西安交通大学学报（医学版）
西安交通大學學報（醫學版）
서안교통대학학보（의학판）
Journal of Xi'an Jiaotong University (Medical Sciences)
2015年
6期
857-861
,共5页
刘春磊%胡懿郃%王贵清%汤勇智%王湘江%侯瀚涛
劉春磊%鬍懿郃%王貴清%湯勇智%王湘江%侯瀚濤
류춘뢰%호의합%왕귀청%탕용지%왕상강%후한도
椎体成形术%骨质疏松症%压缩性骨折%骨水泥
椎體成形術%骨質疏鬆癥%壓縮性骨摺%骨水泥
추체성형술%골질소송증%압축성골절%골수니
vertebroplasty%osteoporosis%compressionfracture%bone cement
目的：探讨椎体成形术不同手术入路治疗老年性骨质疏松压缩性骨折的临床疗效。方法2011年2月~2013年6月,98例老年性骨质疏松症并胸腰椎单节椎体压缩性骨折患者进行椎体成形术治疗,根据手术入路不同,随机分为单侧组(48例)和双侧组(50例),前瞻性分析两组患者临床资料,包括性别、年龄、患者受伤到手术的时间、术后随访时间、手术时间,观察骨水泥注入量、椎体前缘高度压缩率(Lee 法),测量椎体后凸角度(Cobb 角法)及并发症情况,术前、术后1 d、术后1年分别采用 VAS、ODI(视觉模拟评分法、Oswestry 功能障碍指数)评分系统评估患者疼痛情况,比较两组的临床疗效。结果所有患者全部获得完整随访,两组中患者性别、年龄、患者受伤到手术的时间、术后随访时间差异无统计学意义(P >0.05)。单侧组治疗48例,手术时间(34.87±5.91)min,骨水泥注入量(6.20±0.66)mL,术中发现骨水泥渗漏16例(33.3%),椎体前缘高度压缩率改善(10.19±2.12)%,椎体后凸角度改善(13.23°±1.58°)；术后1 d 及1年 VAS 评分较术前分别改善(4.05±0.12)、(5.42±0.12),术后1年 VAS 评分较术后1 d 改善(1.40±0.11)；术后1 d 及1年 ODI 评分较术前分别改善(35.46±1.89)%、(47.88±2.21)%,术后1年 ODI 评分较术后1 d 改善(11.42±0.24)%；术后邻近椎体再发骨折发生10例(20.9%)。双侧组治疗50例,手术时间(41.66±6.90)min,骨水泥注入量(4.88±0.52)mL,术中发现骨水泥渗漏9例(18.0%),椎体前缘高度压缩率改善(10.48±1.43)%,椎体后凸角度改善(13.04°±2.03°)；术后1 d 及1年 VAS 评分较术前分别改善(4.06±0.11)、(5.30±0.10),术后1年 VAS 评 分 较 术后1 d 改善(1.34±0.08)；术后1 d 及1年 ODI 评分较术前分别改善(36.08±2.13)%、(47.54±1.97)%,术后1年 ODI 评 分 较 术后1 d 改善(11.26±0.54)%；术后邻近椎体再发骨折6例(12.0%)。两组发生渗漏患者均无明显临床不适。SPSS16.0统计软件分析两组骨水泥注入量、骨水泥渗漏率、术后1年邻近椎体再发骨折率差异有统计学意义(P <0.05),而 VAS、ODI 评分改善、椎体前缘高度压缩率改善、Cobb 角改善情况差异无统计学意义(P >0.05)。结论椎体成形术不同手术入路治疗老年性骨质疏松椎体压缩性骨折均能获得良好的临床疗效,且双侧经皮椎弓根入路具有骨水泥渗漏发生率低、术后相邻椎体再骨折低的优点。
目的：探討椎體成形術不同手術入路治療老年性骨質疏鬆壓縮性骨摺的臨床療效。方法2011年2月~2013年6月,98例老年性骨質疏鬆癥併胸腰椎單節椎體壓縮性骨摺患者進行椎體成形術治療,根據手術入路不同,隨機分為單側組(48例)和雙側組(50例),前瞻性分析兩組患者臨床資料,包括性彆、年齡、患者受傷到手術的時間、術後隨訪時間、手術時間,觀察骨水泥註入量、椎體前緣高度壓縮率(Lee 法),測量椎體後凸角度(Cobb 角法)及併髮癥情況,術前、術後1 d、術後1年分彆採用 VAS、ODI(視覺模擬評分法、Oswestry 功能障礙指數)評分繫統評估患者疼痛情況,比較兩組的臨床療效。結果所有患者全部穫得完整隨訪,兩組中患者性彆、年齡、患者受傷到手術的時間、術後隨訪時間差異無統計學意義(P >0.05)。單側組治療48例,手術時間(34.87±5.91)min,骨水泥註入量(6.20±0.66)mL,術中髮現骨水泥滲漏16例(33.3%),椎體前緣高度壓縮率改善(10.19±2.12)%,椎體後凸角度改善(13.23°±1.58°)；術後1 d 及1年 VAS 評分較術前分彆改善(4.05±0.12)、(5.42±0.12),術後1年 VAS 評分較術後1 d 改善(1.40±0.11)；術後1 d 及1年 ODI 評分較術前分彆改善(35.46±1.89)%、(47.88±2.21)%,術後1年 ODI 評分較術後1 d 改善(11.42±0.24)%；術後鄰近椎體再髮骨摺髮生10例(20.9%)。