椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折

Kyphoplasty for the treatment of osteoporotic vertebral fractures with vertebral body wall incompetence

目的探讨周壁破损的骨质疏松性椎体骨折采用椎体后凸成形术治疗的个体化手术方案及其可行性与安全性。方法对35例39椎周壁破损的骨质疏松性椎体骨折患者施行椎体后凸成形术,男8例,女27例;年龄48￣85岁,平均68.3岁。术中采用个体化手术方法:对前壁破损的患者采用骨水泥分次灌注的方法,以防骨水泥向前方渗漏;对后壁或侧壁破损的患者采用全程动态“C”型臂X线机监测下灌注骨水泥,以防骨水泥向后方或侧方渗漏。术后观察症状改善、骨折复位及并发症情况。结果全部病例均顺利完成手术,无症状性并发症发生。术后椎体高度平均恢复率68.46%。后凸畸形Cobb角平均矫正8.6°,术前与术后比较差异有统计学意义(t=9.8872,P<0.01)。27例31椎获得随访6￣41个月,平均20.1个月。术后疼痛明显减轻或消失,VAS评分由术前8.7分降至2.6分。结论椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折,采用个体化手术方法防止骨水泥渗漏有一定的可行性与安全性。椎体前壁破损者采用骨水泥分次灌注,椎体后壁或侧壁破损者采用术中全程动态“C”型臂X线机监测,有助于防止骨水泥渗漏。

Objective To discuss the individual method and its feasibility and security of balloon kyphoplasty for the treatment of osteoporotic vertebral fractures with vertebral body wall incompetence. Methods Thirty-nine vertebral bodies were performed for kyphoplasty in 35 osteoporotic patients with vertebral compression fractures with incompetence of vertebral body wall. During operation, the cement was injected twice to avoid anterior leaking in the patients with anterior wall incompetence, while in the patients with posterior or lateral wall incompetence, the cement was injected with continuously X-ray monitoring by C-arm to prevent lateral or posterior leaking. The symptoms improvement, vertebral height restoration and complications were observed. Results All patients tolerated the procedure well with immediate relief of back pain after kyphoplasty. No symptomatic complications were found in all patients. The vertebral height had a recovery rate of 68.46%, and the mean Cobb angle was improved 8.6°. There was significant difference in Cobb angles between preoperation and postoperation （P〈 0.01 ）. Changes in pain and mobility were assessed by follow-up of 20.1 months（6 to 41 months）, pain score by visual analog scale （VAS） reduced from 8.7 to 2.6. Conclusion Kyphoplasty for the treatment of osteoporotic vertebral fractures with vertebral body wall incompetence with individual method is help to prevent cement leakage and there is feasibility and security to a certain extent; to fill cement twice for the anterior wall broken and incompetent and continuously monitor the cement filling with C-arm for the posterior and lateral wall broken and incompetent is help to prevent cement leakage and avoid complication.