球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折

Transpedicular balloon kyphoplasty for aged osteoporotic spinal compressive fractures

目的探讨用球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折.方法共10例患者,男7例,女3例;年龄57～72岁,平均67岁;病变部位:T11 1例,T12 4例,L1 5例.在'C'型臂X线机引导下,采用经皮穿刺方法,经椎弓根将一中空管道置入伤椎以建立通道,将特制耐高压小球囊送入伤椎,用高压注射器向球囊内注入造影剂,球囊扩张将松质骨向四周挤压,使伤椎恢复高度并产生空腔,经'C'型臂X线机观察确认伤椎复位满意后记录球囊的压力及容量,抽出造影剂使球囊回缩至真空后取出.将同量含钡低黏度骨水泥注入由球囊扩张而产生的空腔内,通过'C'型臂X线机观察确认骨水泥充满空腔后完成手术.结果10例患者术后疼痛即刻消失,术后当天或次日即可下床活动.经X线检查确认压缩骨折的椎体高度基本恢复,后凸畸形平均矫正16°(12°～30°).术后平均随访6个月,患者均恢复伤前生活方式,无疼痛,伤椎高度无丢失,无并发症发生.结论微创球囊扩张椎体后凸成形术是治疗老年骨质疏松脊柱压缩骨折安全有效的方法.

Objective To investigate the results of transpedicular balloon kyphoplasty for treatement of aged osteoporotic spinal compressive fractures. Methods Ten cases of aged osteoporotic spinal compressive fractures (range 57 to 72 years old), with T11 1 case, T12 4 cases, L1 5 cases were treated with kyphoplasties under “C” armed imaging guiding. The inflatable bone tamp was inserted into the fractured vertebral body transpedicularly in a minimally invasive way. The balloon was inflated, elevating the endplate and restoring vertebral body height and then confirmed by “C” armed imaging. The balloon was deflated and withdrawn, leaving a cavity within the vertebral body. The cavity was then filled with bone cement or other preferred material, creating an “internal cast” which was also confirmed by “C” armed imaging. Results The back pain disappeared immediately after the kyphoplasty in all of 10 cases. In the same day or following day after the procedure, the patients were allowed to get off bed. The height restoration of vertebral body and correction of kyphosis were confirmed by X-ray after the procedure. The average correction of kyphosis was 16°. At the time of the last follow up, all 10 cases retained the life style as before injury, there was no back pain, and deformity correction was maintained well. No complications occurred. Conclusion Kyphoplasty is a safe and effective way to treat aged osteoporotic spinal compressive fractures.