经皮穿刺球囊扩张椎体后凸成形术治疗老年骨质疏松性脊柱骨折

Percutaneous puncture kyphoplasty in the treatment of osteoporotic vertebral compression fracture in the elderly

目的:观察和分析球囊扩张椎体后凸成形术的初步临床疗效。方法:实验于2004-01/2006-03在南京医科大学附属南京第一医院骨科完成。本组共42例50椎,男10例,女32例,年龄52～81岁,平均69.7岁。术前均经体格检查结合影像学表现确诊为疼痛性骨质疏松脊柱压缩骨折。临床检查除疼痛、腰背部后凸畸形等症状外,无脊髓和神经根受损的症状和体征。CT及MRI检查确认椎体后壁完整,脊髓无压迫,为单纯压缩骨折。实验室及全身检查证实均无明确手术禁忌证。临床检查症状持续时间0.1～0.8个月,平均0.3个月。本组中单椎体压缩骨折34例,两椎体骨折6例,三椎体骨折2例。累及节段:T82椎,T92椎,T104椎,T117椎,T1212椎,L17椎,L29椎,L32椎,L43椎,L52椎。采用球囊扩张椎体后凸成形术治疗42例骨质疏松性椎体压缩骨折的50个病椎,均经两侧椎弓根穿刺灌注聚甲基丙烯酸甲酯骨水泥。术后平卧至少1h,密切观察患者双下肢感觉活动情况,监测生命体征,平卧2h后自由翻身,X射线片检查了解骨折椎体复位情况,骨水泥分布情况。结果:42例50个椎体,所有椎体均双侧穿刺成功,手术时间每例25～65min,平均31.5min。每个椎体平均注射骨水泥4.6mL。1例骨水泥沿椎体上终板渗漏至椎体间隙少许,无神经症状。术后所有病例疼痛缓解显著,术前、术后第3天疼痛目测类比评分比较,差异显著[(9.2±1.3),(3.5±2.1)分,P<0.05]。经1～3个月随诊,疼痛目测类比评分为(2.9±1.0)分。术后压缩椎体高度明显增加。术前、术后骨折椎体前缘平均高度比较,差异显著(16.31,20.62mm,P<0.05);术前、术后中线平均高度比较,差异显著(15.33,19.51mm,P<0.05);术前、术后后缘平均高度比较,差异不显著(P>0.05)。所有患者均获得随访,随访时间2～25个月,平均7.8个月,未发现与手术有关的并发症出现。结论:球囊扩张椎体后凸成形术可有效缓解因骨质疏松性椎体压缩骨折所引起的疼痛,改善椎体高度。是一种有效的微创治疗方法。

AIM： To observe and analyze the primary clinical efficacy of kyphoplasty. METHODS： From January 2004 to March 2006, 50 consecutive kyphoplasty procedures were performed in Department of Orthopaedics, Nanjing First Hospital Affiliated to Nanjing Medical University. There were 10 males and 32 females, aged 52-81 years with an averaged age of 69.7 years. The impression of painful osteoporotic vertebral compression.fracture was identified by physical and imageology exam preoperatively. The symptome included low back pain, kyphosis, without neurological defect. No displacement of posterior vertebral margin into spinal canal, the posterior vertebral margin was intact according to CT and MRI. That was pure compression freacture. Precluding contraindication, the symptom such as pain persist from 0.1 to 0.8 month, averaged 0.3 month. The study group consisted of 34 cases of single compression vertebrae, 6 cases of double vertebraes and 2 cases of three vertebraes, and that involved in 2 T8 vertebraes, 2 T9 vertebraes, 4 T10 vertebraes, 7 T11 vertebraes, 12 T12 vertebraes, 7 L1 vertebraes, 9 L2 vertebraes, 2 L3 vertebraes, 3 L4 vertebraes and 2 L5 vertebraes. Totally 50 consecutive kyphoplasty procedures were performed in 42 patients with osteoporotic vertebral compression fracture. They were perfused with polymethyl methacrylate bone cement by bilateral radix arcus vertebrae puncturation. After operation keeping prostration more than 1 hour, the motor and sensation of lower extremeities were observed closely; vital signs was monitored; the body was turned over freely after postoperative 2 hours. The reduction of compressed vertebrae and distribution of bone cement were displayed by X-ray film. RESULTS： Totally 50 consecutive kyphoplasty procedures were performed in 42 patients successfully. Operation time for each case was from 25 minutes to 65 minutes （31.5 minutes on average）. The mean volume of bone cement injected into each vertebral body was 4.6 mL. Extravertebral leakage of bone cement into intervertebral space were observed in one vertebrae body without nerve symptome. All patients had obvious pain relief. The visual analogue scale （VAS） had significant difference before operation and day 3 after operation [（9.2±1.3）,（3.5±2.1） points,P 〈 0.05]. The VAS score was （2.9±1.0） points after 1-3 months follow-up. The height of compressed body recovered markedly after operation. There was significant difference in average anterior height between pre-operation and post-operation （16.31,20.62 mm, P 〈 0.05）. There was significant difference in average midline height between pre-operation and post- operation （15.33,19.51 mm ,P 〈 0.05）. There was no significant difference in average posterior edge height between pre-operation and postoperation （P 〉 0.05 ）. All the patients were followed up from 2 months to 25 months （7.8 months on average） postoperatively. No patient had complications related to operation. CONCLUSION： Kyphoplasty can effectively release pain induced by osteoporotic vertebral compression fracture and ameliorate ventebral height. It is a promising minimally-invasive intervention.