经皮椎体后凸成形治疗中骨水泥渗漏对椎体高度恢复的影响

Bone cement leakage in percutaneous kyphoplasty for the recovery of vertebral height

背景:将经皮椎体后凸成形通过球囊加压扩张在椎体内形成周围有相对致密松质骨的空腔,可有效降低骨水泥渗漏率,同时扩张的球囊有助于塌陷椎体的复位,矫正脊柱后凸畸形。目的:回顾性分析手法复位后将经皮椎体后凸成形注入骨水泥治疗骨质疏松性椎体压缩骨折渗漏情况及对椎体高度恢复的影响。方法:选择2008-02/2010-06华北石油总医院骨科行经皮椎体后凸成形治疗骨质疏松性椎体压缩骨折患者31例,41椎体。平均年龄69(53～82)岁。并于术前手法按压使腰部过伸复位。观察患者术后疼痛缓解、椎体高度恢复以及骨水泥渗漏情况。结果与结论:所有患者术后随访8～13(11.0±1.6)个月。患者视觉模拟疼痛评分由术前6.7±1.9下降至术后1.3±1.2,差异有显著性意义(P<0.05)。椎体高度由术前(15.7±5.2)mm恢复至(20.2±4.5)mm,椎体高度显著恢复(P<0.05)。发生骨水泥渗漏3例,均无明显临床症状。说明术前手法复位后经皮椎体后凸成形将骨水泥注入骨质疏松性椎体压缩骨折可以显著恢复椎体高度,止痛效果良好且无严重渗漏发生。

BACKGROUND： The percutaneous kyphoplasty may form a cavity with surrounding relatively tight cancellous bone in vertebral body through balloon compression expansion, can effectively reduce the leakage rate of bone cement, at the same time the expanding balloon contributes to reduce collapsed vertebral body and correct kyphosis. OBJECTIVE： To retrospectively analyze the influence of manual reduction combined with percutaneous kyphoplasty bone cement on fracture leakage and vertebral height restoration in treatment of osteoporotic vertebral compression fracture. METHODS： Thirty-one patients （41 vertebras） with osteoporotic vertebral compression fracture, aged 53-82 years at a mean of 69 years, were treated with manual reduction and percutaneous kyphoplasty from February 2008 to June 2010 in Department of Orthopedics, General Hospital of Huabei Oil Field Company. Prior to operation, the lumbar part was over-extending reduction by manipulation. The postoperative pain relief, vertebral height restoration and bone cement leakage were recorded during follow-up. RESULTS AND CONCLUSION： All the patients were involved in follow-up for 8-13 months, with an average （11±1.6） months. The visual analogue scale was reduced from （6.7±1.9） points preoperation to （1.3±1.2） points postoperation, with significant differences （P 0.05）. The vertebral height was restored from （15.7±5.2） mm preoperation to （20.2±4.5） mm postoperation, with significant differences （P0.05）. Extra vertebral leakage of bone cement was observed in three vertebrae with no marked clinical symptoms. Manual reduction combined with percutaneous kyphoplasty is a safety method for osteoporotic vertebral compression fracture, for advantages of pain relief, significant restoration of the vertebrae height and minor the leakage of bone cement.