CAJ | 학술논문

目的探讨数字减影血管造影（ DSA）机监控下经皮椎体后凸成形术（ PKP）治疗老年骨质疏松性椎体压缩骨折（ OVCF）的疗效。方法自2006年1月至2011年12月，在DSA监控下确定责任椎后，行椎体后凸成形术，治疗OVCF 86例，共104个椎体，其中男26例，女60例，年龄67～94岁，平均83.3岁。骨折累及1个椎体共63例，2个椎体18例，3个椎体5例，观察患者手术前后视觉模拟疼痛评分（ VAS）、健康调查简表（SF-36）评分的变化及椎体前缘高度的变化和矢状面Cobb角的变化。结果本组获随访7～38个月，平均16.9个月。86例114个椎体均顺利完成手术，无术中死亡，无发生肺栓塞及神经压迫症状。术后X线及CT扫描显示所有患者均获得脊柱稳定。 VAS由术前（7.8±1.5）分降至术后第3天（1.8±1.2）分，末次随访为（1.9±1.3）分，术前与术后第3天、末次随访比较，差异均有统计学意义（P＜0.01）；SF-36评分由（246±103）分降至术后第3天（352±117）分，末次随访为（367±131）分，术前与术后第3天、末次随访比较，差异均有统计学意义（P＜0.01）；椎体前缘高度术前、术后第3天及末次随访分别为（8.4±1.4）mm、（13.8±1.6）mm和（13.8±1.5）mm，术前与术后第3天及末次随访比较，差异均有统计学意义（P＜0.01）；矢状面Cobb角术前、术后第3天及末次随访分别为（29.1±3.1）°、（20.7±2.3）°及（20.8±2.4）°。术前与术后第3天及末次随访比较，差异均有统计学意义（ P＜0.01）。结论 DSA监控下行PKP操作相对简便、灵活，增加穿刺的准确率，是一种治疗老年OVCF的微创手术，能够有效缓解骨质疏松性椎体骨折引起的疼痛，维持脊柱稳定性，恢复椎体高度，患者可早期下床活动，避免老年患者卧床的常见并发症，从而改善其生活质量，减少死亡率。是一种简单、安全、有效的新方法。目的探討數字減影血管造影（ DSA）機鑑控下經皮椎體後凸成形術（ PKP）治療老年骨質疏鬆性椎體壓縮骨摺（ OVCF）的療效。方法自2006年1月至2011年12月，在DSA鑑控下確定責任椎後，行椎體後凸成形術，治療OVCF 86例，共104箇椎體，其中男26例，女60例，年齡67～94歲，平均83.3歲。骨摺纍及1箇椎體共63例，2箇椎體18例，3箇椎體5例，觀察患者手術前後視覺模擬疼痛評分（ VAS）、健康調查簡錶（SF-36）評分的變化及椎體前緣高度的變化和矢狀麵Cobb角的變化。結果本組穫隨訪7～38箇月，平均16.9箇月。86例114箇椎體均順利完成手術，無術中死亡，無髮生肺栓塞及神經壓迫癥狀。術後X線及CT掃描顯示所有患者均穫得脊柱穩定。 VAS由術前（7.8±1.5）分降至術後第3天（1.8±1.2）分，末次隨訪為（1.9±1.3）分，術前與術後第3天、末次隨訪比較，差異均有統計學意義（P＜0.01）；SF-36評分由（246±103）分降至術後第3天（352±117）分，末次隨訪為（367±131）分，術前與術後第3天、末次隨訪比較，差異均有統計學意義（P＜0.01）；椎體前緣高度術前、術後第3天及末次隨訪分彆為（8.4±1.4）mm、（13.8±1.6）mm和（13.8±1.5）mm，術前與術後第3天及末次隨訪比較，差異均有統計學意義（P＜0.01）；矢狀麵Cobb角術前、術後第3天及末次隨訪分彆為（29.1±3.1）°、（20.7±2.3）°及（20.8±2.4）°。術前與術後第3天及末次隨訪比較，差異均有統計學意義（ P＜0.01）。結論 DSA鑑控下行PKP操作相對簡便、靈活，增加穿刺的準確率，是一種治療老年OVCF的微創手術，能夠有效緩解骨質疏鬆性椎體骨摺引起的疼痛，維持脊柱穩定性，恢複椎體高度，患者可早期下床活動，避免老年患者臥床的常見併髮癥，從而改善其生活質量，減少死亡率。是一種簡單、安全、有效的新方法。
목적탐토수자감영혈관조영（ DSA）궤감공하경피추체후철성형술（ PKP）치료노년골질소송성추체압축골절（ OVCF）적료효。방법자2006년1월지2011년12월，재DSA감공하학정책임추후，행추체후철성형술，치료OVCF 86례，공104개추체，기중남26례，녀60례，년령67～94세，평균83.3세。골절루급1개추체공63례，2개추체18례，3개추체5례，관찰환자수술전후시각모의동통평분（ VAS）、건강조사간표（SF-36）평분적변화급추체전연고도적변화화시상면Cobb각적변화。결과본조획수방7～38개월，평균16.9개월。86례114개추체균순리완성수술，무술중사망，무발생폐전새급신경압박증상。술후X선급CT소묘현시소유환자균획득척주은정。 VAS유술전（7.8±1.5）분강지술후제3천（1.8±1.2）분，말차수방위（1.9±1.3）분，술전여술후제3천、말차수방비교，차이균유통계학의의（P＜0.01）；SF-36평분유（246±103）분강지술후제3천（352±117）분，말차수방위（367±131）분，술전여술후제3천、말차수방비교，차이균유통계학의의（P＜0.01）；추체전연고도술전、술후제3천급말차수방분별위（8.4±1.4）mm、（13.8±1.6）mm화（13.8±1.5）mm，술전여술후제3천급말차수방비교，차이균유통계학의의（P＜0.01）；시상면Cobb각술전、술후제3천급말차수방분별위（29.1±3.1）°、（20.7±2.3）°급（20.8±2.4）°。술전여술후제3천급말차수방비교，차이균유통계학의의（ P＜0.01）。결론 DSA감공하행PKP조작상대간편、령활，증가천자적준학솔，시일충치료노년OVCF적미창수술，능구유효완해골질소송성추체골절인기적동통，유지척주은정성，회복추체고도，환자가조기하상활동，피면노년환자와상적상견병발증，종이개선기생활질량，감소사망솔。시일충간단、안전、유효적신방법。
