椎弓根外穿刺行单侧PVP或PKP术治疗上中位胸椎椎体骨折

Unilateral extrapedicular vertebroplasty and kyphoplasty in the treatment of upper and mid-thoracic vertebral compression fracture

目的:探讨椎弓根外穿刺行单侧PVP或PKP术治疗上中位胸椎骨质疏松性压缩骨折(OVCFs)的特点与疗效。方法:回顾性分析2004年11月～2010年3月我院收治的上、中胸椎OVCFs患者26例39个椎体,均采用椎弓根外穿刺行单侧PVP或PKP术,其中男8例,女18例;平均年龄71.3±1.3岁;原发性OVCFs 19例,继发OVCFs 7例。骨折时间平均3.5周,骨折椎体分布:T3 1个、T4 3个,T5 4个,T6 4个,T7 6个、T8 10个、T9 6个、T10 5个。1个节段17例,2个节段5例,3个节段4例。PVP 15例27个节段,PKP 11例12个节段。术中观察穿刺针针尖达到椎体中线的比率,术后1d及末次随访时测量骨折椎体前缘和椎体中间高度的恢复值、VAS评分的改善率、骨水泥向椎体外渗漏率以及患者的满意度。结果:39个椎体均经单侧胸椎椎弓根外途径穿刺完成PVP和PKP操作。均穿刺成功、骨水泥在椎体内左右对称分布。手术时间为25～35min/椎,无穿刺并发症。骨水泥平均注射量3.5ml/椎。骨水泥渗漏4例,渗漏率10.25%。平均随访时间14个月。VAS评分术前平均为9.8±0.3分,术后1d平均为5.7±0.4分,末次随访时为3.3±0.4分,术前与术后1d及末次随访时的VAS评分比较,疼痛均得到了明显改善(P<0.05);椎体前缘高度恢复值和椎体中间高度恢复值分别为为63.1±18.6%和68.5±25.3%,均较术前明显恢复(P<0.05)。患者对治疗的满意率达100%。结论:治疗上、中位胸椎骨质疏松性压缩性骨折,椎弓根外穿刺行单侧PVP和PKP术是一种安全、可行和有效的治疗方法。

Objective：To evaluate the characteristics and effects of unilateral extrapedicular vertebroplasty and kyphoplasty in the treatment of upper and mid-thoracie vertebral fractures.Methods：Retrospective analysis of 39 vertebrae in 26 patients （M：F =8：IS）who underwent unilateral extrapedicular vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures at upper and mid-thoracic vertebra between November 2004 and March 2010 in our hospital.The fracture vertebras is T3 1,T4 3,T5 4,T6 4,T7 6,T8 10,T9 6,T10 5.The mean age was 71.3±1.3 years.The average time of fracture was 3.5 weeks.One level was 17 cases,two levels were 5 cases and three levels were 4 cases.Clinical outcomes were evaluated using VAS. The rate of loss anterior and middle heights of the vertebral body ,the rate of cement leakage and the rate of suitable puncture before and after operation were evaluated.Results：Twenty-seven levels were treated in 15 cases with PVP,and twelve levels were treated in 11 cases with PKP..The rate of cement leakage was 10.25%.All patients were followed up over 1 year.The VAS scores were 9.8±0.3 preoperatively and 5.7±0.4 of 1 day and 3.3±0.4 of final follow-up postoperatively （P〈0.05）.The anterior and middle vertebral height restoration were 63.1±18.6% and 68.5±25.3% respectively （P〈0.05）.Conlusions：Unilateral extrapedicular vertehroplasty and kyphoplasty were safety in the treatment of upper and mid-thoracic vertebral compression fractures.The osteous track should be measured on three-dimensional CT images before PVP and PKP.