經(jīng)皮椎體后凸成形術(shù)治療重度骨質(zhì)疏松椎體壓縮性骨折

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1、·1220·浙江臨床醫(yī)學(xué)2014年8月第16卷第8期經(jīng)皮椎體后凸成形術(shù)治療重度骨質(zhì)疏松椎體壓縮性骨折張濤姜為民*王根林李雪峰汪恒【摘要】目的探討應(yīng)用經(jīng)皮球囊椎體后凸成形術(shù)（percutaneouskyphoplasty，PKP）治療重度骨質(zhì)疏松性椎體壓縮性骨折（osteoporoticvertebralcompressionfracture，OVCF）的可行性和有效性。方法對(duì)33例重度骨質(zhì)疏松性椎體壓縮性骨折患者行PKP術(shù)。測(cè)量傷椎前緣、中緣及Cobb’s角度術(shù)前、術(shù)后值，同時(shí)應(yīng)用視覺(jué)模擬數(shù)字評(píng)分（VAS）及功能障礙指數(shù)（ODI）綜合評(píng)估手術(shù)療效。結(jié)果33例患者手術(shù)

2、均順利，術(shù)后隨訪14~39個(gè)月，平均22.6個(gè)月。VAS評(píng)分、ODI評(píng)分分別由術(shù)前的（7.9±0.8）分、（74.2±9.9）分降至術(shù)后的（2.9±0.9）分、（36.8±8.6）分，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；末次隨訪時(shí)VAS評(píng)分、ODI評(píng)分分別為（2.7±1.1）分、（35.6±6.9）分，較術(shù)后差異無(wú)統(tǒng)計(jì)學(xué)意義。傷椎前緣、中緣高度由術(shù)前的（30.6±8.1）%、（40.5±14.9）%恢復(fù)至術(shù)后的（66.9±13.5）%、（74.5±10.3）%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。術(shù)前椎體Cobb’s角度（25.3±8.8）°，術(shù)后（14.7±7.2）°

3、，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。11例（33%）術(shù)中出現(xiàn)骨水泥滲漏，但并未產(chǎn)生臨床癥狀。結(jié)論經(jīng)皮球囊椎體后凸成形術(shù)治療重度骨質(zhì)疏松椎體壓縮性骨折療效確切，并發(fā)癥少，術(shù)后功能恢復(fù)良好?！娟P(guān)鍵詞】骨質(zhì)疏松癥椎體壓縮性骨折經(jīng)皮球囊椎體后凸成形術(shù)骨水泥漏【Abstract】ObjectiveToevaluatethefeasibilityandef?cacyofpercutaneouskyphoplastyintreatingverysevereosteoporoticvertebralcompressivefracture.MethodsBetweenJanuary2

4、008andDecember2012，33patients（20women，13men）withveryseverevertebralfracturebodiesunderwentballoonkyphoplasty.Theanteriorvertebralheight，middlevertebralheight，localkyphoticangle，visualanaloguescale（VAS），OswestryDisabilityIndex（ODI）andtheincidenceofcementleakagewereusedtoevaluatepainstat

5、usandfunctionalactivitybeforetheoperation，1dayaftertheoperationandatthe?nalfollow-up.ResultsAll33patientstoleratedprocedurewell.Themeanfollow-upwas22.6months（inrangefrom14to39months）.TheVASandODIdecreasedrespectivelyfrom7.9±0.8and74.2±9.9preoperativelyto2.9±0.9and36.8±8.6postoperativel

6、y（P<0.05）；theVASandODIwas2.7±1.1and35.6±6.9atthe?nalfollow-upwhichhadnosigni?cantdifferencebetweenpostoperativeand?nalfollow-up（P>0.05）.Theanteriorandmiddleheightoffracturevertebralbodyimprovedfrom（30.6±8.1）%，（40.5±14.9）%preoperativelyto（66.9±13.5）%，（74.5±10.3）%postoperatively（P<0.05）.

7、Therewasasignificantdifferencebetweenpreoperativeandpostoperativeheightoftheanteriorandmiddlevertebralbody.TheCobb’sangleimprovedfrom（25.3±8.8）°preoperativelyto（14.7±7.2）°postoperatively（P<0.05）.Asymptomaticcementleakageoccurredin11patients（33%）inourstudy.ConclusionBalloonkyphoplasty