Sky骨膨胀复位器经皮椎体后凸成形术治疗陈旧性骨质疏松椎体压缩骨折

Treatment of old osteoporotic vertebral compression fractures with Sky bone expander percutaneotis kyphoplasty

目的探讨Sky骨膨胀复位器经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗老年陈旧性骨质疏松椎体压缩骨折的临床效果。方法选择2005年3月-2007年6月27例老年陈旧性骨质疏松椎体骨折患者（27个椎体），均接受Sky-PKP治疗。患者术前摄站立正、侧位片、动力位片、CT、MRI，明确伤椎有开合征、真空征和流质聚集征象。比较术前、术后目测类比疼痛评分（VAS评分）、Oswestry功能障碍指数（ODI），椎体前缘高度、中线高度和后缘高度，后凸角度。结果术后平均随访6．2个月，无严重并发症发生。VAS评分从术前7．8分下降至术后3．1分，ODI从术前65％下降至术后37％，椎体前缘高度术后较术前恢复4．6mm，中线高度术后较术前恢复5．7mm，椎体后缘高度术前、术后无明显变化。术后后凸角度比术前减小，平均矫正5．6°。结论Sky-PKP是治疗老年陈旧性骨质疏松椎体压缩骨折的一种行之有效的方法，但应掌握好手术适应证。如果伤椎有开合征、真空征和流质聚集征，适合采用Sky-PKP治疗，疗效满意。但穿刺难度较大，椎体高度和后凸矫正改善不明显。

Objective To discuss the clinical effect of Sky bone expander percutaneous kyphoplasty （Sky-PKP） in treatment of old osteoporotic vertebral compression fractures. Methods The study involved 27 patients （27 vertebrae） with old osteoporotic vertebral compression fractures treated by Sky-PKP from March 2005 to June 2007. Normotopia, lateral and dynamia radiographs, CT scanning and MRI were performed preoperatively to verify fluid collection in the vertebral body, vacuum phenomenon and open-close phenomenon. Visual analog scale （ V-AS）, Oswestry disability index （ ODI）, anterior body height, middle line body height, posterior body height and kyphotic angle changes were measured on a lateral radiograph before and after treatment. Results All patients were followed up for mean 6.2 months, which showed no severe complications. VAS score was decresed from preoperative 7.8 to postoperative 3.1 and ODI from 65% to 37%. However, The anterior vertebral height and middle line vertebral height were recovered for 4.6 mm and 5.7 mm respectively compared with preoperation. Correction of kyphotic angle was mean 5.6° postoperatively. There was no sitatistical changes in regard to posterior body height before and after operation. Conclusions Sky-PKP is a reasonable procedure for treatment of old osteoporotic vertebral compression fractures under strict control of indications, especially with vacuum phenomenon, open-close phenomenon and fluid collection. While high degree of difficulty in puncturation results in insignificant correction of kyphotic angle and body height.