雙側組治療50例,手術時間(41.66±6.90)min,骨水泥註入量(4.88±0.52)mL,術中髮現骨水泥滲漏9例(18.0%),椎體前緣高度壓縮率改善(10.48±1.43)%,椎體後凸角度改善(13.04°±2.03°)；術後1 d 及1年 VAS 評分較術前分彆改善(4.06±0.11)、(5.30±0.10),術後1年 VAS 評 分 較 術後1 d 改善(1.34±0.08)；術後1 d 及1年 ODI 評分較術前分彆改善(36.08±2.13)%、(47.54±1.97)%,術後1年 ODI 評 分 較 術後1 d 改善(11.26±0.54)%；術後鄰近椎體再髮骨摺6例(12.0%)。兩組髮生滲漏患者均無明顯臨床不適。SPSS16.0統計軟件分析兩組骨水泥註入量、骨水泥滲漏率、術後1年鄰近椎體再髮骨摺率差異有統計學意義(P <0.05),而 VAS、ODI 評分改善、椎體前緣高度壓縮率改善、Cobb 角改善情況差異無統計學意義(P >0.05)。結論椎體成形術不同手術入路治療老年性骨質疏鬆椎體壓縮性骨摺均能穫得良好的臨床療效,且雙側經皮椎弓根入路具有骨水泥滲漏髮生率低、術後相鄰椎體再骨摺低的優點。
목적：탐토추체성형술불동수술입로치료노년성골질소송압축성골절적림상료효。방법2011년2월~2013년6월,98례노년성골질소송증병흉요추단절추체압축성골절환자진행추체성형술치료,근거수술입로불동,수궤분위단측조(48례)화쌍측조(50례),전첨성분석량조환자림상자료,포괄성별、년령、환자수상도수술적시간、술후수방시간、수술시간,관찰골수니주입량、추체전연고도압축솔(Lee 법),측량추체후철각도(Cobb 각법)급병발증정황,술전、술후1 d、술후1년분별채용 VAS、ODI(시각모의평분법、Oswestry 공능장애지수)평분계통평고환자동통정황,비교량조적림상료효。결과소유환자전부획득완정수방,량조중환자성별、년령、환자수상도수술적시간、술후수방시간차이무통계학의의(P >0.05)。단측조치료48례,수술시간(34.87±5.91)min,골수니주입량(6.20±0.66)mL,술중발현골수니삼루16례(33.3%),추체전연고도압축솔개선(10.19±2.12)%,추체후철각도개선(13.23°±1.58°)；술후1 d 급1년 VAS 평분교술전분별개선(4.05±0.12)、(5.42±0.12),술후1년 VAS 평분교술후1 d 개선(1.40±0.11)；술후1 d 급1년 ODI 평분교술전분별개선(35.46±1.89)%、(47.88±2.21)%,술후1년 ODI 평분교술후1 d 개선(11.42±0.24)%；술후린근추체재발골절발생10례(20.9%)。쌍측조치료50례,수술시간(41.66±6.90)min,골수니주입량(4.88±0.52)mL,술중발현골수니삼루9례(18.0%),추체전연고도압축솔개선(10.48±1.43)%,추체후철각도개선(13.04°±2.03°)；술후1 d 급1년 VAS 평분교술전분별개선(4.06±0.11)、(5.30±0.10),술후1년 VAS 평 분 교 술후1 d 개선(1.34±0.08)；술후1 d 급1년 ODI 평분교술전분별개선(36.08±2.13)%、(47.54±1.97)%,술후1년 ODI 평 분 교 술후1 d 개선(11.26±0.54)%；술후린근추체재발골절6례(12.0%)。량조발생삼루환자균무명현림상불괄。SPSS16.0통계연건분석량조골수니주입량、골수니삼루솔、술후1년린근추체재발골절솔차이유통계학의의(P <0.05),이 VAS、ODI 평분개선、추체전연고도압축솔개선、Cobb 각개선정황차이무통계학의의(P >0.05)。결론추체성형술불동수술입로치료노년성골질소송추체압축성골절균능획득량호적림상료효,차쌍측경피추궁근입로구유골수니삼루발생솔저、술후상린추체재골절저적우점。
Objective To investigate the clinical effect of the treatment of osteoporotic vertebral compression fractures in the elderly populationthrough different surgical approaches.Methods 98 cases with a single-level osteoporotic vertebral compression fracture in the elderly population were randomly divided into two groups from February 201 1 to June 2013.48 patients were performed by percutaneous vertebroplasty (PVP)through unipedicular approach and 50 patients through bipedicular approachs.The clinical data of patients were prospectively analyzed and the clinical efficacy were compared between two groups using VAS (visual analogue scale method)and ODI (Oswestry disability index)in preoperative,postoperative 1 day and 1 year postoperatively .The