疗总有效率分别为79.3%、96.6%，差异有统计学意义(P<0.05)。随访2～11个月无复发。PVP术后无1例椎体塌陷加重或发生新的压缩，无1例发生严重并发症。结论 PVP是一种微创治疗方法，安全可行，对胸腰椎等多数椎体行PVP只要在C形臂X线机监视下即可，熟练地掌握PMMA使用方法是PVP技术成功的关键因素。只要定位准确、把握好进针点及进针方向、掌握骨水泥调配比例、骨水泥灌注量及速度，经皮椎体成形术(PVP)治疗多节段压缩严重且合并椎弓根和椎体后缘骨质破坏型老年胸腰椎压缩性骨折，同样达到安全、有效、经济、手术简便，麻醉风险低，提前下床活动，减少并发症，住院时间短，住院费用降低等疗效。
[关键词] 严重型；老年性胸腰椎压缩性骨折；椎体成形术
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2017)06(b)-0060-03
[Abstract] Objective To discuss the clinical curative effect of vertebroplasty in treatment of severe senile thoracolumbar compression fracture. Methods 58 cases of senile patients with severe thoracolumbar compression fracture treated in our hospital from April 2013 to August 2015 were selected as a group and randomly divided into two groups with 29 cases in each (69 centrum lesions)， and the control group adopted the conservative treatment， while the observation group adopted the PVP treatment， and there were 20 cases with 2 segments， 7 cases with 3 segments and 2 cases with 4 segments， and the 35 centrums collapse degree was more than 75%， and there were 20 centrums complicated by vertebral pedicle and posterior element bone destruction， 20 cases with osteoporosis vertebral compressed fracture， 5 cases with mild trauma history， 4 cases with unknown compressed fracture， and PVP was conducted under the monitoring of C arm X-ray machine or C arm X-ray machine +CT combination machine， and the ratio of contrast-medium was 3：2：1， and the bone cement dosage was 1-3ml， and the differences in the treatment effect and follow-up results of the two groups were observed. Results The total treatment effective rate in the control group and in the observation group was respectively 79.3% and 96.6%， and the difference was statistically significant(P<0.05)， and there was no recurrence after 2～11 month follow-up， and there was no one with collapsed vertebra aggravation or new compression after PVP surgery， and no one was with severe complications. Conclusion PVP is a minimally invasive treatment method， which can be conducted under the monitoring of C arm X-ray machine， and mastering the use method of PMMA is the key factor of PVP technical success， the accurate orientation， mastering the inserting needle point and direction， mastering the bone cement allocation ratio， bone cement perfusion amount and speed in treatment of vertebral pedicle and posterior element bone destruction can be safe， effective， economic and simple with low anesthesia risks， which can shorten the time to get out of bed， reduce the complications and reduce the length of stay and hospitalization cost., 百拇医药(李炳想 黄顺勇 郭安明 姜益添 韦文龙)
[关键词] 严重型；老年性胸腰椎压缩性骨折；椎体成形术
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2017)06(b)-0060-03
[Abstract] Objective To discuss the clinical curative effect of vertebroplasty in treatment of severe senile thoracolumbar compression fracture. Methods 58 cases of senile patients with severe thoracolumbar compression fracture treated in our hospital from April 2013 to August 2015 were selected as a group and randomly divided into two groups with 29 cases in each (69 centrum lesions)， and the control group adopted the conservative treatment， while the observation group adopted the PVP treatment， and there were 20 cases with 2 segments， 7 cases with 3 segments and 2 cases with 4 segments， and the 35 centrums collapse degree was more than 75%， and there were 20 centrums complicated by vertebral pedicle and posterior element bone destruction， 20 cases with osteoporosis vertebral compressed fracture， 5 cases with mild trauma history， 4 cases with unknown compressed fracture， and PVP was conducted under the monitoring of C arm X-ray machine or C arm X-ray machine +CT combination machine， and the ratio of contrast-medium was 3：2：1， and the bone cement dosage was 1-3ml， and the differences in the treatment effect and follow-up results of the two groups were observed. Results The total treatment effective rate in the control group and in the observation group was respectively 79.3% and 96.6%， and the difference was statistically significant(P<0.05)， and there was no recurrence after 2～11 month follow-up， and there was no one with collapsed vertebra aggravation or new compression after PVP surgery， and no one was with severe complications. Conclusion PVP is a minimally invasive treatment method， which can be conducted under the monitoring of C arm X-ray machine， and mastering the use method of PMMA is the key factor of PVP technical success， the accurate orientation， mastering the inserting needle point and direction， mastering the bone cement allocation ratio， bone cement perfusion amount and speed in treatment of vertebral pedicle and posterior element bone destruction can be safe， effective， economic and simple with low anesthesia risks， which can shorten the time to get out of bed， reduce the complications and reduce the length of stay and hospitalization cost., 百拇医药(李炳想 黄顺勇 郭安明 姜益添 韦文龙)