单侧椎弓根外入路椎体后凸成形术治疗胸椎骨质疏松性椎体压缩骨折38例

Kyphoplasty through unilateral extrapedicular approach in the treatment of 38 patients with thoracic vertebral compression fracture

目的:评价单侧椎弓根外入路经皮椎体后凸成形治疗胸椎骨质疏松性椎体压缩骨折的临床效果。方法:回顾性分析2004-07/2008-05宁夏医科大学附属医院脊柱外科收治的行单侧椎弓根外穿刺入路经皮椎体后凸成形治疗患者38例(52椎),男12例,女26例;年龄55～72岁,平均60.3岁;34例为原发性骨质疏松,4例因其他疾病有半年以上激素服用历史。结合体检、MRI及X射线平片确定责任椎体,骨折部位为T4～T12。采用目测类比评分对患者手术前后的疼痛程度进行评估。观察病椎高度的恢复以及后凸畸形的矫正情况,骨水泥渗漏通过术中透视和术后平片观察,记录骨水泥渗漏位置和椎体外渗漏的并发症。结果:38例患者均安全完成手术,时间25～55min,单椎体骨水泥注入量2.25～4.60mL,平均(3.20±1.40)mL/椎。全部患者均获得随访,随访6～24个月,平均9.5个月。36例(95%)背痛明显缓解,术后3d及末次随访目测类比评分较术前明显降低(P<0.05);复查X射线平片显示术后椎体前缘及中线高度较术前恢复明显(P<0.05),椎体中线高度矫正率为(50.90±34.60)%,而椎体后缘高度手术前后差异无显著性意义(P>0.05),冠状位X射线未发现椎体侧方楔形变增加。38例患者中有3例共5个椎体出现骨水泥渗漏,1例为经穿刺通道渗漏至椎体侧后缘,2例经椎体静脉系统渗漏至椎体侧方,但均未出现临床症状。患者术后第2天下地活动,第三四天出院,术后1个月恢复伤前的生活。无节段血管、脊髓等穿刺副损伤以及术中、术后肺栓塞、血管栓塞等并发症的发生。结论:经椎弓根外入路单侧椎体后凸成形是治疗胸椎骨质疏松性椎体压缩骨折安全有效的方法,可有效恢复椎体高度、迅速缓解疼痛,提高患者生活质量。

OBJECTIVE： To evaluate the clinical outcomes of single-balloon kyphoplasty in the treatment of thoracic osteoporotic compression fractures via extrapedicular approach METHODS： From July 2004 to May 2008, 38 cases （52 vertebra） of thoracic osteoporotic fractures were treated by balloon kyphoplasty via unilateral extrapedicular approach, including 12 males and 26 females with an average age of 60.3 years （range 55-72 years）. There were 34 cases of primary osteoporosis, and 4 had administrated hormone due to other diseases for over 6 months. Symptomatic levels ranged from T4 to T12 confirmed by physical examination, MRI and X-ray. The pain relief, restoration of vertebral height and kyphosis correction were compared before and after operation by using visual analogue scale （VAS） and radiograph, respectively. In addition, bone cement leakage location and complications were recorded. RESULTS： Operation were successfully performed in 38 cases with an average injection of bone cement volume of （3.2±1.4） mL （2.25-4.60 mL in unilateral infusion）. The. mean time of surgery was 25-55 minutes, and that of follow-up was 9.5 months （6-24 months）. Back pain of 36 cases was improved, and the VAS 3 days postoperatively and the final follow-up was significantly reduced （P 〈 0.05）. The vertebral anterior margin and median height following surgery were significantly improved detected by X-ray （P 〈 0.05）, and average median height restoration was （50.90±34.60）%, but no significant change was found in posterior height （P 〉 0.05）. No lateral wedging or changes in the coronal alignment was found. Three cases （5 vertebra） had cement leakage： the bone cement of 1 case leaked to posterior margin through the puncture channel and 2 cases leaked to lateral vertebra through vertebral venous system without any adverse event. The patients could move the second day after surgery, discharged from the hospital at days 3-4, and restored to normal life at 1 month postoperatively No blood vessel or spinal cord puncture injury or pulmonary embolism, or blood vessel embolism was found. CONCLUSION： Unilateral extrapedicular kyphoplasty is safe and effective in treating thoracic osteoporotic fractures. It rapidly releases backache, restores the body height of fractured thoracic vertebrae and improves quality of life of the patients