王林;陶惠人;罗卓荆;李新奎;马真胜;李明全;杨旻;

• 1:第四军医大学西京医院骨科
• 2:第四军医大学西京医院骨科
• 3:第四军医大学西京医院骨科
• 4:第四军医大学西京医院骨科

摘要(Abstract)：

[目的]探讨依据术前MRI检查结果对老年多椎体骨质疏松压缩骨折行选择性椎体后凸成形术的疗效。[方法]自2003年6月～2006年12月老年多椎体骨质疏松压缩骨折21例57椎,采用根据术前MRI信号改变判断疼痛性椎体和陈旧骨折椎体,行选择性球囊扩张后凸成形术的治疗方法。对疼痛性椎体采用正常球囊扩张压力和足量骨水泥充填;对陈旧性骨折椎体采用较低球囊扩张压力和少量骨水泥充填,不追求恢复椎体高度。观察术后症状改善、骨折复位情况及有无并发症发生。[结果]21例手术均顺利完成,术后24h内疼痛均明显缓解。椎体前缘、中部、后缘平均高度术前分别为(1.7±0.9)cm,(1.7±0.7)cm,(2.5±0.9)cm,术后分别为(2.2±0.4)cm,(2.4±0.6)cm,(2.6±0.3)cm,椎体前缘、中部平均高度手术前后差异有统计学意义(P<0.01)。Cobb′s角由术前33.7°±10.9°矫正至术后25.9°±9.3°,手术前后差异有统计学意义(P<0.01)。术后平均随访26.3个月,患者疼痛症状均较术前明显改善或消失,未出现严重并发症。[结论]依据术前MRI结果对多椎体压缩骨折采用选择性后凸成形术治疗,临床效果满意,能够缩短手术时间、减少手术并发症、减少射线损害和手术费用,更适于老年多椎体骨质疏松压缩骨折的治疗。

关键词(KeyWords)： 骨质疏松;脊柱;骨折;后凸成形术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王林;陶惠人;罗卓荆;李新奎;马真胜;李明全;杨旻;

Email:

DOI:

参考文献(References)：

• [1]Lin JT,Lane JM·Osteoporosis:a review[J].Clin Orthop Relat Res,2004:126-134.
• [2]Rao RD,Singrakhia MD.Painful osteoporotic vertebral fracture.Pathogenesis,evaluation,and roles of vertebroplasty and kyphoplas-ty in its management[J].J Bone Joint Surg Am,2003,85-A:2010-2022.
• [3]刘伟,贾连顺.经皮椎体成形术和后凸成形术的充填材料及生物力学研究进展[J].中国矫形外科杂志,2006,14:703-706.
• [4]Crandall D,Slaughter D,Hankins PJ,et al.Acute versus chronic vertebral compression fractures treated with kyphoplasty:early results[J].Spine J,2004,4:418-424.
• [5]杨惠林,顾晓晖,陈亮,等.后凸成形术治疗骨质疏松性脊柱骨折的选择性与个体化[J].中国医学科学院学报,2005,27:174-178.
• [6]Lieberman IH,Dudeney S,Reinhardt MK,et al.Initial outcome and efficacy of"kyphoplasty"in the treatment of painful osteoporotic ver-tebral compression fractures[J].Spine,2001,26:1631-1638.
• [7]Heaney RP.Advances in therapy for osteoporosis[J].Clin Med Res,2003,1:93-99.
• [8]Belkoff SM,Mathis JM,Jasper LE,et al.The biomechanics of verte-broplasty.The effect of cement volume on mechanical behavior[J].Spine,2001,26:1537-1541.
• [9]Masala S,Schillaci O,Massari F,et al.MRI and bone scan imaging in the preoperative evaluation of painful vertebral fractures treated with vertebroplasty and kyphoplasty[J].In Vivo,2005,19:1055-1060.
• [10]唐海,鲁英,王炳强,等.低压力应用单一球囊治疗多椎体骨质疏松性脊柱压缩骨折[J].中华外科杂志,2005,43:1568-1571.
• [11]Villarraga ML,Bellezza AJ,Harrigan TP,et al.The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies[J].J Spinal Disord Tech,2005,18:84-91.
• [12]Pradhan BB,Bae HW,Kropf MA,et al.Kyphoplasty reduction of os-teoporotic vertebral compression fractures:correction of local kypho-sis versus overall sagittal alignment[J].Spine,2006,31:435-441.