应用Jack椎体扩张器行后凸成形术治疗骨质疏松性胸腰椎压缩骨折

Jack dilator-kyphoplasty for osteoporosis thoracolumbar compression fractures

目的:探讨应用Jack椎体扩张器行后椎体凸成形术治疗骨质疏松性胸腰椎压缩骨折的临床疗效。方法:根据胸腰椎椎弓根解剖特点自行设计了Jack椎体扩张器,并于2006年10月至2010年2月应用其行椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折患者71例共71个椎体,男19例,女52例;年龄48～82岁。T113例,T1222例,L123例,L216例,L35例,L42例。分别在术前、术后1周及术后3个月对患者进行疼痛VAS评分、Oswestry功能障碍指数(ODI)评定,在X线片上测量椎体前缘、中部高度及Cobb角。结果:所有病例均顺利完成手术,2例椎体侧方有少量骨水泥渗漏,无其他术中并发症发生,术后腰背痛立即明显减轻。术前、术后1周和术后3个月时的VAS分别为7.9±0.7分、1.9±0.6分、2.0±0.6分;ODI分别为(73.9±11.3)%、(20.8±5.1)%、(21.5±5.2)%;骨折椎体前缘高度分别为19.3±3.0mm、25.6±3.1mm、25.5±3.2mm,中部高度分别为19.1±3.3mm、25.4±2.7mm、25.3±2.7mm,Cobb角分别为17.8°±4.9°、8.6°±4.9°、8.7°±5.0°,术后1周与术前比较均有统计学差异(P<0.01),术后3个月与术后1周比较均无统计学差异(P>0.05)。结论:应用Jack椎体扩张器行椎体后凸成形术治疗骨质疏松性胸腰椎椎体压缩性骨折可以有效恢复骨折椎体前缘和中部高度,矫正畸形,有效缓解疼痛,改善功能,骨水泥渗漏发生率较低。

Objective：To investigate the clinical outcome of Jack dilator-kyphoplasty （DKP） for osteoporosis thoracolumbar compression fracture.Method：According to the anatomical measurement of the pedicles,a rectangular-shaped bone dilator was designed with the mechanism of expanding dilator head parallelly.71 vertebraes from 71 cases（19 males and 52 females,age range,48-82 years old） were received DKP from October 2006 to February 2010.The injured vertebrae included 3 in T11,22 in T12,23 in L1,16 in L2,5 in L3 and 2 in L4.The visual analogue scale（VAS） score,Oswestry disability index（ODI）,the mean anterior,midline vertebral height and kyphosis Cobb′s angle were determined before and after operation or at follow-up.Result： Obvious back pain relief in all patients after operation was noted.No intraoperative complications were documented except bone cement leakage laterally in 2 vertebrae.The VAS score was 7.9±0.7 before operation and decreased to 2.0±0.6 three months after operation（P0.01）.The ODI was （73.9±11.3）% before operation and decreased to （21.5±5.2）% three months after operation （P0.01）.The mean anterior and midline vertebral height were 19.3±3.0mm and 19.1±3.3mm respectively before operation which increased to 25.5±3.2mm and 25.3±2.7mm respectively three months after operation（P0.01）.The kyphosis angle was 17.8°±4.9° before operation and decreased to 8.7°±5.0° three months after operation （P0.01）.Conclusion：DKP has the effect of restoring the anterior and the midline vertebral height,correcting kyphosis Cobb′s angle and good pain relief.