椎体后凸成形术治疗骨质疏松性椎体骨折中期疗效及并发症的临床观察

Clinical observation of effects and complications of the mid-stage in treating osteoporotic vertebral compression fracture with percutaneous kyphoplasty

目的:通过观察球囊扩张后凸成形术(PKP)治疗骨质疏松性椎体骨折的疗效及并发症,探讨骨水泥强化后并发椎体再骨折的原因及对策。方法:自2006年3月至2007年3月,对31例骨质疏松性椎体骨折进行单侧经皮穿刺球囊扩张后凸成形术。男11例,女20例;年龄54～91岁,平均81岁。所有病例随访均超过3年。分别在术前、术后即时及术后1,2,3年测量强化椎椎体前缘高度,进行胸腰背疼痛评分(VAS评分),并统计相关并发症。结果:骨水泥强化椎体前缘高度在术前、术后即时及术后1,2,3年分别为(0.9±0.2)、(2.6±0.3)、(2.6±0.2)、(2.5±0.7)、(2.5±0.4)cm。手术后强化椎体高度恢复明显(P<0.05);随着时间延长强化椎体前缘高度逐步降低(P>0.05)。手术后胸腰背疼痛明显减轻,与术前比较差异有统计学意义(P<0.05);随着时间延长胸腰背疼痛逐年加重,但差异无统计学意义(P>0.05)。至随访末期并发强化椎体不愈合再骨折2例,相邻椎体骨折6例,远位节段椎体骨折2例,相邻椎间隙无症状退变5例。结论:球囊扩张后凸成形术(PKP)治疗骨质疏松性椎体骨折早期疗效确实。中期强化椎体高度逐渐降低,疼痛症状不同程度加剧,再骨折比例较高,尤其邻椎退变骨折明显。规范手术适应证、改变灌注材料及减少骨水泥注射量是降低再骨折的有效方法。

Objective：To observe the clinical effects and complications in treating osteoporotic vertebral fractures with percutaneous kyphoplasty （PKP） and in order to found the cause and countermeasures of the complications. Methods：From March 2006 to March 2007,31 patients with osteoporotic vertebral fractures were treated with unilateral percutaneous kyphoplasty. There were 11 males and 20 females,ranging in age from 54 to 91 years with the mean of 81 years. All patients were followed up for more than three years. At pre treatment and postoperatively immediately,1,2,3 years after PKP,the height of anterior vertebral body and thoracic lumbar and back pain were respectively analyzed by imaging data and VAS scoring. Results： At pre treatment and postoperatively immediately,1,2,3 years after PKP,the height of anterior vertebral body were （0.9± 0.2）,（2.6±0.3）,（2.6±0.2）,（2.5±0.7）,（2.5±0.4） cm,respectively;the VAS soring were （7.6±1.4）,（2.3±0.7）,（2.4±0.5）, （2.8±0.3）,（3.1±0.2） scores,respectively. The height of anterior vertebral body recoveried obviously after PKP （P0.05）;following prolongation of time,the height of anterior vertebral body gradually reduced （P0.05）. The thoracic lumbar and back pain relieved obviously after PKP（P0.05）;following prolongation of time,the pain gradually aggratated,but there was no significant difference （P0.05）. At final follow up,reinforced vertebral re fractures was found in 2 cases,adjacent vertebral fractures in 6 cases,distal vertebral fractures in 2 cases,asymptomatic degeneration of adjacent intervertebral in 5 cases. Conclusion：PKP have definite and early effects in treating osteoporotic vertebral fractures. But in mid stage after PKP,the height of anterior vertebral body reduce and the pain aggravate gradually,especially degenerative adjacent vertebral fracture advent. Strict choosing the candidate of the precedure,improvement of materials of perfusion and reducing of volume of bone cement maybe can decrease incidence rate of complications.