经皮球囊扩张椎体后凸成形术治疗多发性骨髓瘤椎体骨折

Percutaneous balloon kyphoplasty in the treatment of vertebral compression fractures and deformity in multiple myeloma

目的:探讨应用经皮球囊扩张椎体后凸成形术(BKP)治疗多发性骨髓瘤(MM)引起的椎体压缩性骨折(VCFs)的疗效和安全性。方法:2005年6月～2006年12月采用经皮BKP治疗MM导致的VCFs患者共12例29个椎体,平均年龄58.2岁。结合体检、X线与MRI检查确定靶椎体,手术节段为T9～L5。手术前、后进行视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评分,在侧位X线片上测量手术椎体的高度及后凸Cobb角,术后观察骨水泥渗漏情况。结果:12例患者均安全完成手术,手术时间70￣110min,出血量50￣120ml。术中注入骨水泥3￣7ml/椎,平均4.78ml/椎。随访2.5￣23个月,平均9.2个月,共死亡7例,其中术后3个月内死亡2例,3￣6个月死亡2例,>6个月死亡3例。VAS评分由术前8.9±1.2分降为术后1d时2.6±0.2分,5例存活≥12个月的患者末次随访时为3.6±0.1分,术后评分均显著低于术前(P<0.05);ODI评分由术前74.5±6.2分降到术后1d时27.4±3.6分,5例存活≥12个月的患者末次随访时为31.2±4.2分,术后评分均显著低于术前(P<0.05)。术后椎体前缘及中线高度较术前明显恢复(P<0.05),Cobb角矫正8.32°±2.21°。共有4例4个椎体(13.8%)出现骨水泥渗漏,但术后即刻及随访中均无明显的临床症状。结论:经皮BKP治疗MM引起的椎体压缩性骨折具有良好的止痛与改善后凸畸形效果,明显提高了患者生活质量。

Objective：To evaluate the safety and efficacy of percutaneous balloon kyphoplasty in the treatment of vertebral compression fractures resulted from multiple myeloma.Method：From June 2005 to December 2006,a total of 29 vertebral compression fractures due to multiple myeloma were treated by balloon kyphoplasty in 12 patients.The average age of the patients was 58.2 years old with a range of 44 to 71 years. Symptomatic levels were identified by physical examination,magnetic resonance imaging（MRI） and radiograph. Outcome data were obtained by comparing visual analogue scale （VAS） and Oswestry disability index （ODI） score.Pre- and post-operative radiographs were analyzed to assess the restoration of vertebral height,Cobb angle and complications.Result：Operation was successfully performed on all patients with a mean operative time of 33min per vertebra.The average blood loss was 30ml per vertebra and the bone cement volume injected was 4.78ml per vertebra.The mean time of follow-up was 9.2 months （range,2.5-23 months ）.There were 7 cases died during the follow-up period.VAS decreased significantly from 8.9±1.2 points to 2.6±0.2 points one day post-treatment,3.6±0.1 points at the last follow-up （P〈0.05）.ODI score was reduced from 74.5±6.2 to 27.4±3.6 points,and 31.2±4.2 points at the last follow-up （P〈0.05）.The anterior and midline vertebral body heights were increased significantly（P〈0.05）.The mean Cobb angle was improved 8.32°.Clinically asymptomatic cement leakage occurred at 4 fracture levels （13.8%）.Conclusion：Percutaneous balloon kyphoplasty is proved to be safe and effective in the treatment of vertebral compression fractures and deformity resulted from multiple myeloma.