【摘要】 目的 探討經皮脊柱后凸成形手術中骨水泥的應用療效。 方法 2008年10月-2010年10月，應用注射用Ⅲ型丙烯酸樹脂骨水泥及其椎體成形系統，采取經皮脊柱后凸成形術治療40例椎體疾病患者。其中男5例，女35例；年齡53～84歲，平均65歲。老年骨質疏松性椎體壓縮骨折37例，椎體惡性腫瘤2例，椎體血管瘤1例。采用視覺模擬評分（visual analogue scale，VAS）對患者手術前后疼痛程度的改善情況進行評分統計，并觀察術中及術后并發癥的發生情況。 結果 患者出院前行脊柱正、側位透視，發現椎體內骨水泥分布良好；3例有少量骨水泥向椎體外滲漏現象，但均無臨床癥狀。所有患者獲隨訪1～12個月，平均8個月。腰背部疼痛均明顯緩解或消失，日常生活質量大大提高。術前VAS評分為（8.30±0.48）分，術后3 d、1個月及末次隨訪時VAS評分分別為（3.11±0.41）、（2.50±0.36）、（2.50±0.36）分，與術前比較差異均有統計學意義（Plt;0.05）。 結論 骨水泥應用于經皮脊柱后凸成形手術中可取得很好療效，固化的骨水泥對脊柱起到很好的支撐、穩定作用。【Abstract】 Objective To assess the clinical effect of using bone cement in percutaneous kyphoplasty. Methods From October 2008 to October 2010, type Ⅲ Acrylic resin bone cement and the system of vertebroplasty were used in percutaneous kyphoplasty (PKP) to treat 40 patients. There were 5 males and 35 females with an average of 65 years old (53-84 years). There were 37 older patients with osteoporotic vertebral compression fracture, 2 cases of vertebral tumor and one hemangioma. Visual analogue scale (VAS) was used to evaluate the pain before and after the operation. The complications in and after the operation were also recorded. Results Before discharge, posterior-anterior and lateral X-ray films were taken to evaluate the distribution of bone cement. Three patients showed a little bone cement leakage from the vertebral body, but no clinical symptoms were found. All patients were followed for 1 to 12 months with an average of 8 months. Pain in the back decreased obviously or disappeared, and the qualities of daily life were improved greatly. The score of VAS was (8.30±0.48) before the operation, and (3.11±0.41), (2.50±0.36), and (2.50±0.36) 3 days, 1 month after the operation, and during the last follow-up, respectively. Significant differences were found between the VAS score before and after operation (Plt;0.05). Conclusions Good results can be expected when bone cement is used in percutaneous kyphoplasty. Solidified bone cement can effectively support and stablize the spinal column.
【摘要】 目的 評價Bryan人工椎間盤單節段置換治療頸椎間盤退變性疾病的臨床療效。 方法 2004年11月—2008年4月，21例頸椎間盤退變突出并經保守治療無效的患者接受Bryan人工頸椎間盤單節段置換術。患者術前、術后1、6、12、18、24個月時使用頸椎功能障礙指數（neck disable index，NDI）、癥狀程度主觀評價、疼痛視覺模擬疼痛量表（visual analogue scale，VAS）進行療效評估，手術效果使用Odom法評價。影像學檢查包括頸椎功能位X線片、頸椎CT及MRI檢查。 結果 21例患者均順利完成椎間盤置換手術，術后隨訪2年。患者對癥狀的主觀評分，頸痛VAS評分、手臂疼痛VAS評分，NDI分別由術前的（2.80±0.42）、（4.62±1.84）、（5.01±1.79）、（22.60±4.88）分下降到隨訪終止時的（0.20±0.42）、（1.01±0.56）、（0.82±0.24）、（4.30±1.25）分。所有患者對手術效果Odom 評級優良，8例（38.1%）自覺癥狀完全緩解。手術過程平均時間為（110.5±42.6） min，術中出血量平均為（166.0±108.8） mL。影像學評價見植入的人工椎間盤運動功能良好，未見頸椎不穩的表現。2例假體在術后早期輕度前移。 結論 Bryan人工椎間盤單節段置換是治療頸椎間盤退變性疾病的一種安全有效的方法，術后隨訪2年臨床療效滿意。【Abstract】 Objective To evaluate the clinical therapeutic effect of single segment Bryan disc replacement on cervical disc degenerative diseases. Methods From November 2004 to April 2008, 21 patients who had a poor response after conservative treatment for their cervical disc degeneration underwent the single level Bryan disc replacement. Before the operation and 1, 6, 12, 18, and 24 months after the operation, all patients were evaluated by neck disable index (NDI), subjective symptom scale, visual analogue scale (VAS) and Odom score. The radiological examinations included X-ray, CT scan and MRI. Results Operations were successfully executed in 21 patients. All patients had obeyed the follow-up visiting at the expected time in the next two years after the operation. Patients′ symptom scale, VAS for neck pain, VAS for arm pain, NDI were 2.80±0.42, 4.62±1.84, 5.01±1.79, and 22.60±4.88, respectively before the operation and significantly decreased to 0.20±0.42, 1.01±0.56, 0.82±0.24, and 4.30±1.25, respectively at the end of the follow-up. All patients had good or higher score of the Odom score. The ymptoms were completely relieved in eight patients (38.1%). The mean operation time was (110.5±42.6) minutes, the average blood loss was (166.0±108.8) mL. The normal motion of the artificial disc was observed. No cervical instability was observed. Two prosthesis migrated slightly. Conclusion Single segmental Bryan disc replacement is safe and effective on the cervical disc degeneration. The two-year follow-up reveales a satisfied clinical outcome.
