摘要
目的 分析经皮椎体后凸成形术（PKP）治疗胸腰椎骨质疏松性压缩性骨折（OVCF）的骨水泥的灌注量与椎体内骨水泥的分布情况对早期疗效的影响。方法 将该科2011年5月至2013年5月62例OVCF患者按常规行PKP,术中注射骨水泥PMMA。术后将手术椎体做CT平扫并分区,将骨水泥的分布情况分为优、良、中、差4个等级,对患者进行定期随访,比较不同等级骨水泥分布情况及灌注量的术前、术后的疼痛视觉模拟（VAS）评分、Oswestry功能障碍指数（ODI）、椎体高度、后凸Cobb角及并发症。结果 本组62例随访时间3-36个月,平均（10.5±5.3）个月。术前与术后1周VAS评分有显著差异（P〈0.05）。术后3个月各等级间观察指标差异无统计学意义（P〉0.05）。骨水泥灌注量大于5mL的病例术后6个月、12个月分别有3例、6例出现邻椎骨折。骨水泥灌注量小于3mL的病例术后12个月有2例出现手术椎再骨折。术后6个月、12个月骨水泥分布优差等级之间的手术椎高度丢失差异有统计学意义（P〈0.05）,邻椎体继发骨折率差异无统计学意义（P〉0.05）。术后12个月骨水泥分布不同等级间疼痛、功能差异有统计学意义（P〈0.05）。结论 经皮椎体后凸成形术治疗OVCF,按常规操作不同灌注量与分布均有良好的超早期（3个月内）疗效,但骨水泥灌注量适中,分布越均匀、越对称,可能早期疗效越好。
Objective To detect the influence of the perfusion quantity and distribution of bone cement by percutaneous kyphoplasty（PKP） on the early treatment result of thoracolumbar osteoporotic compression ffactures（OVCF）. Methods From May 2011 to May 2013,62 cases of osteoporotic fractures of thoracic or lumber vertebra were treated by PKP. CT scans were performed postoperatively to analysis the distribution of the bone cement in the vertebra. According to the bone cement distribution on the transverse plane CT film,the results were classified into four degrees：excellence,good, fair and poor. The cases were followed-up regularly. Preoperative and postoperanve visual analogue scale（VAS）, oswestry dysfunction index（ODD, height of the operated vertebra, cobb angle, the incidences of complications during and after the surgery were compared between groups of different degrees of bone cement distribution and different amount of bone cement injection. Results Among the 62 cases, the follow-up time ranged from 3 to 36 months[average（10.5 ±5.3）months]. In all of the cases,there was statistically significant difference between the preoperative and postoperative VAS seoring（P〈0.05）. 3 months after suergery,there were no statistically significant influence on the results of VAS scoring, the ODI scoring,the height lost of the operated vertebra and the improvement of the Cobb angle（P〈0.05）. In cases of bone cement injection more than 5 mL,adjacent vertebra fractures happened in 3 cases 6 months postoperatively and 6 cases 12 months postoperatively. In eases of bone cement injection less than 4 mL,there were only 2 cases of adjacent vertebra fractures happened 12 months posoperatively. The degree of vertebra height lost between the bone cement excellent group and poor group was statistically significant in 6 months and 12 months postoperatively. In cases when the distribution of bone cement was excellent,the improvement of pain and function was significantly different（P〈0.05）. Conclusion OVCF is treated by PKP. Through conventional operation,the ultra-early（within 3 months）efficacy is excellent,in cases of different amount of bone cement injection and different degree of bone cement distribution. However, with appropriate amount of bone cement, the more eventfully and symmetrically the distribution of the bone cement is, the better of the early clinical results,probably.
出处
《重庆医学》
CAS
北大核心
2016年第1期62-65,共4页
Chongqing medicine
基金
重庆市卫生局科医学科研计划项目(2012-2-415)
关键词
经皮椎体后凸成形术
骨水泥
分布
灌注量
治疗结果
percutaneous kyphoplasty
bone cement
distribution
injection quantity
treatment outcome
作者简介
文坤树（1966-），主任医师，本科，主要从事脊柱创伤、骨与软组织缺损与修复研究。
