分步体位复位椎体成形术治疗胸腰椎压缩性骨折

Treatment of thoracic and lumbar vertebral compression fracture by stepwise position-diaplasis and percutaneous vertebroplasty

目的探讨分步体位复位经皮椎体成形术治疗胸腰椎椎体压缩性骨折的临床效果。方法 90例胸腰椎椎体骨折患者分2步体位复位,经单侧椎弓根穿刺向椎体注入聚甲基丙烯酸甲酯,手术前后用影像学资料评估伤椎椎体高度恢复率、后凸角度矫正率,用视觉模拟分级法(visual analogue scale,VAS)评估疼痛程度。结果手术均获成功,伤椎椎体前缘高度恢复率为(85.6±12.6)%,椎体中线高度恢复率为(86.6±9.7)%,后凸角度矫正率为(62.2±23.5)%,与术前相比差异均有统计学意义(P<0.05),无并发症发生。术后1周VAS评分为2.6±0.2分,与术前8.2±0.2分相比差异有统计学意义(t=21.95,P<0.01)。82例患者术后获得随访,平均随访36.3个月,胸腰背疼痛无复发,椎体高度无改变,邻椎无骨折。结论分步体位复位经皮椎体成形术能恢复椎体高度,矫正后凸畸形,消除疼痛,增加椎体强度和脊柱稳定性,是治疗胸腰椎椎体骨折经济、安全、有效的方法。

Objective To assess the clinical effect of stepwise pesition-diaplasis and percutaneous vertebroplasty in the treatment of thoracic and lumbar vertebral compression fracture. Methods All Of the 90 patients （98 vertebrae） underwent stepwise position-diaplasis and percutaneous injection of polymethyl methacrylate, Imaging data were used for assessing vertebral height recovery rate, kyphosis Cobb＇ s angle correction rate, visual analogue scale scores （VAS） before and after percutaneous vertebroplasty. Results All of the operation were successful. Average recovery rate of anterior vertebral height was （ 85.6 ± 12.6 ） %, and recovery rate of middle vertebral height was （ 86.6 ± 9.7 ） %. Kyphosis Cobbs angle correction rate was （62.2 ± 23.5）%. There was significant statistical difference between pre-operation and post-operation. No complication had occurred. There was significant statistical difference of VAS scores between postoperative 1 week （2.6 ± 0.2） and preoperative （8.2 ± 0. 2, t = 21.95, P 〈 0.01 ） . Postoperative follow-up examinations were carried in 82 patients for a mean period of 36.3 months. No recurrence or exacerbation of chest and back pain was noted. The height of the veterbral body had no change, and there was no fracture in the adjacent veterbral bodies . Conclusion Stepwise position-diaplasis and percutaneous vertebroplasty is a safe,actable and practical mothod to rebulid vertebral height, correct kyphosis, relieve the pain, improve the strength of the vertebral body and the stability of the vertebrae.