经皮单侧椎弓根穿刺椎体后凸成形术治疗骨质疏松性椎体压缩骨折(长期随访结果)

Unipedicular percutaneous kyphoplasty for osteoporotic vertebra compression fractures and long-term outcomes

目的观察单侧穿刺椎体后凸成形术治疗骨质疏松性椎体压缩骨折的近、长期疗效。方法 22例新鲜骨质疏松性椎体压缩骨折行单侧椎弓根穿刺椎体后凸成形术患者,平均随访时间2.3年;进行术前VAS评分、出院时VAS评分,测量术前压缩椎体前、中、后缘椎体高度及Cobb's角;记录穿刺侧别、应用器械种类、骨水泥注入量及并发症情况;随访时进行VAS评分,测量随访时X线片治疗椎体前、中、后缘椎体高度及Cobb's角,骨水泥位置,相邻椎体情况,是否发生其他椎体骨折。结果疼痛缓解率术后是91%,术后平均2.3年是95%;术前与术后,术后到随访时VAS评分有显著统计学差异;应用Kyphon球囊和SKY;经左、右侧椎弓根穿刺;注入骨水泥量、骨水泥位置之间VAS评分无差异。术前、术后椎体前、中、后缘高度、Cobb's角,均无统计学差异;渗漏率是23%;其他椎体骨折发生率是13.6%。结论 1.单侧穿刺止痛效果明显、长期效果肯定;2.何侧穿刺、器械种类、骨水泥注入部位、注入量,与止痛效果无关;3.对于右手操作者,左侧穿刺更容易达到理想位置。4.骨水泥椎间隙渗漏不影响长期疗效;5.术后1～12个月是再骨折高发阶段。6.PKP总体未达到使骨折部分复位,改善后凸目的 。

Objective To evaluate the postoperative and long-term outcomes of unipedicular percutaneous kyphoplasty （PKP） for osteoporotic vertebral compression fractures（VCFs）.Metheds 22 fresh osteoporotic VCFs were performed PKP through unipedicular technique,there are 6 male and 16 female,th e mean age is 70.86y and the mean fellow-up time is 2.3y.Recording the VAS scores of preoperative,postoperative and at the fellow-up;The preoperative and fellow-up X-Ray were measured to calculate the anterior、middle and posterior vertebral height and Cobb angle;Recording the insertion side,kind of tools,the amount of bone cement and the complication.The location of the bone cement,new VCFs were observed at the fellow-up.Results Pain relief was 91%,95% at 2.3y postoperative.VAS scores was significantly improved postoperative,either at the fellow-up.There were no difference of insertion side,kind of tools,amount and location of the bone cement.The anterior、middle and posterior vertebral height and Cobb＇s angle were no significant change at preoperative and fellow-up.The percentage of leakage was 23%,new fractures was 13.6%.Conclusion Unipedicular PKP is effective in pain relief and stable at 2.3y.Pain relief was not releated to insertion side,kind of tools,amount and location of the bone cement.Insertion by left side is more easily to arrived the perfected location,especially for right-handed surgeons.Bone cement extravasation into the disc space had the similar result at fellow-up.New fractures were mainly occurred in one year period.PKP was not reduce the kyphotic angle.