目的探讨球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的疗效及安全性。方法回顾性分析我院2008年7月至2012年7月80例老年骨质疏松脊柱压缩骨折患者的临床资料,手术前后分别进行视觉模拟疼痛评分(visual analog scale,VAS),椎...目的探讨球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的疗效及安全性。方法回顾性分析我院2008年7月至2012年7月80例老年骨质疏松脊柱压缩骨折患者的临床资料,手术前后分别进行视觉模拟疼痛评分(visual analog scale,VAS),椎体前缘高度、中缘高度、Cobb’s角测量以及患者生活质量评分。结果本组患者术后疼痛均得到有效控制,术前椎体前缘高度与中缘高度分别为(56.02±12.08)%、(58.19±13.11)%,术后分别为(72.10±16.19)%、(78.33±19.02)%,较术前均有明显恢复;VAS评分由术前的(8.31±1.22)分降低至术后的(1.65±0.33)分;Cobb’s角由术前的(24.12±3.28)°降低至术后的(13.56±2.05)°。手术前后前缘高度、中缘高度、VAS评分及Cobb’s角度差异均具有统计学意义(P<0.05)。并发症发生率由术前的23.75%降低至术后的1.25%,二者差异具有显著的统计学意义(P<0.01)。根据QLQC-30生活质量评分,患者术后生活质量明显优于术前,各项统计指标差异均有统计学意义(P<0.05)。结论球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折,疗效显著,安全性高,值得临床推广应用。展开更多
This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who receiv...This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in 展开更多
目的分析骨质疏松性椎体压缩性骨折(OVCF)患者球囊椎体后凸成形术(BKP)后骨水泥渗漏与球囊扩张压力(BEP)的关系。方法回顾性分析在我院接受BKP的116例老年OVCF患者的临床资料,根据术前和术后72 h X射线检查和CT增强扫描结果,评估疗效和...目的分析骨质疏松性椎体压缩性骨折(OVCF)患者球囊椎体后凸成形术(BKP)后骨水泥渗漏与球囊扩张压力(BEP)的关系。方法回顾性分析在我院接受BKP的116例老年OVCF患者的临床资料,根据术前和术后72 h X射线检查和CT增强扫描结果,评估疗效和骨水泥渗漏发生情况。根据是否发生骨水泥渗漏将患者分为骨水泥渗漏组和无骨水泥渗漏组。采用视觉模拟量表(VAS)评分评估患者的疼痛程度,Barthel指数评分法评估日常生活障碍。采用受试者工作特征(ROC)曲线分析BEP和骨水泥体积预测骨水泥渗漏的曲线下面积(AUC)和最佳截断值。采用多因素Logistic回归分析影响骨水泥渗漏的危险因素。结果单节段手术82例,双节段手术27例,三节段手术7例,共涉及157节椎体。患者术后椎体前缘高度、椎体后缘高度和矢状面局部后凸Cobb角、胸腰椎后凸角均得到显著矫正,且VAS评分和Barthel指数评分均较术前改善(P<0.05)。术后24例患者发生骨水泥渗漏,其中1例发生骨水泥肺栓塞(BEP)。骨水泥渗漏组术中BEP和骨水泥体积明显大于无骨水泥渗漏组(P<0.05)。经ROC曲线分析显示,术中BEP(AUC=0.756)和骨水泥体积(AUC=0.661)都可以预测骨水泥渗漏,最佳截断值分别为135 psi和6.08 mL。多因素Logistic回归分析显示,BEP≥135 psi是骨水泥渗漏的危险因素(OR=1.038,95%CI:1.018~1.058,P<0.001)。结论BKP是治疗老年OVCF的安全有效方案,BEP较高是骨水泥渗漏的危险因素,BEP≥135 psi的患者骨水泥渗漏的风险较高。展开更多
目的评价应用经皮球囊扩张椎体后凸成形术治疗对疼痛性胸腰椎骨质疏松压缩骨折止痛效果和对椎体高度恢复的影响。方法应用球囊扩张椎体后凸成形术治疗胸腰椎骨质疏松压缩骨折患者45例85椎（T4-L4）,年龄53~86岁（平均71岁）,有症状的节...目的评价应用经皮球囊扩张椎体后凸成形术治疗对疼痛性胸腰椎骨质疏松压缩骨折止痛效果和对椎体高度恢复的影响。方法应用球囊扩张椎体后凸成形术治疗胸腰椎骨质疏松压缩骨折患者45例85椎（T4-L4）,年龄53~86岁（平均71岁）,有症状的节段均做MRI证实。手术后当天和术后随访分别进行疼痛得分VAS（visual analog scale）测定;手术前后在侧位X线片测量骨折椎体前、中部的高度。结果球囊扩张椎体后凸成形术可以快速止痛、明显增加脊柱负重能力,术后24个月患者疼痛得分从8.3分降至2.2分,手术后85例骨折椎体前、中部的高度增加到了原椎体高度的（78.82±21.84）%和（72.35±22.65）%。椎体楔形变从15°降至10°,这种结果至少保持2年时间。无一例造成骨折后椎管狭窄加重,无严重并发症的发生。结论球囊扩张椎体后凸成形术可以快速改善运动功能和减轻疼痛。可安全增加椎体高度,迅速恢复老年患者行走能力,效果优良。展开更多
We used the finite element method (FEM) to investigate the stress profiles of vertebrae in patients who underwent balloon kyphoplasty (BKP) for vertebral fracture. BKP is often performed for persistent pain after vert...We used the finite element method (FEM) to investigate the stress profiles of vertebrae in patients who underwent balloon kyphoplasty (BKP) for vertebral fracture. BKP is often performed for persistent pain after vertebral fractures. However, fractures are frequently reported in the adjacent vertebrae after BKP. The purpose was to clarify the mechanism of fractures that occur in the adjacent vertebrae after BKP. The subjects were two patients (first case: 74-year-old woman;second case: 88-year-old woman) who had BKP for osteoporotic vertebral fractures (L1). A bone analysis software program, Mechanical Finder, was used to construct three-dimensional finite element models (T11-L3) from computed tomographic (CT) digital imaging and communications in medicine (DICOM) data. Moment loadings were examined to evaluate stress concentrations