后凸成形术治疗多椎体骨质疏松性压缩骨折的疗效分析

Efficacy of balloon kyphoplasty for the treatment of multi-vertebral osteoporotic compression fracture

目的探讨椎体后凸成形术治疗多椎体骨质疏松性压缩骨折的疗效和安全性。方法2002年10月至2007年4月采用椎体后凸成形术治疗多椎体骨质疏松性压缩骨折42例96椎，男14例，女28例；年龄56-91岁，平均72．5岁。在“C”型臂X线机引导下，经皮穿刺完成手术，包括通过工作通道放置球囊，扩张球囊复位骨折和形成空腔，以及骨水泥充填。观察术后症状改善、骨折复位及后凸矫正情况，并分析并发症发生情况。结果42例患者手术均顺利完成，术后平均随访31．4个月。疼痛VAS评分由术前（7．1±2．4）分降低为术后的（2．7±1．3）分，椎体前缘、中部高度分别由术前的（1．8±0．5）cm、（1．6±0．6）em增至术后的（2．3±0．6）cm、（2．2±0．7）cm，差异有统计学意义，椎体后缘高度术前、术后和随访期间均无明显变化。每个椎体后凸角平均矫正9．2°。随访过程中矫正度无丢失。SF-36健康调查评分表8个分项维度中包括机体机能、独立能力、躯体疼痛、活力、情感和精神状态6个维度明显提高。42例中发生骨水泥渗漏6例，未出现临床症状；肺栓塞1例，经治疗症状消失。结论微创椎体后凸成形术是治疗多椎体骨质疏松性压缩骨折安全有效的方法。

Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures. Methods From October 2002 to April 2007, 42 patients （96 vertebrae） with painful muhi-vertebral osteoporotic compression fractures underwent kyphoplasty. The group included 14 men and 28 women with an average age of 72.5 years （range 56-91 years）. Each procedure included insertion and insertion of balloon, fracture reduction and eement filling under ＂C＂-arm monitoring. Preoperative and postoperative pain level, SF-36 score, vertebral height restoration, local kyphosis correction and complications were recorded and analysed. Results All 42 patients tolerated the operation well and were followed up for average 31.4 months （range 12-71 months）. The mean VAS pain score decreased significantly from 7.1±2.4 preoperatively to 2.7±1.3 postoperatively, the mean height of anterior and medial vertebral body were （1.8±0.5） cm, （1.6±0.6） cm preoperatively and （2.3±0.6） cm, （2.2±0.7） cm postoperatively. No signifeicant change of posterior vertebral height was recorded postoperatively.The mean correction of local kyphosis was 9.2°at each level. 6 of 8 subscales measured by SF-36, including physical function, role function, bodily pain, vitality, role emotion, mental health, were significantly improved by the operation. Complications were found in 7 patients including 6 cases of cement leakage with no clinical symptoms （intradiscal cement leakage in two cases, paravertebral vessel leakage in two cases, paravertebral leakage in one case and cement leakage into canal in one case）, and 1 case of pulmonary embolization with symptoms relieved after conservative treatment. Conclusion Kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fractures.