Abstract: 【Abstract】〓Objective〓To observe the effect of CT guided and the C arm X-ray guided percutaneous vertebrolplasty(PVP) in the treatment of senile osteoporotic with thoracolumbar compression fractures. Methods〓A retrospective data of thoracolumbar vertebral compression fractures in the elderly was analyzed in our hospital from June 2008 to October 2013. Twenty-eight cases with 34 vertebral body were received surgical treatment by CT guided PVP(11 cases and 13 compression vertebral body) and the C arm X-ray guided PVP (17 cases and 21 compressed vertebral bodies). The success rate of puncture,.preoperative and postoperative pain according to the WHO standards were recorded and analyzed. The clinical efficacy was evaluated by CT,DR check. Results〓The pain got eased in all post-operative patients according to criterion of WHO. The surgical time of CT guided PVP was from 35 to 60 minutes, with high success rate of puncture. Vertebral bone cement leakage occurred in one case. C arm X-ray guided surgery time ranged from 45 to 130 minutes. Vertebral side clearance leakage of bone cement, and intervertebral leakage occurred in one case respectively, without nerve compression symptoms and signs. Conclusion〓Both CT guided PVP and the C arm X-ray guided PVP can obtain effective pain relief for senile osteoporotic thoracolumbar compression fractures. CT guided surgery shows more accurate, safe and effective puncture.

Key words: PVP osteoporosis, Osteoporosis, Thoracolumbar compression fractures

摘要： 【摘要】〓目的〓观察经CT引导下及经C臂X线引导下行PVP治疗老年骨质疏松性胸腰椎压缩骨折的应用操作及临床疗效。方法〓回顾性分析我院从2008年6月至2013年10月共28例老年性胸腰椎椎体压缩性骨折患者,共涉及34个椎体,应用PVP治疗。其中CT引导组11例共13个压缩椎体,经CT导引下完成PVP操作;C臂X线引导组17例共21个压缩椎体,经C臂X线引导下完成PVP操作。根据手术时间、穿刺成功率观察临床操作情况,术前、术后疼痛按WHO标准进行比较、行CT、DR检查观察骨水泥分布、渗漏情况进行临床疗效评价。结果〓所有患者疼痛按WHO标准进行比较均得到明显缓解,均获得良好的骨水泥分布,无并发感染,无并发神经压迫症状、体征。经CT引导下手术时间35~60 min,穿刺成功率高;1例患者出现椎前骨水泥渗漏。C臂X线引导下手术时间45~130 min,部分患者需反复多次穿刺,操作困难,1例患者出现椎旁间隙骨水泥渗漏,1例出现椎间隙渗漏。结论〓经CT引导下及经C臂X线引导下两种方法PVP治疗老年骨质疏松性胸腰椎压缩性骨折均能获得良好的骨水泥分布及疼痛的有效缓解。两种方法各具优点,需临床根据术者穿刺技术熟练程度及经验选择;胸椎压缩骨折、特别是上胸椎压缩骨折、椎体压缩塌陷程度较重、胸腰椎侧弯椎体旋转、骨质疏松严重、X线显示骨质图像模糊难以良好辨认脊柱各结构者选用经CT引导下手术。

关键词: 椎体成形术, 骨质疏松, 胸腰椎, 压缩性骨折