椎体后凸成形术治疗多节段脊柱骨折中责任椎体的选择

Determination of painful vertebrae treated by kyphoplasty in multlple-level vertebral compression fractures

目的前瞻性研究球囊扩张椎体后凸成形术治疗多节段脊柱压缩骨折中责任椎体的选择及其疗效。方法2002年10月至2005年6月对35例多节段骨质疏松性脊柱骨折患者，根据MRI各序列上信号的改变确定责任椎体，选择性对责任椎体进行球囊扩张椎体后凸成形术治疗。术前骨折椎体MRI有T1WI低信号改变、T2WI及STIR序列高信号改变者，即确定为责任椎体，可参考X线片表现及局部叩击痛。共计120个椎体有压缩骨折，其中确定为责任椎体并接受手术的有51个椎体。观察术后症状改善及骨折复位情况来评估其疗效。结果35例患者均顺利完成手术，术后1～3d完全独立或经搀扶行走。3个椎体出现无症状性骨水泥渗漏，占5．9％（3/51）。31例患者获得随访，平均随访时间16．2个月。术后疼痛明显减轻或消失，视觉模拟评分（VAS）由术前8．7降至随访时的2．1（P〈0．01）。随访时椎体高度平均恢复率59．17％，后凸畸形Cobb角平均矫正10．1°，术前与末次随访时比较，差异有统计学意义（P〈0．01）。结论对于多节段脊柱压缩骨折，可根据MRI不同序列上信号的改变来确定责任椎，选择性对责任椎进行球囊扩张后凸成形术治疗可获得较好疗效。

Objective To explore how to determine painful vertebrae treated by kyphoplasty in multiple-level osteoporotic vertebral compression fractures and clinical outcome. Methods From October 2002 to June 2005,51 consecutive procedures with kyphoplasty were performed on 35 patients with multiplelevel osteoporotic vertebral compression fractures. There were 51 painful vertebrae among 120 vertebral compression fractures. The painful vertebra was determined by the signal intensity changes in MR images, combined with radiography and local percussion pain before operation. Only painful vertebrae were treated by kyphoplasty. Preoperative, postoperative and final follow-up visual analog scale （VAS） and radiographic findings such as vertebral height and Cobb angle were recorded and analyzed. Results All patients tolerated the procedure well with immediate relief of their back pain after kyphoplasty and they can walk at 1-3 days after the procedure. There were 3 vertebrae （ 3/51 ） occurred asymptomatic extravasation of cement. 31 cases were followed up for mean 16. 2 months （range 6-44 months）. VAS reduced from preoperative 8.7 to final follow-up 2. 1 （P 〈0. 01 ）. At final follow-up the vertebral height had a recovery rate of 59. 17%, and the mean Cobb angle was improved 10. 1°. There was a significant improvement between preoperative and final follow-up values （P 〈 0. 01 ）. Conclusions The painful vertebra can be determined by signal intensity changes in MR series images in multiple-level osteoporotic vertebral compression fractures. Selecting painful vertebrae to be treated by kyphoplasty can make patients with multiple-level VCFs gain an excellent result.