单侧椎弓根外途径椎体后凸成形术治疗胸椎骨质疏松性压缩性骨折

Kyphoplasty via Unilateral Extrapedicular Approach for the Treatment of Osteoporotic Thoracic Compression Fractures

目的探讨经椎弓根外途径椎体后凸成形术治疗胸椎骨质疏松性压缩性骨折的疗效及安全性。方法分析2008年1月至2009年1月期间对16例胸椎骨质疏松性压缩骨折椎体行单侧椎弓根外途径椎体后凸成形术患者,MRI确定责任椎体22个。记录手术时间及透视次数。采用视觉模拟评分、Oswstry功能障碍指数评估患者手术前后及末次随访时的疼痛程度及日常功能。通过X线测量评估患者术前、术后椎体高度及后凸畸形纠正情况。结果所有患者均顺利完成手术,1例患者出现少量椎间隙骨水泥渗漏,但无症状性并发症,1例患者出现肋间神经受损的症状。平均手术时间为31 min,透视次数为19.1次。术后胸背痛明显缓解,随访12～24个月(平均14.2个月)。VAS评分术前为(8.2±1.1)分,术后3 d时为(2.6±0.8)分,末次随访时为(2.8±1.1)分。ODI评分术前为(69.2±1.2)分,术后3 d时为(32.2±1.1)分,末次随访时为(35.1±1.8)分。术后椎体前缘高度、中部高度及Cobb's角与术前比较差异均有统计学意义(均P<0.05)。结论经椎弓根外途径椎体后凸成形术治疗胸椎骨质疏松性压缩性骨折是有效的,能减少术者及患者的放射暴露时间。

Objective To explore the feasibility and safety of kyphoplasty via unilateral extrapedicular approach for the treatment of osteoporotic thoracic compression fractures.Methods A total of 16 patients with painful osteoporotic thoracci fractures were treated by kyphoplasty via unilateral extrapedicular approach.Pain was measured using the self-reporting visual analogue scale（VAS） preoperatively,postoperatively and in the final follow-up.Disability was measured using the Oswestry disability index（ODI） preoperatively,postoperatively and in the final follow-up.The height of the compromised vertebral body,the kyphotic angle were measured preoperatively,postoperatively and in the final follow-up.Results Operations were completed smoothly,with the exception of 1 patients with less cement leakage but there was no clinical symptom occurred.The other one had intercostal neuralgia.Relief of pain was achieved in 24 hours post-operation.The mean operation time was 31minutes and the mean fluoroscopic time was 19.1.And the mean VAS score of these patients decreased from 8.2±1.1 pre-operatively to 2.6±0.8 post-operatively（P0.05）,and it improved further to 2.8±1.1 in the final follow-up.The ODI score varied from 69.2±1.2 pre-operatively to 32.2±1.1 post-operatively（P0.05）.Improvement was maintained in the final follow-up.Comparing the height of anterior vertebrae（Ha）,the height of midline vertebrae（Hm） and the kyphotic angle between pre-and post-operation there was no statistical significant difference.Conclusion Kyphoplasty via unilateral extrapedicular approach for the treatment of osteoporotic thoracic compression fractures is effective.It can help reducing the radiation exposure.