选择性单入路多粘度骨水泥后凸成形治疗骨质疏松性椎体骨折后凸侧凸畸形的研究

Selective unilateral percutaneous balloon kyphoplasty with viscosity gradient cement injection for kyphosis and scoliosis induced by osteoporotic vertebral compression fractures

目的探讨选择性单侧入路椎体后凸成形、灌注由高到低多重粘度骨水泥治疗老年骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)后凸伴侧凸畸形的可行性和临床疗效。方法回顾性分析2013年6月—2015年10月,收治16例17椎OVCF,术前CT及X线片证实椎体前方伴侧方压缩,脊柱呈后凸伴侧凸畸形,选择椎体压缩明显的凹侧行单侧入路穿刺后凸成形术,扩张球囊复位伤椎的前方和侧方压缩,灌注由高到低梯度粘度骨水泥强化椎体。记录透视曝光次数和手术时间;比较术前、术后脊柱后凸畸形Cobb’s角、侧凸畸形Cobb’s角、伤椎高度、视觉模拟评分法(visual analogue scale,VAS)比较手术前后骨折相关疼痛,Owestry功能障碍指数(owestry disability index,ODI)评估日常活动。结果本组手术时间25~43 min,平均29.6 min;透视次数13~21次,平均18.6次;术后脊柱后凸及侧凸畸形Cobb’s角、伤椎前部、中部高度与术前比较,差异有统计学意义(P<0.05);VAS评分与ODI评分手术前后比较差异有统计学意义(P<0.01)。未发现症状性骨水泥渗漏、神经损伤等并发症。结论 OVCF后凸侧凸畸形是选择性单侧入路椎体后凸成形术的良好适应证,能够精准复位固定伤椎,多粘度骨水泥强化伤椎可减少渗漏,手术简便有效,放射曝光少。

Objective To evaluate the feasibility and therapeutic effects of selective unilateral pereutaneous balloon ky- phoplasty by injection of multi-viscosity bone cement in the treatment of kyphosis and scoliosis induced by senile osteopo- rotic vertebral compression fractures（OVCF）. Methods The clinical data of 16 cases of OVDF（ 17 vertebral bodies） in our hospital between June,2013 and October,2015 were analyzed retrospectively. Preoperative CT and X-ray showed that vertebral bodies were with anterior and lateral vertebral compression fractures, and spine with kyphosis and scoliosis. The unilateral percutaneous balloon kyphoplasty was conducted by the concave side of vertebral compression. Balloon was in- flated in order to re-expand the vertebral body and to create a void in its spongy bone. The gradient viscosity of bone ce- ment was slowly injected under fluoroscopic guidance to ensure there was no leakage of cement outside of the vertebral body. The operative time and frequency of X-ray imagining were documented. Visual Analogue Pain Scale （VAS）and Oswestry Disability Index（ODI） were used to assess fracture-related pain and patient＇ s disability. The preoperative and post- operative radiographic parameters were compared. Results The mean operative time was 29.6 rain （25 - 43 min）, the average number of fluoroscopy was 18.6（ 13 -21 ）. The mean kyphosis and scoliosis（ Cobb angle）and injured vertebral height（ front and central part） was improved significantly（ P 〈 0.05 ）. The difference in VAS and ODI scores before and after the operation was significant（ P 〈 0.01 ）. The procedure-related complications such as epidural cement leakage or neural damage were not demonstrated in the study. Conclusion Selective unilateral percutaneous balloon kyphoplasty with viscosity gradient cement injection is a simple, safe and effective minimally invasive procedures for scoliosis and ky- phosis caused by osteoporotic thoracolumbar compression fractures. It can accurately restore and fix the fractured vertebra. The multi-viscosity bone cement can strength the injured vertebra and reduce the epidural cement leakage,with less number of fluoroscopy.