单侧经皮椎体后凸成形术治疗胸腰椎骨质疏松性压缩骨折

Investigation on Unilateral Percutaneous Kyphoplast in Treating Thoracolumbar Osteoporotic Compressed Fractures

目的：探讨单侧经皮椎体后凸成形术治疗骨质疏松性压缩骨折的临床效果与安全性。方法：将患者取俯卧位，悬空胸腹部，行C臂下定位病椎，并标记出病椎的椎弓根体表投影，常规消毒、铺巾，1％利多卡因局麻下以标记的椎弓根投影（左侧）10点外3mm处为进针点，针轴与患者矢状面呈30°～45°，侧位上与椎弓根走向保持平行，在透视下向椎弓根穿刺，穿刺达椎体前方3／4时，植入可扩张球囊，通过扩张球囊抬升终板，注人骨水泥填充，术后随访3个月。结果：手术时间平均每个椎体40min，无穿刺失败和损害神经情况，1例2月后临近椎体出现骨折。患者术后平均1d下床活动，术后疼痛得到明显缓解，后凸畸形得到明显纠正，Cobb’s角减小，住院时间平均7．8d，远期疼痛无复发。结论：单侧经皮椎体后凸成形术治疗胸腰椎骨质疏松性压缩骨折具有操作简单、手术时间短、患者及医师辐射少、创伤小、止痛效果好、纠正脊柱后凸畸形、住院时间短、远期疗效好的优点，且手术并发症少，相对安全可靠，为椎体成形技术提供了一种思路。

Objective：To study clinical effectiveness and safety of unilateral percutaneous kyphoplast in treating patients with osteoporotic compression fractures. Methods：The patients were placed in prone position, with chest and abdomen hung in the air,disordered vertebra was determined and pedicle of vertebral arch surface projection under C-arm fiouroscopy was marked out, with conventionally disinfected Sterile towel, anesthetized with 1 % lidocaine. Puncture needle passed the entry point 3mm outside 10 points of pedicle＇s surface projection（left） and inserted into anterior 3/4 of the vertebral body via transpedicular approch under fluoroscopic guidance,while implanting balloon-expandable, and raising end-plate uplift through ballon. Then bone cement was injected into the vertebral body. Patients were followed up for 3months. Results： The average operative time for each vertebral body was 40minutes,without the phenomenon of puncture failure and nerve injury, except 1 case complicated by the adjacent vertebral fractures two months later. After lday of the procedure,the patients were allowed to ambulate and experience significant pain relief,a marked kyphosis corrected, Cobb＇s angle reduced, the mean length of stay were 7.8 days,without pain reacurrence during follow-up. Conclusion：Unilateral Percutaneous kyphoplast is a simple, safe, effective and minimally invasive procedure, which can shorten operation time, reduce radiation of patients, shorten hospital stay,lessen complications,correct kyphosis and maintain long-term efficacy. It can be used as a new alternative procedure for patients with osteoporotic comprossion fracures.