椎体后凸成形术治疗重度骨质疏松性椎体压缩骨折

Treatment of elderly severe osteoporotic vertebral compressive fractures by kyphoplasty

目的探讨应用椎体后凸成形术治疗重度骨质疏松性椎体压缩骨折的可行性和疗效。方法2003年8月至2008年6月，治疗椎体后壁完整的重度骨质疏松性椎体压缩骨折35例（48椎），男2例，女33例；年龄64-86岁，平均74．2岁。患椎压缩程度为75．8％-80．1％，平均77．0％。在“C”型臂X线机引导下经皮穿刺进针，建立工作通道后放入可扩张球囊，行“扩张-放松-再扩张”渐进式复位，扩张压力不超过150psi（1 psi=6．89kPa）。复位基本满意或球囊达椎体皮质时停止扩张，取出球囊，在“C”型臂X线机监视下将可显影骨水泥低压注入椎体。结果35例患者均顺利完成手术。椎体前缘、中部及后缘平均高度分别由术前（0．8±0．1）cm、（0．8±0．2）cm和（2．1±0．8）cm增至术后第3天（1．2±0．3）cm、（1_3±0．2）cm和（2．3±1．0）cm，手术前后椎体前缘、中部高度差异有统计学意义。矢状面Cobb角由术前28．2°±5．2°矫正至术后19．1°±4．9°。疼痛视觉模拟评分（visual analogue scale，VAS）由术前（7．4±1．7）分（5．5±9．4分）降至术后第3天（1．8±1．1）分（0-3．0分）。SF-36健康调查评分由术前（33．2±7．1）分提高至术后第3天（42．7±7．9）分。结论通过改进穿刺复位方法及控制球囊扩张压力。椎体后凸成形术对重度骨质疏松性椎体压缩骨折患者可行且有效。

Objective To evaluate the feasibility and therapeutic effect of kyphoplasty in treating severe osteoporotic vertebral compressive fractures. Methods Thirty-five patients （48 vertebral bodies） with severe osteoporotic compressive fractures were included. There were 33 females and 2 males with the mean age of 74.2 years. The average compressive rate of the affected vertebral bodies was 77.0%. The thoracolumbar vertebrae were treated with kyphoplasties. Percutaneous puncture direction was adjusted according to compressive rate and shape of the vertebral bodies. The inflatable bone tamp was inserted into the fractured vertebral body. The balloon was inflated with low pressure and dilate-relieve-dilate method was applied. The balloon was deflated and withdrawn, leaving a cavity within the vertebral body, which then fulfilled with visualized bone cement. Preoperative and postoperative symptom level, complications and radiographic findings were recorded. Results All 35 patients tolerated procedure well. The mean heights of the anterior, mid and posterior vertebral body had improved from （0.8±0.1） cm, （0.8±0.2） cm, （2.1±0.8） cm preoperatively to （1.2± 0.3） cm, （1.3±0.2） cm, （2.3±1.0） cm respectively after operation （P 〈0.05）. There was significance difference between preoperative and postoperative heights of the anterior and mid vertebral body. The mean kyphosis was improved from 28.2°±5.2° before operation to 19.1°±4.9° after operation. Conclusion Kyphoplasty is feasible and effective for severe osteoporotic vertebral compressive fractures.