CAJ | 학술논문

目的分析经皮椎体后凸成形术治疗老年人骨质疏松性脊柱压缩骨折的手术疗效.方法 2008年8月至2009年11月对76例(87个骨折椎体)随访2年以上资料完整的老年人骨质疏松性脊柱压缩骨折患者进行回顾性分析(平均随访时间2.1年),根据患者不同年龄段分为3组:60 ～69岁(A组),70～79岁(B组),80 ～ 91岁(C组),分析术前患者骨密度(BMD,双能量X线吸收测定法)、术前X线骨折椎体和MRI是否一致、术中手术时间、术前和术后视觉模拟评分(VAS)、Oswestry 功能障碍指数、骨折椎体高度、术中术后并发症及患者的住院费用分析.结果患者骨密度随着年龄增加而降低,各年龄组之间比较差异有统计学意义(P＜0.05)；本组资料中9个骨质疏松压缩性骨折不能在X线片上诊断,在MRI影像诊断明确；术中每个椎体后凸成型术平均时间为28 min；本组患者术前VAS疼痛评分、Oswestry功能障碍指数随着年龄的增加而增加,但A组与B组比较差异无统计学意义,A组、B组与C组比较差异有统计学意义,术后VAS疼痛评分(8.0±1.2)分比(2.6±1.0)分、Oswestry功能障碍指数(82.3±5.6)比(33.9±4.7)与术前比较均明显改善,P＜0.05;A组、B组和C组骨折椎体高度、椎体节段矢状面Cobb角与术前比较均较术前明显改善(17.1±5.1)比(-3.8±0.7),P＜0.05;术后结果与2年后最后随访[2.2分,(26.1±3.6)]比较差异无统计学意义；术中透视下监测有5例出现无症状骨水泥渗漏,1例患者出现骨水泥渗透到椎间盘,2例渗透到椎体旁外,2例渗透到椎旁静脉；术后1例患者17个月后出现相邻椎体的骨折,并行椎体成形术；患者从住院到出院平均费用为33 778元.结论椎体后凸成形术治疗老年骨质疏松压缩性骨折是简单、安全、有效的,能迅速完全或部分缓解患者的疼痛及提高患者脊柱功能活动；能恢复骨折椎体的高度避免骨折椎体高度进一步丢失；同时降低患者合并症的复发,改善患者的生活质量. 目的分析經皮椎體後凸成形術治療老年人骨質疏鬆性脊柱壓縮骨摺的手術療效.方法 2008年8月至2009年11月對76例(87箇骨摺椎體)隨訪2年以上資料完整的老年人骨質疏鬆性脊柱壓縮骨摺患者進行迴顧性分析(平均隨訪時間2.1年),根據患者不同年齡段分為3組:60 ～69歲(A組),70～79歲(B組),80 ～ 91歲(C組),分析術前患者骨密度(BMD,雙能量X線吸收測定法)、術前X線骨摺椎體和MRI是否一緻、術中手術時間、術前和術後視覺模擬評分(VAS)、Oswestry 功能障礙指數、骨摺椎體高度、術中術後併髮癥及患者的住院費用分析.結果患者骨密度隨著年齡增加而降低,各年齡組之間比較差異有統計學意義(P＜0.05)；本組資料中9箇骨質疏鬆壓縮性骨摺不能在X線片上診斷,在MRI影像診斷明確；術中每箇椎體後凸成型術平均時間為28 min；本組患者術前VAS疼痛評分、Oswestry功能障礙指數隨著年齡的增加而增加,但A組與B組比較差異無統計學意義,A組、B組與C組比較差異有統計學意義,術後VAS疼痛評分(8.0±1.2)分比(2.6±1.0)分、Oswestry功能障礙指數(82.3±5.6)比(33.9±4.7)與術前比較均明顯改善,P＜0.05;A組、B組和C組骨摺椎體高度、椎體節段矢狀麵Cobb角與術前比較均較術前明顯改善(17.1±5.1)比(-3.8±0.7),P＜0.05;術後結果與2年後最後隨訪[2.2分,(26.1±3.6)]比較差異無統計學意義；術中透視下鑑測有5例齣現無癥狀骨水泥滲漏,1例患者齣現骨水泥滲透到椎間盤,2例滲透到椎體徬外,2例滲透到椎徬靜脈；術後1例患者17箇月後齣現相鄰椎體的骨摺,併行椎體成形術；患者從住院到齣院平均費用為33 778元.結論椎體後凸成形術治療老年骨質疏鬆壓縮性骨摺是簡單、安全、有效的,能迅速完全或部分緩解患者的疼痛及提高患者脊柱功能活動；能恢複骨摺椎體的高度避免骨摺椎體高度進一步丟失；同時降低患者閤併癥的複髮,改善患者的生活質量.
