经皮脊柱后凸成形术中骨水泥的应用体会

【】　目的　探讨经皮脊柱后凸成形手术中骨水泥的应用疗效。　方法　2008年10月-2010年10月，应用注射用Ⅲ型丙烯酸树脂骨水泥及其椎体成形系统，采取经皮脊柱后凸成形术治疗40例椎体疾病患者。其中男5例，女35例；年龄53～84岁，平均65岁。老年骨质疏松性椎体压缩骨折37例，椎体恶性肿瘤2例，椎体血管瘤1例。采用视觉模拟评分（visualanaloguescale，VAS）对患者手术前后疼痛程度的改善情况进行评分统计，并观察术中及术后并发症的发生情况。　结果　患者出院前行脊柱正、侧位透视，发现椎体内骨水泥分布良好；3例有少量骨水泥向椎体外渗漏现象，但均无临床症状。所有患者获随访1～12个月，平均8个月。腰背部疼痛均明显缓解或消失，日常生活质量大大提高。术前VAS评分为（8.30±0.48）分，术后3d、1个月及末次随访时VAS评分分别为（3.11±0.41）、（2.50±0.36）、（2.50±0.36）分，与术前比较差异均有统计学意义（P<0.05）。　结论　骨水泥应用于经皮脊柱后凸成形手术中可取得很好疗效，固化的骨水泥对脊柱起到很好的支撑、稳定作用。【Abstract】　Objective　Toassesstheclinicaleffectofusingbonecementinpercutaneouskyphoplasty.　Methods　FromOctober2008toOctober2010,typeⅢAcrylicresinbonecementandthesystemofvertebroplastywereusedinpercutaneouskyphoplasty(PKP)totreat40patients.Therewere5malesand35femaleswithanaverageof65yearsold(53-84years).Therewere37olderpatientswithosteoporoticvertebralcompressionfracture,2casesofvertebraltumorandonehemangioma.Visualanaloguescale(VAS)wasusedtoevaluatethepainbeforeandaftertheoperation.Thecomplicationsinandaftertheoperationwerealsorecorded.　Results　Beforedischarge,posterior-anteriorandlateralX-rayfilmsweretakentoevaluatethedistributionofbonecement.Threepatientsshowedalittlebonecementleakagefromthevertebralbody,butnoclinicalsymptomswerefound.Allpatientswerefollowedfor1to12monthswithanaverageof8months.Paininthebackdecreasedobviouslyordisappeared,andthequalitiesofdailylifewereimprovedgreatly.ThescoreofVASwas(8.30±0.48)beforetheoperation,and(3.11±0.41),(2.50±0.36),and(2.50±0.36)3days,1monthaftertheoperation,andduringthelastfollow-up,respectively.SignificantdifferenceswerefoundbetweentheVASscorebeforeandafteroperation(P<0.05).　Conclusions　Goodresultscanbeexpectedwhenbonecementisusedinpercutaneouskyphoplasty.Solidifiedbonecementcaneffectivelysupportandstablizethespinalcolumn.