【摘要】 目的：探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）联合抗骨质疏松综合治疗伴有椎体裂隙征（Intravertebral cleft,IVC）的老年胸腰椎压缩骨折患者近期临床疗效，为临床治疗提供参考。方法：回顾性分析2018年1月—2021年9月南京市中医院接受PVP联合抗骨质疏松综合治疗的37例单阶段伴有IVC的老年胸腰椎压缩骨折患者的临床资料，观察患者术后恢复情况，在术前、术后1周及末次（大于半年）随访拍摄正侧位X片，测量椎体局部后凸角及椎体前缘高度；并采用疼痛视觉模拟评分（VAS评分）及Oswestry功能障碍指数（ODI指数）评价患者术前术后疼痛和生活能力改善情况。结果：37例患者完成手术并接受抗骨质疏松，指导腰背肌功能锻炼等综合治疗，随访时间7～26个月，平均随访时间11.8个月；术中9例患者出现骨水泥外漏，渗漏率为24.32%；多为椎体前缘渗漏，未发生有症状的肺栓塞病例，术后腰背疼痛症状多在1个月内明显缓解，半年内仅部分患者留有腰部酸胀感，通过口服抗炎镇痛、肌松药等药物，联合指导腰背肌肉伸屈功能锻炼后好转。术后1周及末次随访与术前相比，患者椎体后凸角显著减少、椎体前缘高度显著增加，差异有统计学意义（t=16.21、18.42、17.11、22.72,P<0.05）。患者术后1周及末次随访的VAS评分、ODI指数较术前显著降低，差异有统计学意义（t=10.51、6.97、20.19、4.63,P<0.05）。结论：对于伴有IVC的老年胸腰椎压缩骨折，采用PVP结合抗骨质疏松综合治疗，取得明显的疗效。PVP能改善腰背部疼痛症状，预防病变进一步加重，此手术方法操作时间短，创伤小，疗效明显，但术中需灵活掌握手术技巧，预防骨水泥渗漏；术后仍需积极的抗骨质疏松治疗，辅以有效的康复锻炼指导及宣教。更多还原

【Abstract】 Objective:To investigate the recent clinical efficacy of percutaneous vertebroplasty(PVP) combined with anti-osteoporosis combination for the treatment of thoracolumbar compression fractures in elderly people with vertebral fracture signs, and to provide clinical reference.Methods:The clinical data of 37 elderly patients with single-stage thoracolumbar compression fractures with IVC who received combined anti-osteoporosis combination therapy in the hospital from January 2018 to September 2021 were retrospectively analyzed, the patients’ postoperative recovery was observed. Frontal and lateral radiographs were taken preoperatively, 1 week postoperatively, and at the last(>6 months) follow-up visit. The local posterior convexity angle of the vertebral body and the height of the anterior edge of the vertebral body were measured; and the pain visual analogue score(VAS score) and Oswestry dysfunction index(ODI index) were used to evaluate the improvement of pain and living ability of patients before and after surgery.Results:37 patients completed surgery and received comprehensive treatment including anti-osteoporosis and instruction of functional exercises for the low back muscles, with a follow-up period of 7 to 26 months and a mean follow-up period of11.8 months. Intraoperative cement leakage occurred in 9 patients, with a leakage rate of 24.32%, mostly from the anterior edge of the vertebral body, and no cases of symptomatic pulmonary embolism occurred. Most of the postoperative low back pain symptoms were significantly relieved within one month, and only some patients remained sore and swollen in the lumbar region within six months, which improved after oral anti-inflammatory and analgesic drugs, myorelaxants and other drugs, and joint instruction of functional exercises for extension and flexion of low back muscles. At 1 week and at the end of the postoperative period compared with the preoperative period, patients had a significant decrease in the posterior convexity angle of the vertebral body and a significant increase in the height of the anterior edge of the vertebral body at follow-up, and the differences were statistically significant(t=16.21, 18.42, 17.11, 22.72, P<0.05). Patients’ VAS scores and ODI indices were significantly lower at 1 week postoperatively and at the final follow-up compared with the preoperative period, with statistically significant differences(t=10.51, 6.97, 20.19,4.63, P<0.05).Conclusion:In elderly thoracolumbar compression fractures with vertebral fissure sign, PVP combined with anti-osteoporosis comprehensive treatment was used to achieve obvious efficacy. PVP can improve the symptoms of low back pain and prevent further aggravation of the lesion. This surgical method has short operation time, little trauma and obvious efficacy, but intraoperative flexibility is needed to master the surgical technique and prevent leakage of bone cement; postoperative active anti-osteoporosis treatment is still needed, supplemented by effective rehabilitation exercise guidance and propaganda.更多还原