on the vertebrae. Young’s moduli were lower in the second case than in the first case at all vertebral levels. Maximum Drucker-Prager stresses after BKP were larger in the second case than in the first case for compression, flexion, extension, and axial rotation. Strain energy density decreased in L1 and increased in the adjacent ver-tebrae. Our results suggest that post-BKP fractures of the adjacent vertebrae not only are due to bone fragility, but also can be caused by increased rigidity in the vertebrae filled with bone cement, which increases stress concentration on the adjacent verte-brae and raises the likelihood of fracture.展开更多
文摘目的探讨球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的疗效及安全性。方法回顾性分析我院2008年7月至2012年7月80例老年骨质疏松脊柱压缩骨折患者的临床资料,手术前后分别进行视觉模拟疼痛评分(visual analog scale,VAS),椎体前缘高度、中缘高度、Cobb’s角测量以及患者生活质量评分。结果本组患者术后疼痛均得到有效控制,术前椎体前缘高度与中缘高度分别为(56.02±12.08)%、(58.19±13.11)%,术后分别为(72.10±16.19)%、(78.33±19.02)%,较术前均有明显恢复;VAS评分由术前的(8.31±1.22)分降低至术后的(1.65±0.33)分;Cobb’s角由术前的(24.12±3.28)°降低至术后的(13.56±2.05)°。手术前后前缘高度、中缘高度、VAS评分及Cobb’s角度差异均具有统计学意义(P<0.05)。并发症发生率由术前的23.75%降低至术后的1.25%,二者差异具有显著的统计学意义(P<0.01)。根据QLQC-30生活质量评分,患者术后生活质量明显优于术前,各项统计指标差异均有统计学意义(P<0.05)。结论球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折,疗效显著,安全性高,值得临床推广应用。
基金supported by National Natural and Science Foundation(81271988)Jiangsu Natural and Science Foundation (BK2012876)
文摘This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in
文摘目的评价应用经皮球囊扩张椎体后凸成形术治疗对疼痛性胸腰椎骨质疏松压缩骨折止痛效果和对椎体高度恢复的影响。方法应用球囊扩张椎体后凸成形术治疗胸腰椎骨质疏松压缩骨折患者45例85椎（T4-L4）,年龄53~86岁（平均71岁）,有症状的节段均做MRI证实。手术后当天和术后随访分别进行疼痛得分VAS（visual analog scale）测定;手术前后在侧位X线片测量骨折椎体前、中部的高度。结果球囊扩张椎体后凸成形术可以快速止痛、明显增加脊柱负重能力,术后24个月患者疼痛得分从8.3分降至2.2分,手术后85例骨折椎体前、中部的高度增加到了原椎体高度的（78.82±21.84）%和（72.35±22.65）%。椎体楔形变从15°降至10°,这种结果至少保持2年时间。无一例造成骨折后椎管狭窄加重,无严重并发症的发生。结论球囊扩张椎体后凸成形术可以快速改善运动功能和减轻疼痛。可安全增加椎体高度,迅速恢复老年患者行走能力,效果优良。
文摘We used the finite element method (FEM) to investigate the stress profiles of vertebrae in patients who underwent balloon kyphoplasty (BKP) for vertebral fracture. BKP is often performed for persistent pain after vertebral fractures. However, fractures are frequently reported in the adjacent vertebrae after BKP. The purpose was to clarify the mechanism of fractures that occur in the adjacent vertebrae after BKP. The subjects were two patients (first case: 74-year-old woman;second case: 88-year-old woman) who had BKP for osteoporotic vertebral fractures (L1). A bone analysis software program, Mechanical Finder, was used to construct three-dimensional finite element models (T11-L3) from computed tomographic (CT) digital imaging and communications in medicine (DICOM) data. Moment loadings were examined to evaluate stress concentrations on the vertebrae. Young’s moduli were lower in the second case than in the first case at all vertebral levels. Maximum Drucker-Prager stresses after BKP were larger in the second case than in the first case for compression, flexion, extension, and axial rotation. Strain energy density decreased in L1 and increased in the adjacent ver-tebrae. Our results suggest that post-BKP fractures of the adjacent vertebrae not only are due to bone fragility, but also can be caused by increased rigidity in the vertebrae filled with bone cement, which increases stress concentration on the adjacent verte-brae and raises the likelihood of fracture.
