CAJ | 학술논문

背景：球囊扩张椎体后凸成形是近年来发展起来的脊柱微创外科新技术，为老年骨质疏松性脊柱骨折的治疗开辟了新途径。 　　目的：观察经皮穿刺球囊扩张椎体后凸成形技术对骨质疏松性脊柱骨折的治疗效果，探讨注入骨水泥的要点。 　　方法：采用经皮穿刺球囊扩张椎体后凸成形技术治疗22例骨质疏松性椎体骨折患者，年龄60-78岁。在C臂X射线机透视引导下，行经皮穿刺球囊扩张椎体后凸成形治疗。按WHO标准对止痛效果进行评估，并分析骨水泥的注入时机、方式及用量等。 　　结果与结论：所有患者均得到随访，随访时间1-12个月。治疗后15例疼痛完全缓解，7例部分缓解，有效率达100%，患者脊柱活动度增加。所有患者无需切开手术治疗，未出现肺栓塞、神经损伤等并发症。提示经皮穿刺球囊扩张椎体后凸成形技术在治疗骨质疏松性椎体骨折时，创伤小、操作简单、并发症少，能有效地重建椎体强度，并能较好地缓解疼痛，是一种有效的脊柱微创治疗技术。严格掌握治疗要点，能够获得满意的临床疗效，包括准确的疾病诊断，明确患者的疼痛等症状是否因骨折所致，术前术中准确的定位病椎，良好的穿刺技术，以及合适的术后治疗和护理。严格把握骨水泥的推注时间及量也很重要，骨水泥的推注一般在拉丝期，太早容易泄露，发生毒性反应；太晚影响骨水泥的扩散，从而影响治疗效果。骨水泥的推注最好全程在透视下进行，这样才能有效避免骨水泥的泄露。
배경：구낭확장추체후철성형시근년래발전기래적척주미창외과신기술，위노년골질소송성척주골절적치료개벽료신도경。 　　목적：관찰경피천자구낭확장추체후철성형기술대골질소송성척주골절적치료효과，탐토주입골수니적요점。 　　방법：채용경피천자구낭확장추체후철성형기술치료22례골질소송성추체골절환자，년령60-78세。재C비X사선궤투시인도하，행경피천자구낭확장추체후철성형치료。안WHO표준대지통효과진행평고，병분석골수니적주입시궤、방식급용량등。 　　결과여결론：소유환자균득도수방，수방시간1-12개월。치료후15례동통완전완해，7례부분완해，유효솔체100%，환자척주활동도증가。소유환자무수절개수술치료，미출현폐전새、신경손상등병발증。제시경피천자구낭확장추체후철성형기술재치료골질소송성추체골절시，창상소、조작간단、병발증소，능유효지중건추체강도，병능교호지완해동통，시일충유효적척주미창치료기술。엄격장악치료요점，능구획득만의적림상료효，포괄준학적질병진단，명학환자적동통등증상시부인골절소치，술전술중준학적정위병추，량호적천자기술，이급합괄적술후치료화호리。엄격파악골수니적추주시간급량야흔중요，골수니적추주일반재랍사기，태조용역설로，발생독성반응；태만영향골수니적확산，종이영향치료효과。골수니적추주최호전정재투시하진행，저양재능유효피면골수니적설로。
BACKGROUND:Bal oon kyphoplasty is a new technique of microtraumatic surgery of spine developed in recent years, and brings a new pathway for the treatment of osteoporotic vertebral fracture in the elderly. OBJECTIVE:To investigate the therapeutic effect of percutaneous bal oon kyphoplasty on osteoporotic vertebral fracture, and to explore the main point of injecting bone cement. METHODS:A total of 22 patients with osteoporotic vertebral fracture at the age of 60-78 years underwent percutaneous bal oon kyphoplasty under C-arm fluoroscopy. In accordance with the standards of WHO, antalgic effects were evaluated. The injection time, manner and dose of bone cement were analyzed. RESULTS AND CONCLUSION:Al patients were fol owed up for 1-12 months. Postoperative pain was completely lessened in 15 patients, and partial y relieved in 7 cases, with an effective rate of 100%. Spinal mobility increased. No incision surgery was needed in al patients. No complications such as pulmonary embolism or nerve injury appeared. These results indicate that percutaneous bal oon kyphoplasty for treatment of osteoporotic vertebral fractures is minimal y invasive and simple, has less complication and effectively reconstructs vertebral body strength, and can better al eviate the pain, is an effective minimal y invasive spinal treatment technology. To strictly understand the main treatment point can obtain satisfactory clinical curative effects, including precise diagnosis of the disease, identification whether patient’s pain is induced by fractures, preoperative intraoperative exact localization of the affected vertebra, perfect puncturing technique, suitable postoperative treatment and nursing. It is also important to strictly master the time of injecting bone cement and the dose of bone cement. Bone cement injection was commonly done in drawing-wire stage. Too early injection easily induced leakage and toxic reaction. Too late injection affected the expansion of bone cement and therapeutic effects. The injection of bone cement should be finished under a perspective environment, which can effectively avoid bone cement leakage.