经皮球囊扩张椎体成形术治疗骨质疏松性椎体隐匿性骨折

Treatment of subtle fracture of osteoporotic vertebral body by percutaneous kyphoplasty

目的探讨经皮球囊扩张椎体成形术（PKP）治疗骨质疏松性椎体隐匿性骨折的临床应用价值。方法骨质疏松性椎体隐匿性骨折患者35例共52椎，按治疗方法不同分为两组，观察组共19例30椎用PKP治疗，对照组共16例22椎用保守治疗。术后疼痛缓解程度应用视觉模拟评分法进行评估分级，用日常生活自理能力（ADL）量表对治疗后患者生活质量进行评估，同时观察术后伤椎椎体形态学变化，分别在术后1周及3、6、12个月进行评价。结果52节椎体穿刺全部成功，无椎管内渗漏和肺栓塞等并发症；治疗后1周及3、6个月各期疼痛缓解率观察组（分别为83．5％、89．7％、95．2％）明显优于对照组（分别为52．6％、65．4％、74．9％）（X2=7．12、6．24、5．92，均P〈0．01），12个月时疼痛缓解率两组分别为96．4％、89．5％，差异无统计学意义（X2=3．05，／9〉0．05）；治疗后1周及3、6个月各期生活质量评分观察组均明显优于对照组（均P〈0．01），12个月时生活质量评分两组差异无统计学意义（P〉0．05）；治疗后1周及3、6个月各期随访椎体前缘、中央、后缘高度两组差异均无统计学意义（均P〉0．05）；12个月时对照组椎体塌陷较观察组明显[分别为（13．2±0．5）、（5．6±0．7）mm]（t=3．03，P〈0．05）。结论PKP治疗骨质疏松性椎体隐匿性骨折与传统保守治疗相比，可迅速缓解疼痛，明显改善患者的生活质量；并可显著预防椎体进一步塌陷，防止脊椎后凸畸形发生。

Objective To study the results of percutaneous kyphoplasty（PKP） in treating subtle fracture of osteoporotic vertebral body, and to explore the clinical value of PKP in patients with subtle fracture of osteoporotic vertebral body. Methods 52 thoracical vertebral bodies of 35 patients with subtle fracture of osteoporotic vertebral body. Nineteen patients with 30 vertebrae were assigned to group 1 treated by PKP, and sixteen patients with 22 vertebrae were assigned to group 2 treated by conservative therapy. The patients were examined after surgery to ascertain the alleviation of the pain and evaluate the patients＇ life quality, measuring the heights of vertebrae on the lateral plain films during follow-up. Results Surgery was successful in all cases, no serious complications occurred with PVP. Pain relief was obtained in all of group 1 ,pain still remained in all 16 patients of group 2 at 1 week after conservative treatment. Improvement was significantly greater in the group 1 than in group 2 atl week, 1 month,3 months,6 months, but no difference at 12 months after treatment （P 〉 0.05 ）. According to ADL, the patients＇ life quality scores, improvement was significantly greater in the group 1 than in group 2 atl week, 1 month ,3 months ,6 months, but no difference at 12 months after treatment（P 〉 0.05 ）. The height of the veterbral body showed significant difference at 12 months of follow（ P 〈 0.05 ）. Conclusion PKP was an effective and safe procedure for treating subtle fracture of osteoporotie vertebral body. PKP has satisfactory analgesic effect on subtle fracture of osteoporotic vertebral body and improve quality of patients＇ life. PKP could effectively prevent collapse of veterbral body.