【摘要】 [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。更多还原

【Abstract】 [Objective]To evaluate the clinical effect of percutaneous vertebroplasty under C-arm fluoroscopy guidance in the treatment of high thoracic osteoporotic vertebral compression fracture,and to analyze the careful points during the process of puncture.[Method]Thirty-five patients with high thoracic osteoporotic vertebral compression fracture were treated by infusing polymethylmethacrylate(PMMA) into vertebrae with percutaneous transpedicular approach under C-arm fluoroscopy guidance.They were 11 males and 24 females,with average age of 80 years(range,68-92 years).Thirty patients with single level fresh compression fracture and 5 patients with multiple levels old fracture were included in the study.The were T5 in 3 cases,T6 in 8 cases,T7 in 11 cases,T8 in 13 cases.The comparison of scores for pain severity,mobility,and analgesic requirement of pre-and postoperative as the assessment criteria,the clinical outcome were applied to statistical analysis.[Result]All patients were completedly in followed up from 18 months to 24 months(averaged,21 months).Compared with the preoperative one,pain severity,mobility,and analgesic requirement score showed statistical significance at 1 day,1 week,1,3,6,and 12 months postoperatively(P<0.05).The cement leakage observed on radiographs included slight leakage to the paravertebral soft tissues(2 cases) and the perivertebral venous plexus(1 cases),but no associated clinical symptoms occurred.Two patients occurred new fracture in the adjacent vertebrae within 6 months.No other serious complications such as pulmonary embolism,rib fracture,pneumothorax was found.[Conclusion]If the indications are respected,the clinical effect of percutaneous vertebroplasty under C-arm fluoroscopy guidance in the treatment of high thoracic osteoporotic vertebral compression fracture is excellent,it is worthy of popularization.It is vital significance of the operating experience of operator and being familiar with anatomic structure,because of the particularity of thoracic vertebra anatomic structure and the importance of adjacent tissues or organs.更多还原