经皮椎体后凸成形术治疗骨质疏松性胸腰椎单椎体楔形骨折与凹陷型骨折的效果

Effect of percutaneous kyphoplasty for osteoporotic thoracolumbar single vertebral wedge and concave fractures

目的：探讨经皮椎体后凸成形术（PKP）治疗骨质疏松性胸腰椎单椎体楔形骨折和凹陷型骨折的效果。方法：2008年1月～2009年12月对33例骨质疏松性胸腰椎单椎体压缩性骨折患者采用PKP治疗，其中楔形骨折18例（A组），凹陷型骨折15例（B组），观察术前和术后VAS评分、椎体前缘和中央高度比及局部后凸Cobb角。结果：33例患者均顺利完成手术。A组1例骨水泥向下位椎间盘渗漏，B组1例骨水泥向上位椎间盘渗漏、1例骨水泥沿穿刺针道渗漏，均未出现临床症状。A组术前、术后VAS分别为8．1±1．0分、2．3±0．6分，B组分别为8．2±0．8分、1．9±0．6分，每组术前术后评分差异有显著性（P〈0．001）。A组术后椎体前缘高度比和中央高度比均较术前明显增加（P〈0．05），后凸Cobb角较术前明显变小（P〈0．05）；B组术后椎体中央高度比与术前比较明显增加（P〈0．05），前缘高度比和后凸Cobb角与术前比较无明显变化（P〉0．05）。术后A组椎体前缘高度恢复比为（19．3±11．4）％，与B组的（6．4±6．2）％比较差异有显著性（P〈0．05）；A组中央高度恢复比为（15．9±9．3）％．与B组的（15．1±6．7）％比较差异无显著性（P〉0．05）。A组术后后凸Cobb角纠正6．7°±2．2°，B组纠正1．4°±1.3°．差异有显著性（P〈0．001）。随访8～31个月，平均18．3个月，无患椎再骨折和邻近椎体骨折发生。结论：PKP治疗骨质疏松性胸腰椎楔形和凹陷型椎体骨折可以迅速缓解疼痛，有效恢复椎体高度和维持脊柱序列。短期疗效满意。

Objective：To evaluate the clinical efficacy of percutaneous kyphoplasty（PKP） for osteoporotic thoracolumbar single vertebral wedge and concave fractures.Method：From January 2008 to December 2009,33 cases with osteoporotic thoracolumbar single vertebral fractures including 18 wedge fracture（group A） and 15 concave fracture（group B） underwent PKP.Preoperative and postoperative visual analog scale（VAS） scores,anterior and middle vertebral height rate and kyphosis Cobb angle were recorded and analyzed.Result：All operations were performed successfully.Cement leakage into the inferior intervertebral disc occurred in 1 case in group A,while cement leakage into the superior intervertebral disc in 1 case and cement leakage into the needle channel oceured in group B.Both were asymptomatie.Preoperative and postoperative VAS scores in group A were 8.1±1.0 and 2.3±0.6 respectively,and those for group B were 8.2±0.8 and 1.9±0.6,which showed statistically significant difference between preoperative and postoperative VAS scores in each group（P〈 0.O01）.The postoperative anterior and middle vertebral height ratio improved and kyphosis Cobb angle decreased significantly compared with the preoperative ones in group A （P〈O.O5）.In group B,the postoperative middle vertebral height improved significant compared with the preoperative ones （P〈0.05）,but there was no significant difference as for anterior vertebral height and kyphosis Cobb angle （P〉0.05）.There was significant difference as for anterior vertebral body height restoration rate between both groups （P〈0.05）[group A： （19.3± 11.4）%,group B： （6.4±6.2）%],but no significant difference as for middle vertebral body height restoration rateexisted between both groups （P〉0.05） [group A ： （ 15.9±9.3 ） %, group B ： （ 15.1±6.7 ） %].There was also statistically significant difference as for Cobb angles（P〈0.001）（group A corrected 6.7°±2.2°,group B corrected 1.4°±1.3°）. The follow-up ranged 8-31 months（average,18.3months）.No vertebrae refracture or adjacent vertebral fractures was noted.Conclusion：PKP for osteoporotic thoracolumbar single vertebral wedge and concave fractures can relieve pain quickly,restore the height of fractured vertebra and maintain the spinal alignment,which ensure good short-term outcome.