【摘要】 目的:总结经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折的临床效果,并观察骨水泥材料与宿主的生物相容性反应。方法:①患者对象:阳江市中医医院2003-02/2005-12收治的骨质疏松症性椎体压缩性骨折患者26例(32个椎体),在C形臂X射线机透视下,行经皮椎弓根途径椎体成形术治疗。其中65岁以下的8例患者(8椎体)在硬膜外麻醉下行体位及手法复位后再行经皮椎体成形术治疗。②骨水泥注入方法及途径:调配骨水泥为英国CORIN公司生产的低黏滞度聚甲基丙烯酸甲酯,在骨水泥中加入尹索显或欧乃派克,粉∶液∶造影剂比例为3∶2∶1。应用1mL专用注射器(美国COOK公司产品)经穿刺针将处于黏稠阶段的骨水泥注入椎体,当骨水泥达椎体后壁即停止注射。如果单侧穿刺骨水泥分布未超过椎体中线,则同时行另一侧椎弓根穿刺。③效果评估:观察椎体高度的恢复,采用目测类比评分法评估疼痛缓解程度,并发症发生情况与材料及宿主的反应。结果:26例均完成手术进入结果分析。①每椎体注射骨水泥3.5￣8.0mL,平均4.5mL,24h后即离床活动。②手法复位后行经皮椎体成形术者,椎体高度椎体高度恢复到正常的75%￣90%,随访≥12个月无椎体高度丢失。③术前目测类比评分为8.1(5.6￣9.5)分,术后为2.7(1.2￣4.8)分。23例患者腰痛术后24h内消失,3例陈旧性骨折患者腰痛术后部分缓解。④并发骨水泥椎旁渗漏4例4椎体,未发现特殊的材料和宿主反应;前引流静脉渗漏2例2椎体,无临床症状;穿剌针抽出脑脊液1例,改行另侧穿剌成功。结论:①经皮椎体成术治疗老年骨质疏松性椎体压缩骨折具有微创、见效快、疗效肯定的优点。②体位及手法复位后行经皮椎体成术,能大部分恢复椎体高度,适合于年龄相对较轻,椎体楔形压缩较多的患者。③只要操作熟练,单侧椎弓根穿刺即能达到临床目的。④骨水泥材料与宿主之间呈现较好的生物相容性。更多还原

【Abstract】 AIM: To summarize the clinical efficacy of percutaneous vertebroplasty (PVP) for treating vertebral compression fracture (VCF) in aged patients with osteoporosis, and observe the biocompatibility between bone cement and host. METHODS: ①Object: 26 old patients (32 vertebrae) with VCF, enrolled from Yangjiang Hospital of Traditional Chinese Medicine from February 2003 to December 2005, were treated with PVP with the help of C-arm fluoroscopy. Among them, 8 cases (8 vertebrae) aged below 65 years were treated with PVP under epidural anesthesia after body position and manipulative reduction.②Injection of bone cement: Bone cement was prepared with low-viscosity polymethylmethacrylate, the product of England CORIN Company, in mixture with iotrolan or iohexol. The powder, liquid and contrast media accorded with the rate of 3:2:1. Then the sticky bone cements were injected into vertebral body via a transfixion pin using 1 mL injector (America COOK Company), until the bone cement fulfilled the posterior wall of vertebral body. Bilateral paracentesis through pedicle of vertebral arch was performed when bone cement did not exceed vertebral median line.③Evaluation: The recovery of vertebral height was observed; pain relief was measured by visual analogue scale; complication and the reaction of materials and host were also detected. RESULTS: All of 26 patients were involved in the result analysis.①Each vertebrae was injected with bone cement 3.5-8.0 mL, mean 4.5 mL, and patients conducted ambulation 24 hours later.②After PVP with manipulative reduction, the vertebral height was recovered to 75%-90% of normal level, and no loss of vertebral height was found during the followed-up for more than 12 months.③The scores of visual analogue scale were 8.1 (5.6-9.5) points before operation and 2.7 (1.2-4.8) points after operation. Of the 26 cases, 23 patients obtained fully relief of pain within 24 hours, while the painful symptom of 3 obsolete fracture patients was relieved partly.④Bone cement leaked to the lateral vertebrae in 4 cases (4 vertebrae) and to ante-draining vein in 2 cases (2 vertebrae), there were no specific reaction of materials and host or clinical symptoms. Cerebrospinal fluid was drawn out in one patient, who was treated with contralateral puncturing. CONCLUSION: ①PVP is a mini-invasive, quick and affirmatively effective procedure for treating VCF in aged osteoporosis patients.②The vertebral height can be mostly recovered with PVP after body position and manipulative reduction, and it is suitable for the relatively younger patients with more grave wedge compression.③As long as we operate skillfully, vertebral puncture on single side pedicle of vertebral arch can obtain clinical effect.④There are good biocompatibilities between bone cement materials and host.更多还原