목적 분석경피추체후철성형술치료노년인골질소송성척주압축골절적수술료효.방법 2008년8월지2009년11월대76례(87개골절추체)수방2년이상자료완정적노년인골질소송성척주압축골절환자진행회고성분석(평균수방시간2.1년),근거환자불동년령단분위3조:60 ～69세(A조),70～79세(B조),80 ～ 91세(C조),분석술전환자골밀도(BMD,쌍능량X선흡수측정법)、술전X선골절추체화MRI시부일치、술중수술시간、술전화술후시각모의평분(VAS)、Oswestry 공능장애지수、골절추체고도、술중술후병발증급환자적주원비용분석.결과 환자골밀도수착년령증가이강저,각년령조지간비교차이유통계학의의(P＜0.05)；본조자료중9개골질소송압축성골절불능재X선편상진단,재MRI영상진단명학；술중매개추체후철성형술평균시간위28 min；본조환자술전VAS동통평분、Oswestry공능장애지수수착년령적증가이증가,단A조여B조비교차이무통계학의의,A조、B조여C조비교차이유통계학의의,술후VAS동통평분(8.0±1.2)분비(2.6±1.0)분、Oswestry공능장애지수(82.3±5.6)비(33.9±4.7)여술전비교균명현개선,P＜0.05;A조、B조화C조골절추체고도、추체절단시상면Cobb각여술전비교균교술전명현개선(17.1±5.1)비(-3.8±0.7),P＜0.05;술후결과여2년후최후수방[2.2분,(26.1±3.6)]비교차이무통계학의의；술중투시하감측유5례출현무증상골수니삼루,1례환자출현골수니삼투도추간반,2례삼투도추체방외,2례삼투도추방정맥；술후1례환자17개월후출현상린추체적골절,병행추체성형술；환자종주원도출원평균비용위33 778원.결론 추체후철성형술치료노년골질소송압축성골절시간단、안전、유효적,능신속완전혹부분완해환자적동통급제고환자척주공능활동；능회복골절추체적고도피면골절추체고도진일보주실；동시강저환자합병증적복발,개선환자적생활질량.
Objective To analyze the clinical outcomes of percutaneous kyphoplasty under local anesthesia for osteoporotic vertebral compression fractures.Methods In this study,76 elderly patients with osteoporotic vertebral compression fractures undergoing percutaneous kyphoplasty were followed up for 2-3.1 years.They were divided into 3 groups according to different ages:60-69 yrs (A group),70-79 yrs (B group) and 80-91 yrs (C group).Pre-and post-operative and last follow-up evaluations were conducted.And the parameters of bone mineral density (BMD),kyphotic angle,change of visual analog scale (VAS),Oswestry disability index,average vertebral body height,complications and costs of hospitalization were recorded and analyzed.Results BMD decreased with advancing age and had statistical significance between three groups (P ＜ 0.05).Three thoracic spine fractures and 6 lumbar spine fractures could not be detected with digital radiography and were observed only on magnetic resonance imaging (MRI).The pre-operative levels of visual analogue scale and Oswestry disability index increased in all groups.No statistical significance existed between A and B groups.But there was statistical significance between A or B and C groups (P ＜ 0.05).Pre-and post-operative assessments showed that statistically significant improvements were found in visual analogue scale and Oswestry disability index in all groups (P ＜0.05).And statistically significant improvements were found for the pre-and post-operative kyphotic angles and vertebral body heights in A,C group and B groups (P ＜ 0.05).The sites for symptomatic leakage of cement included paravertebral vein (n =2),intervertebral disc (n =1) and paravertebral space (n =2).Adjacent vertebral fracture occurred in 1 patient at 17 months and underwent percutaneous kyphoplasty.The mean operative duration was 28 minutes per vertebrae and the mean cost of hospitalization at RMB yuan 33 778.Conclusion As a simple and safe procedure for osteoporotic vertebrae compression fractures,percutaneous kyphoplasty may relieve pain quickly,restore vertebral height,prevent further fractures and improve the patient's quality-of-life.