微创治疗陈旧性老年骨质疏松性椎体压缩骨折

Minimally invasive treatment of chronic osteoporotic vertebral compression fractures in the elderly

目的探讨应用微创球囊扩张椎体成形术（PKP）治疗陈旧性老年骨质疏松性椎体压缩性骨折的可行性. 方法 2007年2月-2009年2月收治以胸背或者腰背部疼痛为主并且无明显神经损伤的老年陈旧性骨质疏松性椎体压缩骨折27例,其中男11例,女16例;年龄55～86岁,平均72.4岁.病史3～17个月,平均7.6个月.其中单阶段病变25例,双阶段病变2例.Genant二级10例,11个椎体;Genant三级17例,18个椎体.术前模拟视觉疼痛评分（VAS）平均8.3分,X线测量椎体前高与后高比平均为39%,脊柱后凸角测量平均27.60°.所有患者均在局部麻醉下行PKP治疗. 结果 术后所有患者疼痛消失或明显减轻,第3或4天能够下地活动.平均随访11.2个月,所有患者疼痛无反复,心肺功能有明显改善,无严重并发症发生;术后VAS平均2.8分,X线测量椎体前高与后高比平均为47.6%,脊柱后凸角测量术后平均15.60°. 结论应用微创PKP治疗以疼痛为主且不伴有神经损伤的老年陈旧性骨质疏松性椎体压缩骨折能够尽快去除疼痛,尽快使患者下床活动,减少长期卧床的并发症,改善心肺功能.

Objective To study a new method of minimally invasive balloon kyphoplasty （PKP）for treatment of chronic osteoporotic vertebral compression fractures. Methods The study involved 27 patients with chronic osteoporotic vertebral compression fractures treated with PKP in our hospital from February 2007 to February 2009. There were 11 males and 16 females, at mean age of 72.4 years （range 55-86 years）. The history of chronic osteoporotic vertebral compression fractures ranged 3-17 months （mean 7.6 months）. The pathological changes were determined at one stage in 25 patients and at two stage in two. According to the Genant classification, there were 10 patients （11 vertebrae） at grade two and 17 patients （18 vertebrae） at grade three. Before operation, the visual analog scale （VAS） score was average 8.3, the ratio of compression height of the anterior vertebral body to the posterior vertebral body was 39% by X-ray measurement and the kyphosis angle was average 15.60°. All patients received PKP under local anesthesia. Results Patients were followed up for average 11.2 months, which showed that all the patients achieved significant pain relief and ambulation at days 3 or 4 after operation. Cardiorespiratory function was significantly improved, with no reoccurrence of pain or severe complications found.After operation, the VAS score was average 2.8, ratio of compression height of the anterior vertebral body to the posterior vertebral body was average 47.6% and the kyphosis angle was average 15.60°. Conclusions Minimally invasive PKP can achieve rapid relief of pain, help early ambulation, decrease various complications resulting from long-term confinement to bed and improve cardiorespiratory function for elderly patients with chronic osteoporotic vertebral compression fractures of the vertebral body mainly with pain but without nerve injury.