经皮球囊扩张椎体后凸成形术治疗骨质疏松性脊柱压缩性骨折

Treatment of osteoporotic vertebral compression fractures with percutaneous balloon kyphoplasty

目的研究球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效。方法我院2006年12月至2008年12月，采用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折26例33个伤椎，均经单侧椎弓根置入可扩张球囊使骨折塌陷椎体复位，然后使用骨水泥充填椎体，观察术后症状改善及骨折复位情况。结果随访5个月至2．5年，平均1．1年。平均疼痛视觉评分由术前（8．8±0．2）分到术后（2．1±0．2）分和最终随访（2．5±0．4）分，差异有统计学意义（P〈0．01）；手术椎体前中柱平均高度由术前（12．7±0．4）mm到术后（22．0±0．5）mm和最终随访（21．0±0．5）mm，差异有统计学意义（P〈0．01）；Cobb角平均由术前（23．2±0．6）°到术后（11．1±0．4）°和最终随访（11．7±0．4）°，差异有统计学意义（P〈0．01）。3例5个椎体发生骨水泥渗漏，2例出现邻近阶段椎体压缩性骨折，无其他严重并发症的发生。结论球囊扩张椎体后凸成形术可有效恢复骨质疏松性椎体压缩性骨折椎体的高度，缓解疼痛，改善患者的功能，明显减少骨水泥的渗漏，是一种安全、有效的治疗方法。

Objective To evalvate the efficacy of Kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Methods From December 2006 to December 2008, 26 cases with osteoporotic vertebral compressive fracture were treated with kyphoplasty. 33 consecutive procedures were performed including single inser- tion of inflatable balloon through pedicle of vertebal arch to make fracture reduction and bone cement augmentation. Postoperative symptomatic improvement and fracture reduction were recorded and analyzed. Results The mean duration of follow up was 1.1 years （ 5 months - 2.5 years）. The mean VAS score improved from （ 8.8 ± 0.2） preop- eratively to （2.1 ± 0.2 ） postoperatively and was （ 2.5 ± 0.4 ） at the last follow up （ P 〈 0.01 ）. The height of anterior and middle column vertebra increased from （ 12.7 ± 0.4） mm preoperatively to （22.0 ± 0.5 ） mm postoperatively and was （21.0 ± 0.5 ） mm at the last follow up （P 〈 0.01 ）. Cobb angles were corrected from（23.2 ± 0.6）° preoperatively to（ 11.1 ± 0. 4） °postoperatively and was （11.7 ± 0.4）°at the last follow up （P 〈 0.01 ）. 3 patient with 5 veterbra had cement leakage and 2 cases had fracture of the adjacent veterbra. Conclusions Kyphoplasty for the treatment of osteoporotic vertebral compression fracture can restore the heights of fractured vertebra, achieve immediate pain relief and functional improvement as well as minimize the incidence of cement leakage. Kyphoplasty is a safe and effective method for treating osteoporotic VCF.