经皮椎体成形术治疗胸腰椎压缩性骨折29例随访分析

Treatment of 29 cases of vertebral fractures by percutanous vertebroplasty and morphologic analysis

[目的]总结经皮椎体成形术对胸腰椎压缩性骨折的治疗效果,探讨影像学测量方法。[方法]随访2006年3月～2007年6月本科以Sky膨胀式椎体成形系统行经皮椎体成形术治疗的胸腰椎压缩性骨折患者29例35椎,行术前后侧位X线片测量及数据分析。[结果]术后随访时间8～24个月,平均16个月,术前后骨折椎体中线M与后缘线P比值,骨折椎体中线M与下位椎体中线NM比值,及骨折椎体前缘线A与下位椎体中线NM比值有统计学差异(P<0.05);3例患者术后3～12个月因内科疾病死亡;术后疼痛缓解明显,VAS评分为1.88±1.49;主观治疗满意度为90%;Roland-Morris功能障碍问卷显示无严重功能障碍患者;术后下地站立时间为(14.65±15.71)d,支具保护时间为(56.00±23.23)d;局部麻醉耐受程度100%;1例出现无症状椎管内骨水泥渗漏。[结论]Sky膨胀式椎体成形系统经皮椎体成形术对胸腰椎压缩性骨折治疗效果良好,疼痛缓解及功能恢复满意,术前后侧位X线片骨折椎体前缘线A及中线M与骨折椎体后缘线P及下位椎体中线NM的比值为有效的影像学测量指标。

[ Objective] To analyze 29 cases of vertebral fractures treated with percutaneous vertebroplasty （PVP）. [ Method ] Twenty-nine patients （35 vertebral bodies） undergoing percutaneous vertebroplasty from March 2006 to June 2007 and followed-up for 8 -24 months （average 16 months） were observed and analyzed. [ Result] The ratio of M line（ middle height of the vertebral body）of fractured vertebra to P line（ post edge height of the vertebral body） of fractured vertebra and the ratios of A line （ anterior edge height of the vertebral body） and M line to NM line（ M line of the next vertebral body） had statistical differences （P 〈 0. 05 ）. Three patients died of other diseases 3 - 12 months post operation. Pain relief was obvious, average VAS score was 1.88 ＋ 1.49. Satisfaction rate was 90%. According to the Roland-Morris questionnaire, no patient had severe dysfunction in this group. Average standing time was 14.65 ± 15.71 days post operation. Average cast protection was 56.00 ± 23.23 days. The tolerance of local anesthesia was 100%. One case had bone cement leakage in the spinal canal but with no symptom. [ Conclusion] PVP by sky system can improve pain relief and life quality in patient with vertebral fracture. The ratios of A and M line of fractured vertebral body to P line of fracture vertebral body and M line of next vertebral body are efficient indexes of morphology.