单侧经皮椎体后凸成形术治疗有“真空裂隙征”的骨质疏松椎体骨折

Percutaneous Kyphoplasty via the Unipedicular Approach for Osteoporotic Vertebral Compression Fractures with Vacuum Clefts Phenomenon

目的探讨单侧经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗有"真空裂隙征"的骨质疏松椎体骨折的临床疗效。方法 2007年1月～2009年5月,过伸位下单侧PKP治疗有"真空裂隙征"的骨质疏松椎体骨折32例。术前行站立侧位、过伸过曲位X线片,CT,MRI,明确伤椎有开合征、真空裂隙征和流质聚集征象,记录术前、术后、末次随访时疼痛视觉模拟评分(VAS评分),Oswestry功能障碍指数(ODI),椎体前缘高度,后凸角。结果本组均顺利完成手术。术后随访2～26个月,平均7.6月,其中8例>12个月。椎体前缘高度术前(10.63±1.40)mm,术后(21.62±3.75)mm,最终随访(20.98±3.01)mm。Cobb角(中立位)术前29.65°±2.48°,术后13.68°±1.72°,最终随访12.91°±1.92°。术前VAS评分(8.38±0.58)分,术后24 h(2.39±0.70)分,最终随访(2.47±0.69)分。Oswestry功能评分术前(39.59±4.12)分,术后(22.01±3.51)分,最终随访(21.65±4.61)分。各观察指标手术前后差异有统计学意义(P<0.01),术后与最终随访差异无显著性(P>0.05)。结论单侧PKP治疗有"真空裂隙征"的骨质疏松椎体骨折,可以有效缓解疼痛,恢复椎体高度,临床疗效满意。

Objective To evaluate the effectiveness of unipedicular percutaneous kyphoplasty（PKP） in the treatment of osteoporotic vertebral compression fractures with vacuum clefts phenomenon on CT.MethodsFrom January 2007 to May 2009,32 patients with osteoporotic vertebral body compression fractures with vacuum clefts phenomenon shown by CT underwent PKP at extension position by using unilateral transpedicular puncture in our hospital.Before the operation,fluid collection,vacuum clefts and open-close phenomena were confirmed by upright lateral and flexion-extension X-ray,CT and MRI.We measured the VAS,ODI,and the height and Cobb angle of the vertebral bodies before and after the surgery,and at the end of follow-up.ResultsThe procedure was completed in all the cases.The patients were followed up for 2 to 26 months with a mean of 7.6 months（12 months in 8 cases）.The mean height and Cobb angle of the vertebral bodies were（10.63±1.40） mm and 29.65°±2.48° before the operation,（21.62±3.75） mm and 13.68°±1.72° after the operation,and（20.98±3.01） mm and 12.91°±1.92° at the end of the follow-up.And the VAS and ODI were 8.38±0.58 and 39.59±4.12 preoperation,2.39±0.70 and 22.01±3.51 postoperation,and 2.47±0.69 and 21.65±4.61 in the end of the follow-up.All the measurements changed significantly after the operation（P0.01）,but showed no significant change after that（P0.05）.ConclusionsPKP via an unilateral approach is effective for osteoporotic vertebral compression fracture with vacuum clefts phenomenon.It is a good choice to relieve pain and restore vertebral height.