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目的:探讨数字减影血管造影(DSA)导向下中医手法整复配合微创、中西医结合治疗高龄重症胸腰椎压缩骨折及操作注意事项。方法:对16例(共19个椎体)高龄重症骨质疏松性胸腰椎压缩骨折患者,在DSA导向下行中医手法复位,整复后分别施以经皮椎体成形术(PVP)术式(5例,6个椎体)、经皮椎体后凸成形术(PKP)术式(11例,13个椎体)微创治疗。结果:13例患者得到有效随访,随访时间为4～27月,平均随访16.3月。术后1～24h患者腰背部疼痛均缓解,2组术后2周及随访时视觉模拟评分(VAS)与术前比较,差异均有显著性意义(P<0.05);2组随访时VAS评分与术后2周比较,差异均无显著性意义(P>0.05);无脊髓神经损伤、肺栓塞等并发症。结论:中医手法整复配合DSA导向精准定位PVP及PKP对于高龄重症胸腰椎压缩骨折的治疗是可行的。术前采用中医手法整复,可较好恢复椎体的高度,为PKP或PVP术中骨水泥的注入提供了更多的空间。运用DSA导向可在术中协助判断椎体复位情况,快速精准定位,即时观察骨水泥分布,有效预防骨水泥渗漏等严重并发症。围手术期运用中西医结合治疗,缩短了疗程,保证了手术的成功和减少并发症。因此,中医手法整复配合DSA导向微创手术中西医结合治疗高龄重症胸腰椎压缩骨折安全有效,临床值得推广。
Objective: To investigate the treatment of elderly patients with severe thoracolumbar vertebral compression fractures under the direction of digital subtraction angiography (DSA) guided by traditional Chinese medicine (TCM) combined with minimally invasive and integrative medicine. Methods: Thirty-six patients (19 vertebrae) with severe osteoporotic thoracolumbar vertebral compression fracture underwent DSA-guided reduction with traditional Chinese medicine (TCM), and were treated with percutaneous vertebroplasty (PVP) 5 cases, 6 vertebrae), minimally invasive treatment of percutaneous kyphoplasty (PKP) (11 cases, 13 vertebrae). Results: Thirteen patients were effectively followed up for 4-27 months with an average follow-up of 16.3 months. The pain of lower back in 1 ~ 24h after operation was relieved. There was significant difference between the two groups in visual analog scale (VAS) at 2 weeks after operation and before operation (P <0.05). The VAS score Compared with 2 weeks after operation, there was no significant difference (P> 0.05). No spinal nerve injury, pulmonary embolism and other complications. Conclusion: The manipulation of traditional Chinese medicine combined with DSA-guided precise positioning of PVP and PKP is feasible for the treatment of severe thoracolumbar vertebral compression fractures. Preoperative rehabilitation using traditional Chinese medicine method can restore vertebral height, PKP or PVP intraoperative bone cement injection provides more space. The use of DSA guidance can help judge the situation of vertebral body reduction during operation, quickly and accurately locate the bone cement distribution and effectively prevent serious complications such as bone cement leakage. Perioperative use of integrated traditional Chinese and Western medicine treatment, shortening the course of treatment to ensure the success of surgery and reduce complications. Therefore, the traditional Chinese medicine method combined with DSA-guided minimally invasive surgery in the treatment of advanced age with severe thoracolumbar compression fractures is safe and effective, clinical worth promoting.