老年无神经损伤胸腰椎爆裂骨折经皮椎体成形术

Percutaneous vertebroplasty for thoracolumbar burst fractures without nerve deficit in the elderly

摘要:

[目的]探讨经皮椎体成形术治疗无神经损伤老年椎体爆裂骨折的临床疗效。[方法]2017 年 9 月—2020 年 9 月 48 例无神经损伤老年椎体爆裂骨折的患者纳入本研究，采用经皮椎体成形术 （percutaneous vertebroplasty, PVP） 治疗。观察术后临床与影像指标。[结果] 48 例患者均顺利完成手术，术中均无严重血管、神经损伤，有 8 例患者出现骨水泥渗漏，渗漏率 16.7%，术后均未出现骨水泥栓塞、骨水泥渗漏引起的神经症状等严重并发症。术后随访 9~36 个月，平均随访时间 （23.3± 3.6）个月。与术前相比，术后第 1 d 及末次随访时 VAS 评分、ODI 评分均显著降低（P＜0.05）。影像方面，术后伤椎前缘相对高度显著增加（P＜0.05），伤椎后凸 Cobb 角显著减小（P＜0.05），至末次随访时，均未见邻近节段新发骨折。[结论]PVP 治疗无神经损伤的老年椎体爆裂骨折疗效可靠。

Abstract:

[Objective] To investigate the clinical outcomes of percutaneous vertebroplasty (PVP) for thoracolumbar burst fractures without nerve deficit in the elderly. [Methods] Forty-eight elderly patients received PVP for thoracolumbar burst fractures without nerve deficit from September 2017 to September 2020. The clinical and radiographic documents were analyzed. [Results] All the 48 patients had operation conducted smoothly without serious complications. Of them, 8 patients proved bone cement leakage, accounting for 16.7%, where- as which not led to severe consequences, such as cement embolism and nerve injuries. As time went in the follow-up period lasted from 9 to 36 months with an average of (23.3±3.6) months, the VAS and ODI scores significantly decreased (P＜0.05). Radiographically, the relative anterior vertebral height significantly increased, whereas the local kyphotic Cobb angle significantly declined postoperatively compared with those preoperatively (P＜0.05). Until the latest follow up, no new-occurred fracture or adjacent segment fracture was found in anyone of them. [Conclusion] PVP is still a reliable treatment for thoracolumbar burst fractures without nerve injury in the elderly.