经皮穿刺球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折的临床应用

Clinical Application of Percutaneous kyphoplasty in treatment of osteoporotic vertebral fracture

目的:观察经皮穿刺球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折的临床疗效。方法:21例患者先在过伸体位下使病椎的高度恢复,然后在C臂透视下,经椎弓根穿刺,置入球囊,球囊扩张后使用骨水泥充填椎体,观察术后症状改善及骨折复位情况。结果:21例手术顺利,疼痛于术后48 h内均明显缓解并可下床活动,4～12 d内出院,随访6～18个月,平均11个月。平均VAS评分由术前(8.5±0.3)分到术后(2.1±0.2)分和最终随访(2.3±0.3)分(P<0.01);Oswestry功能评分由术前(43±1.32)分到术后(21±1.29)分和最终随访(22±1.25)分(P<0.01);手术椎体前中柱平均高度由术前(14.8±2.8)mm到术后(24.3±2.1)mm和最终随访(24.4±1.9)mm(P<0.05);Cobb角平均由术前23.2°±4.6°到术后10.3°±3.1°和最终随访10.2°±4.3°(P<0.05)。结论:本方法治疗骨质疏松性椎体压缩性骨折可以有效缓解疼痛,部分恢复椎体高度,临床疗效满意。

Objective To investigate the clinical effects of percutaneous kyphoplasty in over- extending position tomanage osteoporotic vertebral compression fractures.Methods Percutaneous kyphoplasty in over—extending position wasperformed in 30 vertebrae of 21 patients,which were all fresh fractures,without neurotic symptoms and signs.The posterior vertebral walls were all intact in all patients under CT scan.In over—extending position,the height of the com—pressed vertebral body would be restored.Then under the guidance of＂C＂type arm X ray unit.puncting neck of vertebrawith sacculus proprius.The vertebral body was filled with bone cement through pedicle of vertebral arch by percutaneouspuncture.Results Operations in all the 21 patients were completed smoothly,and immediate relief of their back pain was achieved within 48 hours postoperatively,and patients were discharged in 4 ~ 12 days.The mean duration of follow up was 11 months（6 - 18 months）.VAS pain score improved from（8.55±0.3） preoperatively to（2.1±0.2）postoperatively and was（213±0.13）at the last follow up.Oswestry score improved from（43±1.32）preoperatively to（21±1.29）postoperatively and was（22 ＋ 1.25）at the last follow up.The height of anterior and middle column vertebra increased from（14.8±2.7）mm preoperatively to（24.3±2.l）mm postoperatively and was（24.4±1.9）mm at the last follow up.Cobb angles were corrected from 23.2°±4.6°preoperatively to 10.3°±3.l°postopera—tively and was 10.2°±4.3°the last follow up.Conclusions Percutaneous kyphoplasty can relieve the pain and restore the compressed vertebral height evidently with better outcomes.