椎体后凸成形术治疗老年人无神经症状的胸腰段不完全爆裂性骨折

Kyphoplasty in the treatment of aged thoracolumbar burst fractures(Magerl A3.1) without neurological deficit

[目的]探讨椎体后凸成形术治疗老年人无神经症状不完全性胸腰段爆裂性骨折的安全性及其疗效。[方法]椎体后凸成形术试行治疗18例无神经症状的老年人胸腰段爆裂性骨折(Magerl分型:A3.1)。术中采用体位复位及逐步球囊扩张技术,在C型臂X线机动态观察下灌注骨水泥。术前、术后及术后12个月时采用疼痛视觉模拟评分(visual analog score,VAS)评估疼痛程度,并测量术前、术后及术后12个月时骨折椎体前缘高度比、Cobb角及椎管内骨块占位率。[结果]手术操作顺利,术后无神经损伤的并发症发生,患者症状迅速缓解。患者VAS评分平均由术前(8.17±0.618)分降为术后(2.33±0.767)分(P<0.05),术后12个月随访时维持在(2.39±0.698)分。椎体前缘高度从平均73.72%±6.153%纠正为术后的92.78%±1.927%(P<0.05),术后12个月为92.33%±1.534%;Cobb角由术前平均20.50°±2.333°改善为6.00°±1.847°(P<0.05),术后12月随访Cobb角部分丢失为8.83°±2.056°(P<0.05)。椎管内骨块占位率术前平均为16.22%±4.387%,而术后为15.56%±4.162%(P>0.05)。[结论]在C型臂X线机动态观察下,利用体位复位结合球囊分次逐步扩张技术,椎体后凸成形术治疗无神经症状的老年人胸腰段不完全性爆裂性骨折手术安全、疗效满意。

[Objective] To explore the feasibility and clinical outcome of kyphoplasty in the treatment of aged thoracolumbar burst fractures without neurological deficit.[Method]A total of 18 aged patient with thoracolumbar burst fracture（Magerl A3.1） without neurological deficit were treated by kyphoplasty.Modified techniques including combined position replacement with staged balloon expansion and dynamic fluoroscopic monitoring were used.Pain was measured using the visual analogue pain scale（VAS） preoperatively,postoperatively and at 12-month follow-up.The height of compromised vertebral body,the kyphotic angle and spinal canal compromise were measured preoperatively,postoperatively and at 12-month follow-up.[Result]Operations were completed smoothly without neurological deficit symptoms or other complications.Pain relief was achieved postoperatively.Mean VAS in these patients decreased from 8.17±0.618 pre-operatively to 2.33±0.767 post-opertively（P0.05）,and it maintained 2.39±0.698 at 12-month follow-up.The height of anterior vertebrae were restored from 73.72%±6.153% pre-operatively to 92.78%±1.927% post-opertively（P0.05）,and it maintained 92.33%±1.534% at 12-month follow-up.The kyphotic angle improved from 20.50°±2.333°pre-operatively to 6.00°±1.847° post-opertively（P0.05）,but it lost to 8.83°±2.056° at 12-month follow-up（P0.05）.The spinal canal compromise had no statisticaly significant difference pre-and post-operatively.[Conclusion]Kyphoplasty is a relatively safe and effective method for the treatment of aged thoracolumbar burst fractures（Magerl A3.1） without neurological deficit.Modified techniques including combined position replacement with staged balloon expansion and dynamic fluoroscopic monitoring may help to avoid cement leakage.