Zeng Ming, Zhao Xin-jian, Zhang Jian-ping, Tan Jian-shao
Department of Orthopedics, First People's Hospital of Foshan, Foshan 528000, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2006 May;26(5):640-3.
To compare the clinical efficacy of 3 approaches of vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures.
Twenty-five patients with severe osteoporotic vertebral compression fractures were observed, whose average age was 72 years with average disease history of 12 days and average compression of the affected vertebral bodies of 73%. The patients were divided into 3 groups for 3 different fracture types according to Rao's classification of osteoporotic vertebral structure and deformity, namely wedge type (group A, n= 12), biconcave type (group B, n= 7) and crush type (group C, n=6). Unipedicular approach was adopted in group A, far lateral bipedicular approach in group B, and posterior wall vertebroplasty and pedicle screw fixation in group C. The average follow-up time was 1 year. Visual analog scale (VAS), analgesic use and the mobility were measured in the patients preoperatively and 3 days (7 days in group C) and 6 months after the operation, respectively, and the success rates and complications were observed.
All the surgical procedures were successful. The average operation time was 35 min in group A, 50 min in group B, and 2 h in group C. The average volume of cement injected into each vertebral body was 2.0 ml. The average blood loss was 30 ml in groups A and B, and 600 ml in group C. The procedure increased mobility and decreased analgesic use. VAS was decreased by a mean of 4.8 in Group A, 6.2 in group B 3 days after the operation and 5.4 in group C 7 days postoperatively, and remained stable till 6 months after the operation (P<0.01). Cement extravasation occurred in 9 cases, cement in the vertebral canal in 2 cases with transient neurological symptoms, and cement extravasation in the intervertebral space and the anterior space of the vertebral bodies took place in 5 and 2 cases, respectively. No neurological complications were observed.
Different types of severe osteoporotic vertebral compression fractures require management with different approaches of vertebroplasty for adequate filling of the remaining vertebral body, which provides significant pain relief with wider indications.
比较三种椎体成形术治疗重度骨质疏松性椎体压缩骨折的临床疗效。
观察25例重度骨质疏松性椎体压缩骨折患者，平均年龄72岁，平均病程12天，患椎平均压缩率73%。根据Rao对骨质疏松性椎体结构和畸形的分类，将患者分为3组对应3种不同骨折类型，即楔形（A组，n = 12）、双凹形（B组，n = 7）和粉碎形（C组，n = 6）。A组采用单椎弓根入路，B组采用远外侧双椎弓根入路，C组采用后壁椎体成形术联合椎弓根螺钉固定。平均随访时间为1年。分别于术前、术后3天（C组为7天）和6个月测量患者的视觉模拟评分（VAS）、镇痛药使用情况及活动度，并观察成功率和并发症。
所有手术均成功。A组平均手术时间为35分钟，B组为50分钟，C组为2小时。每个椎体平均注入骨水泥量为2.0毫升。A组和B组平均失血量为30毫升，C组为600毫升。该手术增加了活动度并减少了镇痛药的使用。术后3天A组VAS平均下降4.8，B组下降6.2，C组术后7天下降5.4，至术后6个月保持稳定（P < 0.01）。发生骨水泥渗漏9例，椎管内骨水泥2例伴短暂神经症状，椎间隙及椎体前方骨水泥渗漏分别为5例和2例。未观察到神经并发症。
不同类型的重度骨质疏松性椎体压缩骨折需要采用不同的椎体成形术方法进行处理，以充分填充剩余椎体，从而更广泛地缓解疼痛。
