球囊扩张椎体后凸成形注入骨水泥治疗骨质疏松性脊柱骨折58例

Balloon kyphoplasty combined with bone cement for the treatment of osteoporotic vertebral fracture in 58 cases

背景：探讨球囊扩张椎体后凸成形注入骨水泥治疗骨质疏松性脊柱骨折的疗效。方法：采用球囊扩张椎体后凸成形治疗老年人骨质疏松性单节段椎体压缩性骨折58例，58个椎体。病变位于T6~L4椎体，以T10~L2胸腰段发生多见。所有患者均采用局麻方法，患者俯卧于脊柱外科手术架上，在C臂透视下行单侧或双侧椎弓根穿刺，注入骨水泥。结果：发生骨水泥渗漏8例，骨水泥沿后纵韧带渗漏至邻近椎体后缘1例，椎体外边缘6例，皮下1例，但患者没有临床症状。治疗后脊柱 X射线片显示椎体高度有所恢复，脊柱后凸畸形改善。所有患者疼痛明显缓解，疼痛缓解率100%，视觉模拟评分、后凸角度、活动能力评分治疗前与治疗后6个月比较，差异有显著性意义（P 〈 0. 05），治疗后6个月与随访结束时比较差异无显著性意义（P 〉 0. 05）。结论：球囊扩张椎体后凸成形注入骨水泥治疗能够明显缓解骨质疏松性脊柱骨折导致的疼痛，并可以部分恢复椎体高度和脊柱后凸畸形，有利于改善脊柱的功能，提高患者的生活质量。

OBJECTIVE： To investigate the effect of balloon kyphoplasty combined with bone cement on the treatment osteoporotic vertebral fracture. METHODS： A total of 58 aged patients with single osteoporotic vertebral compression fracture （58 vertebral bodies） were treated with balloon kyphoplasty. The fracture always occurred at T6-L4 segment of vertebral body in particular at T10-L2 segment of thoracic waist. By local anesthesia, lateral or bilateral pedicle of vertebral arch was punctured to injection bone cement under C-arm fluoroscopy. RESULTS： Bone cement leakage occurred in 8 cases, including leakage along posterior longitudinal ligament into adjacent posterior margin of vertebral body （n=1）, external edge of vertebral body （n=6）, and subcutaneous tissue （n=1）; however, all the patients did not have clinical symptoms. C-arm fluoroscopy showed that height of vertebral body was increased, and rachiokyphosis was improved after treatment. Pain was obviously improved, and the easement rate of pain was 100%. There was significant difference in visual simulation score, angle degree of rachiokyphosis, and living activity scale before and 6 months after treatment （P 〈 0.05）, but there was no significant difference between 6 months after treatment and following up stopping （P 〉 0.05）. CONCLUSION： Balloon kyphoplasty can significantly ease pain caused by osteoporotic spinal fractures and tumor metastatic spinal fractures and can partially restore vertebral body height and kyphosis deformity, there is conducive to improving spinal function and improving the quality of life.