CT引导下经皮穿刺球囊扩张椎体后凸成形术治疗胸腰椎骨折

Clinical application of percutaneous kyphoplasty in spinal fracture guided by CT

目的介绍一种经皮穿刺椎体后凸成形治疗胸腰椎骨折的新方法。方法CT荧屏上确定胸腰椎骨折的成形平面并设计进针点和进针方向,CT光标下定位,局麻下按预设计进针点和进针方向经皮穿入手钻,CT证实手钻位置满意后沿手钻置入导针,拔出手钻后沿导针置入工作通道至椎体后壁前方3mm左右,拔出导针,用钻头通过工作通道于骨折椎体内开一隧道至距椎体前壁3～5mm,通过工作通道于隧道内置入KyphX可膨胀球囊,CT证实球囊位置满意后,向球囊内缓慢注入碘造影剂至骨折椎体高度恢复满意而皮质骨壁保持完整或球囊内压力达400Pa,抽出造影剂,拔出球囊,用配套器械通过工作通道于复位后的骨折椎体空腔内缓慢注入骨水泥3～5mL,等骨水泥固化后拔出工作通道,皮肤穿刺口用创可贴封闭。共治疗胸腰椎骨折12例,男7例,女5例,年龄45～71岁,平均64岁,单纯椎体压缩性骨折9例,椎体轻度爆裂性骨折3例。结果所有患者均为1侧穿刺成形,平均手术时间55min,术中出血10～20mL,无1例损伤脊髓、脊神经、血管或胸腹腔脏器,无骨水泥渗漏与栓塞;术后1～3d戴腰围下地行走,除3例有腰背部酸胀外无其它不适。结论CT引导下经皮穿刺球囊扩张椎体后凸成形术治疗胸腰椎骨折疗效可靠、操作简便、定位精确、损伤小、恢复快,适应证较广,放射暴露少,是一种值得推广的微创手术。

[ Objective ] To introduce a new therapy method of pereutaneous kyphoplasty （PKP）. [ Methods ] Inserting the awl in the projected point and angle confirming it on the screen of the computed tomography, establishing the work passage to the point that is 3 mm to the antetheea of the vertebra, inserting the KyphX saccule through the work passage to the point that is 3-5 mm to the antetheca of the vertebra. Injecting diodone and distending the saccule to recover the height of vertebral body, injecting the bone cement （3-5 mL）. Pulling out the awl after solidification of bone cement. [ Results ] All patients were operated at one side, the even time consuming of the operation were 55 minutes, and the bleeding in operation were 10 to 20mL. No patient suffered the injure the ambient tissue and organs. All patients walked 1-3 days after the PKP. [ Conclusions ] PKP guided by CT is an available and minor injured operation because of its safety, convenient, fidelity etc. It is worth to spread.