椎体后凸成形术结合过伸体位复位治疗骨质疏松性椎体压缩骨折伴椎体真空征

PERCUTANEOUS KYPHOPLASTY IN HYPEREXTENSION POSITION FOR TREATMENT OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE WITH VACUUM PHENOMENON

目的评估球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)结合过伸体位复位治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)伴椎体真空征的疗效。方法 2004年4月-2009年8月,采用PKP结合过伸体位复位治疗35例OVCF伴椎体真空征患者,其中27例获随访。男9例,女18例;年龄58～90岁,平均75岁。1例累及2个椎体,26例累及1个椎体。病程2～17个月,平均9.8个月。根据Krauss等的诊断标准均确诊为椎体真空征。术后定期随访,通过侧位X线片测量伤椎前、中、后缘高度和后凸角,采用疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评价临床疗效。结果所有患者均顺利完成手术,无严重并发症发生。27例术后随访时间24～58个月,平均32个月。临床骨折愈合时间为3～6个月,平均4个月。术后1周和末次随访时VAS评分、ODI、伤椎前缘高度、伤椎中缘高度及伤椎后凸角均较术前显著改善,差异均有统计学意义(P<0.05),末次随访与术后1周比较差异无统计学意义(P>0.05);伤椎后缘高度手术前后各时间点间差异均无统计学意义(P>0.05)。术后1周3例发生骨水泥渗漏,但均无临床症状。所有患者椎体真空腔内骨水泥分布呈致密团块状。1例术后7个月出现邻近椎体骨折。结论球囊扩张PKP结合过伸体位复位治疗OVCF伴椎体真空征患者,术后可即刻缓解疼痛,显著恢复椎体高度,减小后凸畸形,恢复脊柱矢状序列。

Objective To evaluate the efficacy of percutaneous kyphoplasty（PKP） in hyperextension position for the treatment of osteoporotic vertebral compression fracture（OVCF） with vacuum phenomenon.Methods Between April 2004 and August 2009,35 patients who suffered from OVCF with vacuum phenomenon were treated with PKP in hyperextension position,8 patients were excluded because of lost follow-up.In 27 follow-up cases,there were 9 males and 18 females with an average age of 75 years（range,58-90 years） and with an average disease duration of 9.8 months（range,2-17 months）.One vertebral body was involved in 26 cases and 2 vertebral bodies were involved in 1 case.According to the imaging examination and Krauss et al.criterion,all patients were diagnosed as having vertebral vacuum phenomenon.Refer to the lateral X-ray views,the height and the kyphotic angle of the involved vertebral body were measured pre-and postoperatively.The surgical outcomes were evaluated by using visual analogue scale（VAS） and Oswestry disability index（ODI） system.Results All operations were performed successfully with no severe complication.The mean follow-up of 27 patients was 32 months（range,24-58 months）.The mean clinical healing time of OVCF was 4 months（range,3-6 months）.The VAS score,ODI system,anterior and medial height of involved vertebral body,kyphotic angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up（P 0.05）;there was no significant difference between at 1 week after operation and at last follow-up（P 0.05）.There was no significant difference in the posterior height of involved vertebral body among different postoperative time-points（P 0.05）.Asymptomatic cement leakage occurred in 3 patients.Adjacent vertebral fracture occurred in 1 patient at 7 months.Intravertebral vacuums showed a compact and solid cement filling pattern.Conclusion PKP in hyperextension position can significantly relieve back pain,restore vertebral height,and correct local kyphosis in the treatment of OVCF with vacuum phenomenon.