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目的探讨选择性单侧入路椎体后凸成形、灌注由高到低多重粘度骨水泥治疗老年骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)后凸伴侧凸畸形的可行性和临床疗效。方法回顾性分析2013年6月—2015年10月,收治16例17椎OVCF,术前CT及X线片证实椎体前方伴侧方压缩,脊柱呈后凸伴侧凸畸形,选择椎体压缩明显的凹侧行单侧入路穿刺后凸成形术,扩张球囊复位伤椎的前方和侧方压缩,灌注由高到低梯度粘度骨水泥强化椎体。记录透视曝光次数和手术时间;比较术前、术后脊柱后凸畸形Cobb’s角、侧凸畸形Cobb’s角、伤椎高度、视觉模拟评分法(visual analogue scale,VAS)比较手术前后骨折相关疼痛,Owestry功能障碍指数(owestry disability index,ODI)评估日常活动。结果本组手术时间25~43 min,平均29.6 min;透视次数13~21次,平均18.6次;术后脊柱后凸及侧凸畸形Cobb’s角、伤椎前部、中部高度与术前比较,差异有统计学意义(P<0.05);VAS评分与ODI评分手术前后比较差异有统计学意义(P<0.01)。未发现症状性骨水泥渗漏、神经损伤等并发症。结论 OVCF后凸侧凸畸形是选择性单侧入路椎体后凸成形术的良好适应证,能够精准复位固定伤椎,多粘度骨水泥强化伤椎可减少渗漏,手术简便有效,放射曝光少。
Objective To explore the feasibility of selective unilateral vertebral kyphoplasty and perfusion of multi-viscous cements with osteoporotic vertebral compression fractures (OVCF) And clinical efficacy. Methods Retrospective analysis from June 2013 to October 2015, 16 cases were treated with OVCF vertebrae, preoperative CT and X-ray confirmed the anterior vertebral body with lateral compression, the spine was kyphosis with convex deformity, vertebral compression Obvious concave side of the line unilateral approach puncture kyphoplasty, expansion of the anterior and lateral reduction of the injured vertebra compression, perfusion of cement gradient from high to low gradient viscosity vertebral body. The number of fluoroscopic exposures and operation time were recorded. Cobb’s angle, kyphosis Cobb’s angle, vertebral height and visual analogue scale (VAS) were compared before and after operation to compare fracture-related pains before and after operation. Owestry Dysodial index (owestry disability index, ODI) to assess daily activities. Results The operation time ranged from 25 to 43 minutes (average 29.6 minutes). The number of fluoroscopy was from 13 to 21 times (mean, 18.6 times). The Cobb’s angle, the anterior and medial height of the injured vertebrae were significantly different from those before operation (P <0.05). There was significant difference between VAS score and ODI score before and after operation (P <0.01). No symptomatic bone cement leakage, nerve injury and other complications were found. Conclusions The convex kyphosis of OVCF is a good indication of selective kyphoplasty. It can precisely reset vertebral kyphoplasty, and multi-viscosity cement can reduce the leakage, and the operation is simple and effective. Radiation exposure less.