姜欢畅 张兆飞 杨晓东 刘志祥

[摘要] 目的 評价单侧可弯曲椎体成形术治疗骨质疏松胸腰椎压缩性骨折的安全性和疗效。 方法 回顾性分析2018年1月至2020年5月采用单侧可弯曲椎体成形术治疗的74例（85个椎体）骨质疏松胸腰椎压缩性骨折患者的资料。记录手术时间、术中透视次数、出血量、骨水泥注入量及分布情况，观察神经损伤、骨水泥渗漏、再骨折等并发症，分别测量术前、术后1 d及6个月的椎体高度压缩率和局部后凸 Cobb角，术前、术后1 d、术后6个月采用视觉模拟评分（VAS）评估患者背痛;术前、术后6个月采用Oswestry功能障碍指数（ODI）评估患者生活质量恢复情况。 结果 手术均顺利完成，切口甲级愈合，无感染、血管神经损伤、肺栓塞、骨水泥反应等并发症。手术时间21～53 min，平均（28.16±5.21）min;出血量2～9 mL，平均（3.41±0.17）mL;术中透视次数15～31次，平均（18.34±2.16）次;骨水泥注入量3.1～6.2 mL，平均（4.52±0.36）mL。骨水泥渗漏发生率为8.24%（7/85椎），未发生有症状的骨水泥渗漏。6个月内邻近节段骨折发生率4.05%（3/74例），无术椎的再发骨折。骨水泥分布良好率为91.76%（78/85椎）。术后1 d椎体高度压缩率、局部后凸Cobb角及VAS评分低于术前，差异有统计学意义（P<0.05）;术后6个月和术后1 d比较，差异无统计学意义（P>0.05）;ODI术后6个月低于术前，差异有统计学意义（P<0.05）。 结论 采用单侧可弯曲椎体成形术治疗骨质疏松胸腰椎压缩性骨折手术操作安全，疗效满意。

[关键词] 椎体成形术;脊柱骨折;骨质疏松;胸椎;腰椎

[中图分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2021）34-0081-04

[Abstract] Objective To evaluate the safety and efficacy of unilateral flexible vertebroplasty for the treatment of osteoporotic thoracolumbar compression fractures. Methods The data of 74 patients（85 vertebrae） with osteoporotic thoracolumbar compression fractures treated with unilateral flexible vertebroplasty from January 2018 to May 2020 were retrospectively analyzed. The operation time， the number of intraoperative fluoroscopy， blood loss， bone cement injection volume， and distribution were recorded. The nerve injury， bone cement leakage， and re-fracture were observed. The height compression rate of the vertebral body before the operation， 1 day after the operation， and 6 months after the operation， and local kyphotic Cobb angle were measured. Visual analog scale（VAS） was used to evaluate the back pain before the operation， 1 day after the operation， and 6 months after the operation. Oswestry dysfunction index（ODI） was used to assess the recovery of the patient's quality of life before and 6 months after the operation. Results All the operations were completed， and the incisions healed at grade A. There were no complications such as infection， vascular and nerve injury， pulmonary embolism， and bone cement reaction. The operation time was 21 to 53 minutes， with an average time of （28.16±5.21） min. The blood loss was 2-9 mL， with an average amount of （3.41±0.17） mL. The number of intraoperative fluoroscopy was 15 to 31， with an average number of （18.34±2.16） times. The injection volume of bone cement was 3.1～6.2 mL， with an average injection volume of （4.52±0.36） mL. The incidence of bone cement leakage was 8.24%（7/85 vertebrae）， and no symptomatic bone cement leakage occurred. The incidence of adjacent segmental fractures within 6 months was 4.05%（3/74 cases）， and there were no recurrences of the operated vertebral fractures. The good distribution rate of bone cement was 91.76%（78/85 vertebrae）. The height compression rate of the vertebral body， local kyphotic Cobb angle， and VAS scores one day after surgery were lower than those before surgery， and the differences were statistically significant（P<0.05）. There was no significant difference between 6 months after surgery and 1 day after surgery（P>0.05）. The ODI 6 months after surgery was lower than before surgery， and the difference was statistically significant（P<0.05）. Conclusion The use of unilateral flexible vertebroplasty for the treatment of osteoporotic thoracolumbar compression fractures is safe and effective.

[Key words] Vertebroplasty; Spinal fracture; Osteoporosis; Thoracic vertebrae; Lumbar vertebrae

骨质疏松性椎体压缩骨折（Osteoporotic vertebral compression fracture，OVCF）导致骨折椎体高度丢失、后凸畸形，引起顽固性胸腰背痛，影响患者生活质量，可引发严重并发症而导致死亡[1]。随着人口老龄化的加剧，OVCF发病率逐年上升，成为威胁老年人生存状态的严重社会问题，引起了广大骨科医师的重视[2]。……