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骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)的发病率逐年增高,我国每年大约有110万OVCF病人[1],50岁以上中老年病人中约有25%受其困扰[2]。对于OVCF的治疗,多数专家及学者建议行手术治疗,包括经皮椎体成形术(percutaneous vertebroplasty, PVP)及经皮椎体后凸成形术(percutaneous kyphoplasty,PKP),其创伤小,恢复快,有效缓解疼痛,可早期下地,有效避免卧床带来的并发症[3-7]。“三明治”型OVCF为一种特殊类型骨折,表现在一节完整的椎体上下邻近椎体均发生了OVCF,我们称之为夹心椎体。当对其上下骨折椎体进行骨水泥强化后,是否会双向增加其应力负荷,导致夹心椎体术后骨折。PITTON等[8]在2008年报道中,纳入11例病人,随访后发现夹心椎体骨折的发生率高达55%,由此引起部分专家及学者的重视。WANG等[9]在2012年通过对42例行PKP治疗的“三明治”型椎体进行随访发现,9例病人出现夹心椎体骨折,骨折率约为21%。由于受到双重压力负荷,导致椎体易于骨折[10]。将夹心椎体进行小剂量(约2mL)骨水泥强化后,在增加椎体本身强度和刚度的同时,可最大限度地减少本身强化带来的椎板变形及偏曲,减少对邻近骨折椎体的应力,并且可以有效避免骨水泥注入过多带来的渗漏及肺栓塞等并发症。笔者收集石家庄市第一医院2015年1月至2018年8月行PKP治疗的“三明治”型OVCF病人共58例,其中29例病人在常规行PKP基础上进行夹心椎体小剂量骨水泥(约2mL)预防性强化,另外29例夹心椎体不强化,随访观察夹心椎体骨折情况,分析“三明治”型OVCF病人行PKP时对夹心椎体进行小剂量骨水泥预防性强化的必要性。
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2组病人年龄、体质量指数及术前骨密度差异均无统计学意义(P>0.05)(见表 1)。
分组 n 年龄/岁 体质量指数/(kg/m2) 术前骨密度/(g/cm2) 观察组 29 74.1±5.1 22.7±2.0 -2.7±1.5 对照组 29 74.7±5.8 22.0±2.1 -2.9±1.4 t — 0.42 1.30 0.52 P — > 0.05 > 0.05 > 0.05 表 1 2组病人一般资料的比较(x±s)
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观察组有1例(3.45%)发生夹心椎体骨折,对照组有8例(27.59%)发生邻近椎体骨折,2组椎体骨折发生率差异有统计学意义(χ2=4.73,P < 0.05)。
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病人,女,78岁,于2016年10月出现T12、L2椎体新鲜压缩骨折,骨折3 d后行T12、L2 PKP治疗,L1预防性注入少量骨水泥,随访至今未发现L1椎体再骨折现象(见图 1)。
夹心椎体小剂量骨水泥预防性强化治疗“三明治”型骨质疏松性椎体压缩骨折的临床分析
Clinical analysis of small-dose bone cement prophylactic strengthening of sandwich vertebra in the treatment of "sandwich" osteoporotic vertebral compression fracture
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摘要:
目的探讨“三明治”型骨质疏松性椎体压缩骨折(OVCF)行椎体后凸成形术时对夹心椎体进行小剂量骨水泥预防性强化的必要性。 方法选择“三明治”型OVCF行椎体后凸成形术治疗的病人58例,其中观察组29例在常规行骨折椎体后凸成形术基础上进行夹心椎体小剂量骨水泥(约2 mL)预防性强化,对照组29例未行夹心椎体强化,随访观察夹心椎体骨折情况。 结果2组术前骨密度、年龄、体质量指数方面差异无统计学意义(P>0.05);观察组中有1例(3.45%)骨折发生,B组中有8例(27.59%)发生骨折,2组术后骨折率差异有统计学意义(χ2=4.73,P < 0.05)。 结论在常规对“三明治”型OVCF行椎体后凸成形术时,行夹心椎体小剂量骨水泥预防性强化能降低术后夹心椎体骨折风险。 Abstract:ObjectiveTo investigate the necessities of the small-dose bone cement prophylactic strengthening of sandwich vertebra in the treatment of "sandwich" osteoporotic vertebral compression fracture during percutaneous kyphoplasty. MethodsA total of 50 "sandwich" osteoporotic vertebral compression fracture patients treated with percutaneous kyphoplasty were selected, 29 cases were treated with the small-dose bone cement prophylactic strengthening of sandwich vertebra based on the conventional percutaneous kyphoplasty(observation group) and 20 cases were treated without sandwich vertebrula strengthening(control group).The incidence of sandwich vertebral fractures was followed up. ResultsThe differences of the preoperative bone mineral density, age and body mass index were not statistically significant between two groups(P>0.05).One case with fracture in the observation group and 8 cases with fractures in the control group were identified, and the difference of postoperative fracture rate between two groups was statistically significant(χ2=4.73, P < 0.05). ConclusionsIn the conventional percutaneous kyphoplasty of "sandwich" osteoporotic vertebral compression fracture, the small-dose bone cement prophylactic strengthening of sandwich vertebra can reduce the risk of postoperative sandwich vertebral fractures. -
表 1 2组病人一般资料的比较(x±s)
分组 n 年龄/岁 体质量指数/(kg/m2) 术前骨密度/(g/cm2) 观察组 29 74.1±5.1 22.7±2.0 -2.7±1.5 对照组 29 74.7±5.8 22.0±2.1 -2.9±1.4 t — 0.42 1.30 0.52 P — > 0.05 > 0.05 > 0.05 -
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