CT下椎体成形术对骨质疏松性椎体压缩骨折的疗效观察

（沈建雄教授的文稿）

【摘　要】　目的：观察椎体成形术治疗骨质疏松性椎体压缩骨折的临床效果。方法：2000年3月以来，应用椎体成形术治疗20例20个椎体骨质疏松性椎体压缩骨折患者，并观察疗效。结果：术后1～2天所有患者疼痛消失或明显减轻，2-3天后下地活动。随访3～12个月，所有患者疼痛无反复。无严重并发症发生。结论：椎体成形术治疗骨质疏松性胸腰椎椎体压缩性骨折是一种简单、安全、经济、有效的治疗方法，但是也有一定的并发症出现，该技术需要进行不断改进，严格操作指证。【关键词】　椎体成形术　骨质疏松　压缩性骨折 治疗 The research of vertebroplasty for osteoporosis vertebral compressed fracture under CT Abstract: Objective: To investigate the effects of the treatment of osteoporotic compressed vertebral fracture by vertebroplasty. Methods: Since March 2000, 20 patients of this kind of disease with 20 vertebras were treated by vertebroplasty and the effects were observed. Results: All patients feel pain disappeared or decrease significantly in one to two days later after the operation. They could walk around in the next day or three days later after the operation. All patients have no pain again in three to twelve months followed. There was no severe complication. Conclusion: This kind of technique is a simple, safe, economic and effective treatment means. However, there are some complications. So the technique should be improved step by step and the operation applications should be strict. Key words: Vertebroplasty osteoporotic compressed fracture treatment 经皮椎体成形术（Percutaneous Vertebroplasty，PVP）是一种在影像引导下治疗疼痛性椎体压缩骨折的脊柱外科微创技术[1]，国内近来有一些报道。我院骨科自2000年3月起应用局部麻醉，在CT下经椎弓根注入骨水泥，行椎体成形术治疗骨质疏松性椎体压缩骨折，疗效满意。 Percutaneous Vertebroplasty is a kind of technology to treat painful vertebral compressed fracture under image leading (1). There are some reported files recently in our country. Since March 2000, in our hospital, we have used this kind of technology to treat osteoporotic vertebral compressed fracture under Ct scanning by injecting bone cement through pedicels. The effects are satisfaction. 一、一般资料 2000年3月至今，行经皮椎体成形术共20例，20个椎体，其中Ｌ16个，Ｌ23个，Ｌ32个，Ｌ42个，Ｔ121个。男。女12例。年龄33岁～85岁，平均62岁。骨水泥种类有锶羟基磷灰石活性骨水泥、PMMA和强生骨水泥。 1. General information Since March 2000, we have used vertebroplasty in 20 cases with 20 vertebras. In these vertebras, six segments of Ｌ1，three segments of Ｌ2, two segments of Ｌ3, two segments of Ｌ4, one segment of Ｔ12. There are eight males and twelve females. Average 62 years old (from 33~85 years old). Three kinds of bone cements which were active Strontium hydroxyapatite cement, PMMA and Johnson ＆ Johnson Medical bone cement. 二、手术方法 1、体位：俯卧位于CT检查台上。 2、麻醉：均局部麻醉。本组20例20个椎体全部用2%的利多卡因局麻完成手术。 3、入路：通常采用经椎弓根入路，背部贴附定位标尺，术前ＣＴ测量定位入针点。用皮质开口器穿透椎弓根后侧皮质，再次CT扫描，确定角度。 1.2.Operation Methods: 1.2.1 Posture: Pronate on CT scanning table. 1.2.2 Anesthesia: All cases were operated in local anesthesia with 20% Lidocaine. 1.2.3. Pathway: Generally through pedicels. After attached a staff guage on one’s back, the vertebras were located by CT scanning. After CT scanning to locate vertebra and to point out the needle site, we use the cortex puncture needle to penetrate the pedicels, then CT scan again to locate the needle’s angle. 4、建立工作通道：按照CT指示，逐渐进针，到达椎体前1/3处。取出导针。 5、将骨水泥或可注射性人工骨调和至适当粘度，用5ml注射器加压注入椎体，CT扫描观察充填及扩散情况。注入量约4ｍｌ～8ｍｌ，平均6ml。术中注意询问患者有无不适。 6、退出套管，缝合皮肤1针或不予缝合，仅胶布拉紧粘贴。观察10分钟，生命体征平稳，结束手术。 4、建立工作通道：按照CT指示，逐渐进针，到达椎体前1/3处。取出导针。 5、将骨水泥或可注射性人工骨调和至适当粘度，用5ml注射器加压注入椎体，CT扫描观察充填及扩散情况。注入量约4ｍｌ～8ｍ