体位设定复位联合椎体骨水泥注入成形治疗重度椎体骨质疏松压缩性骨折

Postural reduction and percutaneous vertebroplasty for severe osteoporotic vertebral compression fractures

背景:在压缩程度超过原有椎体高度2/3的重度压缩骨折病例中,椎体成形是禁忌的。目的:验证可通过椎体成形联合患者体位设定治疗重度椎体骨质疏松压缩性骨折。方法:共75例骨质疏松单一椎体压缩骨折患者行椎体成形及体位设定复位,根据发病时间不同分为<4周组、4～8周组、>8周组,其中30例患者椎体高度压缩程度超过原有椎体2/3,分别测量椎体压缩比(椎体前方高度/后方高度)和节段Cobb角,分析复位程度与发病持续时间的关系。结果与结论:最初检查时患者骨折椎体前后方平均压缩比为0.60±0.15,椎体成形后增加到0.75±0.17。最初检查时Cobb角为(16.14±11.29)°,椎体成形后矫正到(10.71±12.08)°。压缩比差、矢状面骨折节段Cobb角差均随发病持续时间延长而减小。30例中的28例(占其中的93%)重度压缩骨折患者通过体位复位后,可行椎体成形。患者椎体成形后疼痛均缓解。提示椎体骨折发病时间越短,复位程度越好,Cobb角纠正越多,脊柱矢状面后凸畸形改善越明显,椎体成形后疼痛程度越明显改善。

BACKGROUND： In the severely collapsed vertebrae of more than two-thirds of their original height, vertebroplasty is regarded as a contraindication. OBJECTIVE： To verify percutaneous vertebroplasty combined with postural reduction can treat severe osteoporotic vertebral compression fractures. METHODS： Seventy-five patients with single-level vertebral compression fracture were treated with postural reduction and vertebroplasty. They were divided into three groups according to the onset duration, 4 weeks group, 4-8 weeks group and 8 weeks group. In 30 of 75 patients, the vertebral body was severely collapsed more than two-thirds of its original height. Compression ratio （anterior height/posterior height） was calculated, the Cobb angle was measured and the degree of re-expansion was analyzed according to the onset duration. RESULTS AND CONCLUSION： The mean compression ratio was 0.60±0.15 initially and increased to 0.75±0.17 after vertebroplasty. The mean Cobb angle was （16.14±11.29）° before treatment and corrected to （10.71±12.08）° after vertebroplasty. Over the onset duration, the compression ratio and Cobb angle decreased. Twenty-eight of thirty （93%） severely collapsed vertebrae re-expanded after postural reduction, which made vertebroplasty possible. Patients’ pain relieved after vertebroplasty. It is indicated that the onset duration of vertebral fractures is shorter, and the degree of re-expansion, correction of Cobb angle, improvement of spinal sagittal kyphosis and pain relieve after vertebroplasty degree are higher.