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球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折后骨坏死

Balloon kyphoplasty for osteoporotic vertebral compression fractures with osteonecrosis

摘要:

目的 探讨球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折后骨坏死的效果.方法 回顾性分析2005年1月至2008年1月收治的31例骨质疏松性椎体骨折后骨坏死患者的临床资料.其中男性13例,女性18例;年龄57~84岁,平均71岁;背部疼痛病史1个月~lO年.术前行x线片、CT、MRI等影像学检查.患者均行球囊扩张椎体后凸成形术治疗,术中取椎体内组织进行术后常规病理学检查.测量并比较术前、术后1 d及末次随访时站立位X线片伤椎前缘相对高度.采用疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评价手术疗效.结果 患者均获随访,随访时间18~48个月,平均27个月.术前与术后1 d伤椎前缘相对高度分别为(34.7±3.1)%和(71.4±2.3)%,差异有统计学意义(P<0.05);末次随访时为(70.2±2.5)%,与术后1 d相比差异无统计学意义(P>0.05).术前VAS及ODI评分分别为8.7±0.4和89.1±2.7,术后1 d分别为2.3±0.7和31.7±3.1,手术前后差异均有统计学意义(P<0.05);末次随访时分别为1.9±0.2和29.1±2.7,与术后1 d相比差异无统计学意义(P>0.05).所有指标数据末次随访时与术前比较,差异均有统计学意义(P<0.05).2例发生骨水泥渗漏,未出现临床症状.1例术后发生其他椎体骨折.结论 球囊扩张椎体后凸成形术是治疗骨质疏松性椎体骨折后骨坏死的有效方法.

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abstracts:

Objective To explore the clinical effcacy of the percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures with osteonecrosis.Methods The clinical data of 31 patients with osteoporotic vertebral compression fractures associated with osteonecrosis from January 2005 to January 2008 were analyzed retrospectively.There were 13 male and 18 female in this study.The mean age of the patients was 71 years(range from57 to 84 years).The back pain lasted for 4.2 months(from 1 month to 10 years).Radiography.MRI and CT examination were performed.The patients were treated by percutaneous balloon kyphoplasty and the vertebral body tissue was extracted to perform common pathological examination.The anterior vertebral height was measured on a standing lateral radiograph before operation,after operation (one day after operation)and at the final follow-up.A Visual Analog Scale(VAS)and the Oswestry Disability Index(ODI)were chosen to evaluate pain status and functional activity.Resuits The mean follow-up was for 27 months(range,18 to 48 months).The anterior vertebral body height of fracture vertebra was restored from(34.7±3.1)% preoperatively to(71.4±2.3)% postoperatively,and to(70.2±2.5)% at the final follow-up.There was a significant improvement between preoperative and postoperative values(P<0.05)and no difference between postoperatively and at the final follow-up(P>0.05).The VAS was 8.7±0.4 preoperatively,2.3±0.7 postoperatively,and 1.9±0.2 at the final follow-up;and the ODI was 89.1±2.7 preoperatively,31.7±3.1 postoperatively,and 29.1±2.7 at the final follow-up.There was statistically significant increment in the VAS and ODI postoperatively compared with preoperatively (P<0.05),while there was no statistically significant differences between postoperatively and at the final follow-up(P>0.05).There was a significant increment between preoperative and final follow-up values (P<0.05).Asymptomatic cement leakage occurred in two cases.New vertebral fracture occurred in one case.Conclusion Balloon kyphoplasty is a safe and effective procedure for osteoporotic vertebral compression fractures with osteonecrosis.

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作者: 王根林 [1] 杨惠林 [1] 姜为民 [1] 陈亮 [1] 孟斌 [1] 梅昕 [1] 陈康武 [1] 唐天驷 [1]
第一作者: 王根林
期刊: 《中华外科杂志》2010年48卷8期 593-596页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2010.08.010
发布时间: 2010-06-29
基金项目:
江苏省基础研究计划(自然科学基金)项目
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