摘要
目的 总结经皮及开放式椎体成形术治疗老年骨质疏松性脊柱骨折的疗效 ,探讨其适应证的选择。方法 采用经皮或开放式椎体成形术加内固定方法治疗老年性骨质疏松性脊柱骨折。经皮椎体成形术 (PVP)病例选择标准 :单个或二个椎体骨折 ,病程 3个月以内 ,无脊髓或神经压迫症状 ,CT示椎体后缘完整。开放式椎体成形术 (OVP)病例选择标准 :①陈旧性单个或多个椎体骨折并脊柱侧弯或后凸畸形 ;②合并脊髓或神经压迫症状或脊柱不稳。PVP者经一侧椎弓根注入骨水泥 3～ 7ml,OVP加内固定者经后路切开VP后再植入椎弓根钉系统。结果 2 7例PVP及OVP加内固定者术后疼痛均明显缓解 ,平均 1 8周后疼痛完全缓解 ,VAS评分 (疼痛视觉模拟评分法 )平均由术前的 (9 3± 1 4 )分下降到术后 (1 6± 1 2 )分 ,Cobb角术后改善 8°～ 16°。经平均 1年 9个月随访 ,无断钉、拔钉、Cobb角加大等情况发生 ,未发现明显的VP并发症。结论 PVP治疗老年性骨质疏松性脊柱骨折具有微创、止痛效果好、可早期下地等独特的优越性 ,但临床应用具有局限性。对陈旧性骨折、有脊髓或神经压迫症状、脊柱不稳者采用OVP加内固定治疗 ,可取得良好的疗效。
Objective To present the clinical results of percutaneous and open vertebroplasty for elderly osteoporotic vertebral fracture and consider its inidications.Methods Percataneous vertebroplasty(PVP) and open vertebroplasty(OVP) combined with internal fixation were used for the treatment of elderly osteoporotc vertebral fracture. The indications of PVP were fracture of single or two vertebrae that occurred in three months and without signs of nerves or spinal cord. The indications of OVP combined with internal fixation were that: ① Old fracture of single or multiple vertebrae combined with scoliosis or kyphosis; ②Fracture combined with signs of nerve or spinal cord, or with unstable spine. Three to 7ml Polymethylmethacrylate(PMMA) was injected through unilateral pedicle of vertebral arch. In the patients with OVP combined with internal fixation, pedicle screw system was applied after vertebroplasty.Results In a total of 27 cases, all patient's pain distinctly relieved, and completely relieved after an average of 1.8 weeks.Visual analogue pain scale(VAS) reduced from (9.3±1.4) to (1.6±1.2), and Cobb angle improved 8° to 16°. After an average of 21 months follow up, no complication occured in all cases.Conclusion PVP is a good minimal invasive method in treatment of osteoporotic vertebral fractures. The effect of pain relief is specially remarkable. But its application is not suitable for the patients with old fracture,symptoms of nerve or spinal cord and unstable spine. OVP combined with internal fixation should be chossed for this kind of cases, and its effect is good.
出处
《骨与关节损伤杂志》
2004年第8期525-527,共3页
The Journal of Bone and Joint Injury
