骨质疏松性椎体骨折经皮后凸成形术中伤椎和手术入路的选择

Choice of injured vertebrae and operating approach on percutaneous kyphoplasty in treatment of osteoporotic vertebral fracture

目的探讨骨质疏松性椎体骨折经皮后凸成形术中伤椎定位和手术入路选择。方法36例骨质疏松性椎体压缩性骨折患者,术前根据CT及MRI确定伤椎,根据伤椎椎弓根CT层面经椎弓根进针线确定单、双侧入路,采用球囊或Sky扩张器行椎体后凸成形术。术前、术后1周及随访时摄X线片测量椎体高度恢复率、后凸Cobb角及疼痛视觉类比评分(VAS)。结果36例50节骨质疏松性椎体压缩性骨折中,44节椎体行经皮椎体后凸成形术。术前计划单侧经椎弓根入路32节椎体,双侧经椎弓根入路12节椎体;术中单侧入路22节椎体,双侧入路22节椎体,其中10节椎体由单侧入路改为双侧入路。术后1周及最末随访时椎体高度恢复率分别为66.3%、65.2%;术前后凸Cobb角为23.4°,术后1周及最末随访时分别为9.2°、10.2°,较术前显著改善(P<0.01);术前VAS评分为8.9分,术后1周及最末随访时分别为1.9分、2.3分,较术前均改善(P<0.01)。结论术前CT伤椎体清晰的骨折线是椎体新鲜骨折的依据,陈旧性骨折需进一步检查MRI确定责任椎。大部分中胸椎及腰椎可以采用单侧经椎弓根入路行经皮椎体后凸成形术,部分下胸椎骨质疏松性骨折患者需行双侧经椎弓根入路。

Objective To explore the method of choice of injured vertebrae and operating approach on percutaneous kyphoplasty in treatment of osteoporotic vertebral fracture. Methods 36 patients with osteoporotic vertebral fracture were operated with pereutaneous kyphoplasty by balloon or SKY system. Injured vertebrae was identified preoperatively by CT and MRI. Unipedicular or bipedicular approach was affirmed by transverse pedicle plane on CT. Restoration of vertebral height, Cobb angle and VAS score was recorded pre-operatively and 1 week, follow-up time post-operatively. Results Of 55 vertebrae in 36 patients, 44 vertebrae were chosen for PKP operation. Pre-operatively, 32 vertebrae via unipedicular approach, 12 vertebrae via bipedicular approach were scheduled. 10 vertebrae via unipedicular approach according to pre-operative schedule were performed via bipediele while operating. The restoration rate of vertebral height 1 week and the last follow-up post-operative was 66.3% and 65.2% . The Cobb angle pre-operative and lweek, the last follow-up post-operative was 23.4°, 9.2°, 10.2°respectively. The VAS score pre-operative and 1 week, the last follow-up post-operative was 8.9,1.9 and 2.3. Conclusion The distinctive fracture llne of injured vertebrae on CT graph is important evidence for fresh fracture. Injured vertebrae could be affirmed by MRI for old fracture. Most mid-thoracic vertebrae and lumbar vertebrae could be operated via unipedicular approach. Some lower thoracic vertebrae should be operated via bipedicular approach.