摘要
目的改进多椎体压缩骨折行椎体后凸成形术(PKP)的手术技巧。方法回顾、总结和比较多椎体PKP两种手术操作方法的差异。48例60岁以上骨质疏松性多椎体(3个及以上)骨折患者其中,常规手术组(C组)20例82椎,手术节段3～6个椎体(平均4.1椎体),分布范围T_5～L_5,常规PKP手术技术和流程进行定位、穿刺、球囊扩张、聚甲基丙烯酸甲酯骨水泥灌注,完成一个椎体后行第二个椎体手术。改良手术组(M组)28例112椎体,手术节段3～7个(平均4.0椎体),分布范围T_4～S_1,采用改良操作技术和流程,定位、经椎弓根基底途径穿刺、双椎体同时穿刺或二重穿刺注射等方法进行手术。两组均局部麻醉下行单侧穿刺手术,术中静脉注射地塞米松20mg,如骨水泥分布未超过中线则增加对侧手术。比较两组术前和术后3d疼痛视觉模拟评分(VAS)、手术时间、骨水泥灌注量、骨水泥外漏发生率和临床并发症。结果 C组和M组术前VAS评分分别为(8.6±2.3)和(8.2±1.9),术后3 d时VAS评分分别为(3.5±2.6)和(3.2±3.0),组间比较无明显差异。C组14个椎体(15.73%)行双侧手术,明显高于M组的1个椎体(0.89%)(P<0.0001)。骨水泥灌注量,C组每例8.0～23.1ml[平均(15.3±3.1)m1],M组每例8.5～25.5 ml[平均(16.2±4.1)ml];骨水泥外漏发生率在C组为19.5%,在M组为1 8.75%,两组间骨水泥总量和外漏率无明显差异(P>0.05)。C组手术时间每例为70～230min,每椎体(26.9±6.7)min,M组每例45～162min,每椎体(1 6 3±5.2)min,M组每椎体平均手术时间远低于C组(P<0.001)。两组均末发生临床并发症。结论改进手术操作技术和流程可缩短多椎体PKP手术时间,减少双侧穿刺次数。聚甲基丙烯酸甲酯骨水泥灌注总量在26ml以内可能是安全的。
Objective To improve the therapeutic results of multilevel osteoporotic vertebral compression fracture in the elderly with modified percutaneous kyphoplasty（PKP） technique.Methods Forty-eight patients over 60 years suffering from multilevel（3 or more levels） vertebral compression fracture were divided into two groups：common PKP group（group C） and modified PKP group（group M）.In group C,there were 20 patients with 82 vertebraes from T_5-L_5.Three to six surgical levels（average 4.1 levels） were processed with routine PKP technique.In group M,there were 28 cases with 112 vertebraes from T_4-S_1.Three to seven surgical levels were processed with modified PKP technique.Local anesthesia was performed in both groups.Dexamethasone（20mg） was used in group M.Additional puncture were carried out if the distribution of bone cements was not satisfactory.The visual analog scale（VAS） scores,duration of surgical procedure,volume of bone cements,rate of leaking and clinical complications were analyzed and compared between the two groups.Results The VAS scores were（8.6±2.3） and（8.2±1.9） before the surgery,and（3.5±2.6） and（3.2±3.0） at 3 days after surgery in group C and group M respectively.There was no significant difference between the two groups.Fourteen vertebral bodies were processed in both sides in group C（15.73%）,and only 1 vertebral body was processed in both sides in group M（0.89%）（P0.0001 ）.The volume of bone cements was 8.0-23.1（15.3±3.1 ） ml in group C and 8.5-25.5 （16.2±4.1 ） ml in group M.The leaking rate of cements was 19.5%in group C and 18.75%in group M.The duration of surgical procedures was 70-230min[（26.9±6.7）min/level]in group C and 45-162 min[（16.3±5.2）min/level]（P0.001 ）.No clinical complication was observed in either group.Conclusion Modified PKP technique can shorten the duration of surgical procedures and allow less puncture.It is safe to keep the volume of injection under 26ml.
出处
《中华老年多器官疾病杂志》
2011年第5期397-400,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
经皮椎体后凸成形术
骨内压
骨水泥
骨折
压缩性
percutaneous kyphoplasty
intraossous pressure
bone cement
vertebral compression fracture
