椎体后凸成形术治疗骨质疏松性脊柱压缩骨折

Kyphoplasty for the treatment of osteoporobe vertebra compressive fracture

[目的]分析椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床和影像学结果,评价其临床效果.[方法]本组43例骨质疏松性椎体压缩骨折均接受经皮椎体球囊扩张后凸成形术.其中男19例,女24例;年龄56～85岁,平均68.2岁.本组共61个椎体骨折,其中单椎体26例,两椎体骨折11例,三椎体骨折4例,四椎体骨折2例.椎体骨折部位T7～L5.术后对患者的疼痛、日常功能以及影像学结果进行了分析.[结果]所有患者随访1a以上,平均18.8个月(12～36个月).平均VAS评分由术前8.6到术后2.3和最终随访2.7(P＜0.001),Oswestry评分由术前55到术后30和最终随访35(P＜0.01).手术椎体前、中柱平均高度由术前的12.20 mm到术后的25.38mm和最终随访26.36 mm.脊柱矢状位后凸畸形改善平均9.9°(4.3～22°),随访丢失平均1.6°(0.8～1.7°).4例发生骨水泥渗漏,但无严重并发症发生.最终随访时有3例患者发生3个临近节段椎体压缩骨折.[结论]球囊扩张椎体后凸成形术可有效恢复骨质疏松性骨折椎体的高度、迅速缓解疼痛、改善病人的功能,明显减少骨水泥的渗漏率,是一种安全、有效的治疗方法.

[ Objective ] To analyze the clinical and radiographic results of kyphoplasty for the treatment of osteoporobe vertebra compressive fracture. [ Method ] Forty-three patients with osteoporotie vertebral compressive fractures were treated with kyphoplasty. There were 19 male and 24 female with an average age of 68. 2 years （ ranged, 56 ～ 85 years）. The fractures included 61 vertebrae totally and there were single vertebra fractures in 26 cases, double in 11 cases, triple in 4 cases and quadric-fractures in 2 cases respectively. The levels of fractures ranged from T7 to L5. Tbe pain, daily function and radiographic results were compared pre-and post-operatively. [ Result] All patients were followed up for at least one year （ 12 ～ 36 months, averaged, 18. 8 months）. VAS pain score improved from 8.6 preoperatively to 2. 3 postoperatively and was 2. 7 at last follow up. Oswestry score improved from 55 preoperatively to 30 postoperatively and was 35 at last follow up. The heights of anterior and middle column of the vertebrae increased from 12. 20 mm to 25.38 mm and was 26. 36 mm at last follow up. The average correction of kyphosis was 9.9 degree and 1.6 degree of correction lost at last follow up. Four patients had cement leakage without adverse event. Three patients developed three adjacent level fractures at last follow up. [ Conclusion ] Kyphoplasty for the treatment of osteoporotie compressive vertebra fracture can restore the height of fractured vertebra, achieve immediate pain relief and functional improvement as well as minimize the incidence of cement leakage. Kyphoplasty is a safe and effective method for treating osteoporotic VCF.