经皮骨水泥融合术治疗强直性脊柱炎伴假关节形成的邻近椎体应力骨折4例

Percutaneous bone cement fusion for the stress fracture of vertebral body adjacent to pseudoarthrosis in patients with ankylosing spondylitis: preliminary results in 4 cases

目的探讨经皮骨水泥融合术治疗强直性脊柱炎伴假关节形成的邻近椎体应力骨折的必要性及临床应用。方法回顾性分析4例经皮骨水泥融合术治疗强直性脊柱炎伴假关节形成的邻近椎体应力骨折的患者,通过经皮骨水泥注射术共实施4个节段骨水泥融合。通过比较患者术前及术后疼痛视觉模拟评分(VAS)及Oswesty功能障碍指数(ODI)评分的变化来评价疼痛、日常运动功能状况的改善。结果上述4例患者均获得手术成功,平均每个节段注入骨水泥约14.5 ml,1例发生少量骨水泥外渗,但无严重的临床并发症。术后VAS由术前平均9分,降至术后平均3.5分;ODI指数由术前平均43.8分降至术后平均14.5分,疼痛状况及日常运动功能明显改善。结论经皮骨水泥融合术治疗强直性脊柱炎伴假关节形成的邻近椎体应力骨折是一种微创、安全、有效的方法。

Objective To assess the clinical value of percutaneous bone cement fusion in treating stress fracture of vertebral body that is adjacent to pseudoarthrosis in patients with ankylosing spondylitis. Methods The clinical data of 4 ankylosing spondylitis patients with stress fracture of vertebral body adjacent to pseudoarthrosis, which was treated with percutaneous bone cement fusion, were retrospectively analyzed. Bone cement fusion through injection of bone cement was performed for 4 vertebral segments. Visual analogue scale （VAS） of pain and Oswesty disability index （ODD were determined before and after operation, the results were compared, and the improvements of pain and daily activity were evaluated. Results The operation was successfully accomplished in all the 4 patients. The mean used amount of bone cement for each vertebral segment was 14.5 ml. Small amount of bone cement extravasation was observed in one patient, but no severe clinical complication occurred. The mean VAS score decreased from preoperative 9 points to postoperative 3.5 points; ODI score decreased from preoperative 43.8 points to postoperative 14.5 points. After the treatment, the pain was obviously relieved and the daily activity was markedly improved. Conclusion For the treatment of stress fracture of vertebral body that is adjacent to pseudoarthrosis in patients with ankylosing spondylitis, percutaneous bone cement fusion is minimally-invasive, safe and effective. （J Intervent Radiol, 2017, 26： 551-554）