椎体后凸成形术治疗老年骨质疏松椎体压缩骨折

Treatment of spinal compressive fracture in aged patients with osteoporosis by percutaneous kyphoplasty

目的探讨经皮穿刺球囊扩张椎体成形术（PKP）治疗老年骨质疏松椎体压缩骨折（VCFs）的初步疗效。方法36例（47椎）老年骨质疏松性VCFs患者，在C臂X线机监视下经皮穿刺，经椎弓根建立管性通道，将可扩张球囊置入伤椎，高压注入造影剂使球囊扩张，X线确认椎体骨折复位，骨水泥注入扩张产生的空腔。结果36例患者术后腰背部疼痛明显缓解或消失，VAS术前（8．6±1．2）分，术后（2．2±1．1）分（P〈0．01）。术后椎体前缘和中央高度分别由术前原椎体高度的（56．82±21．24）％和（61．36±25．27）％增加到了原椎体高度的（76．43±22．38）％和（79．94±18．12）％（P〈0．01）。术后骨折脊柱后凸明显得到矫正，Cobb角由术前的22．4°±4．6°矫正至11．2°±3．8°（P〈0．01）。有3例骨水泥渗漏，未发生严重并发症。随访2—24个月，未发现强化椎体高度丢失。1例L2椎体骨折PKP治疗后2个月出现T12、L1椎体新鲜骨折，1例L4椎体骨折术后1个月出现L5椎体再骨折。结论PKP是治疗老年骨质疏松VCFs的一种新型微创技术，操作简便，能够迅速缓解疼痛，改善功能。

Objective To assess the safety and efficacy of percutaneous kyphoplasty （PKP） in the treatment of compression fracture of vertebra （VCF） in elderly patients with osteoporosis. Methods 36 aged patients （47 vertebrae） with VCF were reviewed. Percutaneous puncture was guided by C-arm image intensifier, and a canal was created in the pedicle. A balloon was introduced into the fractured vertebra through the canal, and expanded with radiopaque contrast medium injected into the balloon under high pressure. After the compression fracture vertebra was reduced as verified by X-ray, bone cement was injected into the new - formed cavity. Results The Cobb angle was improved from 22.4°±4. 6° to 11.2° ± 3.8°（ P 〈 0. 01 ）. Back pain disappeared or relieved in all 36 cases postoperatively. Pain score by visual analog scale （VAS） was reduced from （ 8. 6 ± 1.2 ） preoperatively to （ 2. 2 ± 1.1 ） postoperatively （ P 〈 0. 01 ）. The rate of anterior and middle vertebral heights had enhanced from （ 56. 82 ± 21.24 ） % and （ 61.36 ± 25.77 ） % to （ 76.43 ± 22. 38 ） % and （ 79.94 ± 18. 12 ） % （ P 〈 0. 01 ）. There were 3 cases occurred bone cement leakage. No complications were found. The average duration of the follow - up was 6. 5 months （ 2 to 24 months）. There was no collapse of vertebral body during the follow - up. 1 case of compression fracture of L2 occurred fresh vertebra fracture of T12 and L1 in 2 months. Conclusions PKP is a new kind of microsurgery to treat spinal compression fracture in aged patients with osteoporosis. It is simple and effective in relieving pain and recovering function.