过伸体位下球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折

Percutaneous kyphoplasty in hyperextension position for treatment of osteoporotic vertebral fracture

目的观察过伸体住下球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折的临床疗效。方法16例（24个椎体）骨质疏松性椎体压缩性骨折患者先在过伸体位下使病椎的高度恢复，然后在C臂透视下，经椎弓根穿刺，置入球囊，球囊扩张后使用骨水泥充填椎体，观察术后症状改善及骨折复位情况。结果16例手术顺利，疼痛于术后48h内均明显缓解并可下床活动，4～12d内出院。随访6～18个月，平均11个月。平均VAS评分由术前（8．5±0．3）分到术后（2．1±0．2）分和最终随访（2．3±0．3）分（P〈0．01）；Oswestry功能评分由术前（43±1．32）分到术后（21±1．29）分和最终随访（22土1．25）分（P〈O．01）；手术椎体前中柱平均高度由术前（14．8±2．8）mm到术后（24．3±2．1）mm和最终随访（24．4±1．9）mm（P〈0．05）；Cobb角平均由术前23．2°±4．6°到术后10．3°±3．1°和最终随访10．2°±4．3°（P〈0．05）；未发生骨水泥渗漏及其他并发症。结论过伸体位下球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折可以有效缓解疼痛，部分恢复椎体高度，临床疗效满意。

Objective To investigate the clinical effects of percutaneous kyphoplasty in over-extending position to- manage osteoporotic vertebral compression fractures. Methods Percutaneous kyphoplasty in over-extending position was performed in 24 vertebrae of 16 patients, which were all fresh fractures, without neurotic symptoms and signs. The pos- terior vertebral walls were all intact in all patients under CT scan. In over-extending position, the height of the com- pressed vertebral body would be restored. Then under the guidance of ＂C＂ type arm X ray unit, puncting neck of vertebra with sacculus proprius. The vertebral body was filled with bone cement through pedicle of vertebral arch by pereutaneous puncture. Results Operations in all the 16 patients were completed smoothly, and immediate relief of their back pain was achieved within 48 hours postoperatively, and patients were discharged in 4-12 days. The mean duration of follow up was 11 months （ 6 = 18 months）. VAS pain score improved from （8. 5 ：h 0. 3 ） preoperatively to （ 2.1 d： 0.2 ） postoperative- ly and was （213±0. 13） at the last follow up（P〈0. 01）. Oswestry score improved from （43±1.32） preoperatively to（21± 1.29）postoperatively and was （22：1：1.25） at the last follow up （P〈0.01）. The height of anterior and middle column vertebra increased from （14.8±2.7） mm preoperatively to （24. 3±2.1） mm postoperatively and was （24. 4±1.9） mm at the last follow up （P〈0.05）. Cobb angles were corrected from 23.2°±4.6° preoperatively to 10.3°±3.1° postopera- tively and was 10.2°±4. 3° the last follow up （P〈0.05） . Patient had not cement leakage without adverse events. Con- clusions Percutaneous kyphoplasty in over-extending position can relieve the pain and restore the compressed vertebral height evidently with better outcomes.