脊柱压缩骨折微创治疗的初步报告

Minimally invasive therapy for vertebral compression fractures

目的 探讨椎体成形术及椎体后凸成形术治疗脊柱压缩骨折 (vertebralcompressionfractures,VCF)的初步疗效和安全性。 方法 2 0 0 0年 5月～ 2 0 0 2年 10月分别采用椎体成形术 (vertebroplasty ,VP)及椎体后凸成形术 (kyphoplasty ,KP)治疗脊柱压缩骨折 4 3例 6 9椎 ,分别为椎体后壁完整的疼痛性骨质疏松性压缩骨折及椎体血管瘤导致的椎体压缩骨折。先经双侧椎弓根或椎弓根旁置入导针或可扩张球囊使骨折塌陷椎体复位 ,然后骨水泥充填椎体 ,观察术后症状改善及骨折复位情况 ,分析并发症。 结果 4 3例手术均顺利 ,疼痛于术后 4 8h内均明显缓解。VP组椎体高度无明显改变 ,KP组骨折椎体前缘和中部高度的丢失分别由术前的 ( 13 6± 2 3)mm和 ( 9 2± 1 4 )mm减少至 ( 4 7± 1 5 )mm和 ( 3 4± 1 1)mm(t=2 85 ,3 2 7;P <0 0 1) ,后凸畸形Cobb角由术前的 2 4 4°± 5 2°矫正至 9 5°± 4 7°(t=3 2 1,P <0 0 1)。 1例一侧术中穿刺管内出现脑脊液 ,该侧当即停止手术。未发现其他严重并发症。随访 3～ 2 8个月 ,平均 13个月 ,SF - 36评分由术前 ( 187 5± 10 3)分恢复至术后( 376 4± 15 9)分 (t=4 36 ,P <0 0 1)。 结论 椎体成形术及椎体后凸成形术可迅速、有效缓解疼痛 ,改善功能 。

Objective To evaluate the initial efficacy and safety of vertebroplasty (VP) and kyphoplasty (KP) in the treatment of vertebral compression fractures (VCF). Methods VP and KP were performed in 43 patients with VCF (69 vertebrae), including painful osteoporotic compression fractures with intact posterior vertebral body wall and painful VCF resulted from vertebral hemangioma, from May 2000 to October 2002. Each procedure included bilateral insertion of guide needle or inflatable balloon through or by the pedicle of vertebral arch, fracture reduction, and bone cement augmentation. Postoperative symptomatic improvement, fracture reduction, and complications were recorded and analyzed. Results Operations in all the 43 patients were completed smoothly, and immediate relief of their back pain was achieved within 48 postoperative hours. No change was found in vertebral heights in patients receiving VP, while in patients receiving KP, the loss of anterior and middle vertebral heights had dwindled from (13.6±2.3) mm and (9.2±1.4) mm preoperatively to (4.7±1.5) mm and (3.4±1.1) mm postoperatively ( t =2.85 and 3.27; P <0.01), and the kyphosis Cobb angles were corrected from 24.4°±5.2° preoperatively to 9.5°±4.7° postoperatively ( t =3.21, P <0.01). Because unilateral cerebrospinal fluid leakage occurred in 1 case, the operation on this side was terminated immediately. No other serious complications were found. Follow-up checkups for 3～28 months (mean, 13 months) revealed that the mean SF-36 scores were elevated from 187.5±10.3 preoperatively to 376.4±15.9 postoperatively ( t =4.36; P <0.01). Conclusions Both vertebroplasty and kyphoplasty can provide quick relief of pain and improvement of function, while the latter can recover the spinal alignment more effectively.