椎体后凸成形术对相邻椎体影响的初步观察

A study of effect of kyphoplasty on the adjacent vertebral body

目的通过观察随访利用椎体后凸成形术治疗椎体压缩骨折术后,患椎下一位相邻椎体高度在术前、术后的变化情况,为临床治疗提供参考依据。方法 2003年6月～2008年4月采用美国Kyphon公司提供的微创器械及特制球囊,对我院收治的70例骨质疏松性脊柱压缩骨折患者的85个椎体行椎体后凸成形术的治疗。术后随访时间为1～3年,分别测量患者骨折椎体下一位未骨折椎体术前、术后和末次随访时的高度,以及患者腰背部疼痛变化情况。结果所有研究对象(n=70)术后疼痛均得到有效控制,VAS评分从术前的平均8.39±1.14分,下降为术后一周的3.42±1.81分,最后随访时的2.67±1.28分,较术前明显下降(P<0.05);术前、术后复查X线片示下一位未骨折椎体的高度未发生明显形态学变化,椎体前缘与椎体后缘高度比值(Ha/Hp)术前(0.953±0.010)与最后随访(0.926±0.031)时点的比较虽存在一定程度的差异,但没有统计学意义(P>0.05);椎体中线与椎体后缘高度比值(Hm/Hp)术前(0.931±0.019)与最后随访(0.894±0.059)时点同样存在一定程度差异,但无统计学意义(P>0.05)。测量椎体后缘与对照椎体后缘比较(Hp/Hp+1)术后(0.956±0.033)及末次随访(0.949±0.039)与术前比(0.963±0.029)也没有明显差异(P>0.05)。结论对于骨质疏松椎体压缩骨折的患者,应用椎体后凸成形术治疗后能取得满意的疗效,患椎下一位未骨折椎体术后随着时间推移会发生一定程度的畸变,即高度轻度减低,但并不影响患者的生活质量,亦没有明显的再骨折迹象。但对于此类患者应该进行术后的密切随访。

Objective To evaluate the height change of the adjacent non-fractured vertebral body before and after kyphoplasty for vertebral compression fractures （VCFs） in order to provide a guide for clinical treatment of VCFs. Methods From Jun ：2003 to Apt 2008, 85 VCFs from 70 patients were performed kyphoplasty with micro-invasive equipment and special balloon provide by Kyphon, USA. Pain relieve and the height of adjacent non-fractured vertebral body were observed during the 1-3-year follow-up periods. Results All 70 patients had effective back pain control after kyphoplasty. Visual Analogue Score （VAS） was decreased from 8.39 ± 1. 14 points pre-operatively, to 3.42 ± 1.81 points post-operatively, and to 2.67 ± 1.28 points at the end of follow-up. VAS was significantly decreased （ P 〈 0.05 ）. The height of the adjacent non-fractured vertebral body was not obvious changed before and after operation in X-rays. The ratio of anterior to posterior vertebral body height （Ha/Hp） decreased from 0. 953± 0. 010 pre-operatively to 0. 926 ±0. 031 at the end of follow-up with no statistical difference （P 〉 0. 05）. The ratio of midline to posterior vertebral body height （Hm/Hp） decreased from 0. 931 ± 0. 019 pre-operatived to 0. 894 ± 0. 059 at the end of follow-up with no statistical difference （ P 〉 0. 05 ）. The ratio of posterior to contrast vertebral body height （ Hp/Hp ＋ 1 ） changed from 0. 956 ± 0. 033 post-operatively to 0. 949 ±0. 039 at the end of follow-up with no statistical difference （P 〉 0.05）. Conclusion Kyphoplasty is effective and safe in the treatment of VCFs. The height of adjacent non-fractured vertebral body may decrease in a certain extent. However, this does not affect the quality of life. These patients should be followed-up closely after the operation.