唐盛辉;李斯明;周子强;王敏;张勋梦;

• 1:暨南大学第四附属医院
• 2:广州市红十字会医院骨科

摘要(Abstract)：

[目的]探讨C型臂X线机透视下经皮椎体成形术治疗高位胸椎骨质疏松性椎体压缩骨折的临床疗效及穿刺时的注意要点。[方法]在C型臂X线机透视监控下,经皮穿刺经椎弓根入路,向椎体内注入聚甲基丙烯酸甲酯(PMMA)骨水泥治疗35例高位胸椎骨质疏松压缩性骨折患者,其中男11例,女24例;年龄68～92岁,平均80岁,单节段新鲜压缩性骨折30例,合并多节段陈旧性骨折5例;T53例,T68例,T711例,T813例。以术前及术后不同时间疼痛程度、术后活动能力、止痛药物的使用为评价标准,并进行统计学分析。[结果]本组病例均获得完整随访,随访时间为12～18个月,平均15个月。术后1 d、1周,1、3、6、12个月疼痛程度、活动能力、止痛药物的使用评分与术前比较,差异有统计学意义(P<0.05)。2例骨水泥渗漏至椎旁软组织;1例骨水泥渗漏至周围静脉丛,但均未引起相应的临床症状;2例半年内出现相邻椎体骨折;无肺动脉栓塞、肋骨骨折、气胸等其他严重并发症发生。[结论]在严格掌握手术适应证的前提下,C型臂X线机透视下经皮椎体成形术治疗高位胸椎骨质疏松性椎体压缩骨折疗效显著,值得推广;由于胸椎解剖结构的特殊性及毗邻组织或器官的重要性,术者的操作经验以及对解剖结构的熟悉掌握显得尤为重要。

关键词(KeyWords)： 经皮椎体成形术;高位胸椎;骨质疏松;压缩骨折

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 唐盛辉;李斯明;周子强;王敏;张勋梦;

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DOI:

参考文献(References)：

• [1]Galibert P,Dermond H,Rosal P,et al.Preliminary note on the treate-ment of vertebral angiona by percutaneous crylic vertebroplasty[J].Neurochirurgie,1987,33:166-168.
• [2]Denis F.The three column spine and its significance in the classifica-tion of acute thoracolumbar spinal injuries[J].Spine,1983,8:817-831.
• [3]O'Brien JP,Sims JT,Evans AJ.Vertebroplasty in patients with severevertebral compression fractures:a technical report[J].Neuroradiolo-gy,2000,21:1555-1558.
• [4]赵帅,郭玉海,陈博来,等.老年上中段胸椎骨质疏松性压缩骨折的微创治疗[J].江苏医药,2011,15:1834-1835.
• [5]Tanigawa N,Kariya S,Kojima H,et al.Improvement in respiratoryfunction by percutaneous vertebroplasty[J].Acta Radiol,2008,49:638-643.
• [6]Ebraheim NA,Jably G,Xu R,et al.Anatomic relations of the thoracicpedicle to the adjacent neural structures[J].Spine,1997,22:1553-1557.
• [7]Seong JY,Kim JS,Jung BJ,et al.CT-guided percutaneous vertebro-plasty in the treatment of an upper thoracic compression fracture[J].Korean J Radiol,2009,10:185-189.
• [8]李文华,陈志瑾,迟长功,等.CT、C型臂X线机联合导引椎体成形术对重度压缩性骨折的临床引用[J].当代医学,2009,11:208-211.
• [9]Kim AK,Jensen ME,Dion JE,et al.Unilateral transpedicular percu-taneous vertebroplasty[J].Radiology,2002,3:737-741.
• [10]Han KR,Kim C,Eun JS,et al.Extrapedicular approach of percutane-ous vertebroplasty in the treatment of upper and mid-thoracic verte-bral compression fracture[J].Acta Radiol,2005,46:280-287.
• [11]Padovani B,Kasriel O,Brunner P,et al.Pulmonary embolism causedby acrylie cement:a rare complication of percutaneous vertebroplasty[J].Neuroradiology,1999,20:375-377.
• [12]Ratliff J,Nguyen T,Heiss J.Root and spinal cord compression frommethylemthacrylate vertebroplasty[J].Spine,2001,26:300-302.
• [13]Belkoff SM,Mathis JM,Erbe EM,et al.Biomechanical evaluation of anew bone cement for use in vertebroplasty[J].Spine,2000,25:1061-1064.
• [14]刘伟,郑君涛,马原,等.不同容量骨水泥用于经皮穿刺椎体成形术的疗效评价[J].中国矫形外科杂志,2011,16:1394-1395.
• [15]Kallmes DF,Jensen ME.Percutaneous vertebroplasty[J].Radiology,2003,229:27-36.
• [16]吕振木,杨中华,崔青,等.小剂量骨水泥椎体成形术治疗骨质疏松伴椎体压缩性骨折[J].中国矫形外科杂志,2010,12:1043-1044.