Objective To evaluate the therapeutic effect of percutaneous kyphoplasty ( PKP ) in treating senile osteoporotic vertebral body fracture ( OVCF ) under the monitoring of digital subtraction angiography ( DSA ) machine.Methods From January 2006 to December 2011,monitored by DSA searching for the targeted vertebral body,operated by the protruding after angioplasty to treat the senile of OVCF in 86 cases(114 vertebral body in 86 cases)of which 26 cases of men,60 cases of women,aged from 67 to 94 years old,and the average was 83.3.Fracture involved one vertebral body in 63 cases,two vertebral body in 18 cases,and three vertebral body in 5 patients.The patients were observed by visual analogue score ( VAS ) and the MOS item short from health sur-vey ( SF-36 ) score ratings change according to preoperative and postoperative and so on to the vertebral body height change and sagittal plane Cobb Angle change .Results The mean followed up period was 16.9 months ( 7-38 months ) .86 cases ( 104 vertebral body ) were successfully completed operated , no death case , no happen pulmonary embolism and nerve compression symptoms .The X-ray and CT scanning all showed that all patients were obtain the stability of the spine . The VAS of patients from ( 7.8 ±1.5 ) score preoperatively to ( 1.8 ±1.2 ) score third days postoperatively ( P <0.01),and then to(1.9 ±1.3)score at final follow-up.There was statistically significant difference between the preoperative score and the score at third days postoperative or at final follow -up.The SF-36 of patients from(246 ± 103)score preoperatively to(352 ±117)score third days postoperatively (P<0.01),and then to(367 ±131)score at final follow-up.There was statistically significant difference between the preoperative score and the score at third days postoperative or at final follow-up.The mean height of the anterior vertebral body was (8.4 ±1.4)mm preoperatively, ( 13.8 ±1.6 ) mm third days postoperatively and ( 13.8 ±1.5 ) mm at final follow-up respectively .There was statistically significant difference between the preoperative and at third days postoperative or at final follow -up( P<0.01 ) .The sagittal plane Cobb angle was ( 29.1 ±3.1 ) °preoperatively , ( 20.7 ±2.3 ) °third days postoperatively and ( 20.8 ±2.4 ) ° at final follow-up respectively .There was statistically significant difference between the preoperative and at third days postoperative or at final follow-up ( P <0.01 ) .Conclusions DSA monitoring descending PKP operation relative simple ,flexible,increase the puncture accuracy ,it is a kind of treatment in senile of OVCF of minimally invasive surgery ,can effectively alleviate pain casing by OVCF ,maintain the spinal stability , restore vertebral body height ,patients can be get out of bed early ,avoid the common complications in elderly patients , so as to improve the quality of life and reduce mortality .It is a simple,safe and effective new method .