data of age, gender,injury to the patients with operation time,postoperative follow-up time,operation time,bone cement injection,bone cement leakage and other complications were observed.Cobb angle,vertebral compression ration were observed by imaging data.Results All the cases were followed-up.There was no statistical difference in preoperative clinical data between the two groups (P >0.05).In unilateral group (48 cases),the data of operation time,bone cement injection,bone cement leakage,Cobb angle improve,vertebral compression ration improve were (34.87±5.91)min,(6.20±0.66)mL,1 6 cases(33%),(10.1 9±2.12)%,(13.23°±1.58°)and adjacent vertebral fractures was 10 cases (20.9%).VAS score was respectively improved (4.05 ± 0.12 ),(5.42 ± 0.12 ) in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.40 ±0.1 1 )in postoperative 1 year than 1 day.ODI score was respectively improved (35.46 ± 1.89)%,(47.88 ±2.21 )% in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.42±0.24)% in postoperative 1 year than 1 day.In bilateral group (50 cases).The data of operation time,bone cement injection,bone cement leakage,Cobb angle improve, vertebral compression ration improve were (41.66±6.90)min,(4.88±0.52)mL,9 cases(18.0%),(10.48±1.43)%,(13.04°±2.03°)and adjacent vertebral fractures was 6 cases(12.0%).VAS score was respectively improved (4.06±0.1 1),(5.30±0.10)in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.34± 0.08)in postoperative 1 year than 1 day.ODI score was respectively improved (36.08±2.13)%,(47.54±1.97)%in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.26 ± 0.54)% in postoperative 1 year than 1 day.There was no obvious clinical problems after occurred leakage in two groups.there was statistical difference in cement injection,bone cement leakage and postoperative adjacent vertebral fractures after operation between the two groups.there was no statistical difference in Cobb angle improve,vertebral compression ration improve,VAS score and ODI score between the two groups.Conclusion Both approaches are effective in the treatment of osteoporotic vertebral compression fractures in the elderly population ,but there is advantage of decrease the incidence of bone cement leakage and postoperative adjacent vertebral fractures through bilateral approach.
