球囊椎体后凸成形术治疗肿瘤性椎体压缩性骨折的疗效观察

Curative effect of percutaneous balloon kyphoplasty on neoplastic vertebral compression fracture

目的探讨应用经皮穿束0球囊椎体后凸成形术（PKP）治疗肿瘤性椎体压缩性骨折（VCFs）的疗效和安全性。方法2007年3月至2008年12月采用PKP治疗肿瘤性VCFs患者16例28个椎体。结合体检、X线与MRI检查确定靶椎体，经皮穿刺椎弓根途径进入病椎瘤灶内，行肿瘤活检，置人可扩张球囊，扩张球囊复位塌陷的病椎，并形成骨水泥充填空腔，注入团状期骨水泥强化稳定病椎。应用视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评分观察手术前、后疼痛及功能变化情况，观察手术前、后椎体高度和后凸角度的恢复及并发症发生的情况。结果16例28椎均顺利完成手术，术后2d内疼痛均缓解，VAS评分由术前（8．7±1．3）分降为术后2d、3、6、12个月时的（2．3±0．5）、（2．4±0．3）、（2．5±0．6）、（2．7±0．2）分（P〈0．05）；ODI评分由术前（75．6±6．7）分降到术后2d、3、6、12个月时的（25．6±2．8）、（26．7±2．1）、（27．5±2．2）、（29．2±2．4）分（P〈0．05）。术后椎体高度及Cobb角矫正较术前明显恢复（P〈0．05）。术后无脊髓神经根受损表现，未发现骨水泥栓塞等并发症。共有4例4个椎体（14．3％）出现骨水泥渗漏，但术后即刻及随访中均无明显的临床症状。结论应用PKP治疗肿瘤性VCFs，具有确切的缓解疼痛与改善功能的效果，能明显提高患者的生活质量，同时对病椎高度的恢复和后凸畸形的矫正也具有良好的效果，近期疗效满意。

Objective To evaluate the safety and efficacy of pereutaneous balloon kyphoplasty in the treatment of neoplastic vertebral compression fractures. Methods From March 2005 to December 2008 ,a total of 28 neoplastic vertebral compression fractures were treated by percutaneous kyphoplasty in 16 patients. All patients complained of stubborn pain. No patients had neurologic symptoms or signs preop- eratively. Symptomatic levels were identified by physical examination, magnetic resonance imaging （MRI） and radiograph. The operation involved percutaneously inserting inflatable bone tamps into the lesion transpedieularly under fluoroscopy, inflating the bone tamp to elevate the end plates, restoring the vertebral body back toward its original height, and creating a cavity filled with bone cement. Tumor biopsies were performed. Outcome data were obtained by comparing visual analogue scale（VAS） and Oswestry disability index（ODI） score. Pro - and post -operative radiographs were analyzed to assess the restoration of vertebral height, Cobb angle and complications. Results Operation was successfully performed on all patients with immediate relief of back pain within 2 days. VAS scores were decreased significantly from 8.7 ± 1.3 to 2.3 ± 0.5,2.4 ±0.3,2.5 ±0.6,2.7 ±0.2 at 2nd day, 3 rd, 6th, 12th month after treatment （ P 〈 0.01 ）. ODI score was reduced from 75.6 ± 6.7 to 25.6 ±2.8,26.7± 2.1,27.5 ± 2.2,29.2 ± 2.4 at 2nd day, 3rd,6th,12th month after treatment （P 〈 0.01 ）, respectively. The anterior and midline vertebral body heights and the mean Cobb angle were improved significantly （ P 〈 0.05 ）. There was no leakage of cement into the epidural space. Clinically asymptomatie cement leakage occurred at 4 fracture levels （ 14.3% ）. Condusion Percutaneous kyphoplasty is proved to be safe and effective in the treatment of neoplastic ver- tebral compression fractures ,which could relieve pain ,effectively improve functional ability and the life quality. Meanwhile,it can effectively restore the vertebral body heights and reduce the kyphotic angle.