椎体后凸成形术治疗骨质疏松性椎体爆裂骨折

Kyphoplasty in treatment of osteoporotic spinal burst fracture

背景:骨质疏松性椎体爆裂骨折被认为是经皮椎体成形术及椎体后凸成形术的相对禁忌证。无神经症状的骨质疏松性椎体爆裂骨折在临床上较常见,其治疗方法有待探讨。目的:探讨椎体后凸成形术治疗骨质疏松性椎体爆裂骨折的可行性、疗效及椎管重建情况。方法:回顾性分析2008年1月至2009年1月采用椎体后凸成形术治疗的无神经症状的骨质疏松性椎体爆裂骨折患者18例。术前、术后及末次随访时采用疼痛视觉模拟评分(visual analog score,VAS)评估疼痛程度;Oswsetry功能障碍指数(Oswsetry disability index,ODI)评估患者日常生活功能;测量术前、术后及末次随访时骨折椎体椎管内骨块占位率,骨折椎体前缘、中缘的高度,Cobb角。结果:18例全部获得随访,随访时间为12～33个月,平均20.4个月。术后无感染、肺栓塞等并发症,仅1例患者出现椎间盘少量骨水泥渗漏但无症状。患者术后疼痛迅速缓解,VAS评分术前8.2±1.3分,术后2.8±0.8分(P<0.05),末次随访时维持在3.0±0.8分。ODI评分术前为67.4%±7.7%,术后降至37.8%±3.1%(P<0.05),末次随访时为38.9%±2.6%。椎管内骨块占位率术前与术后无统计学差异(P>0.05),术前与末次随访比较有统计学差异(P<0.05),椎体前、中缘和Cobb角的术前与术后、术前与末次随访比较有统计学差异(P<0.05)。结论:椎体后凸成形术治疗骨质疏松性椎体爆裂骨折安全、有效;椎体后凸成形术治疗骨质疏松性椎体爆裂骨折亦存在椎管重建现象。

Background： Osteoporotic spinal burst fracture is mentioned as a relative contraindication of percutaneous vertebroplasty or kyphoplasty. Osteoporotic spinal burst fracture without neurological deficit is an increasingly common problem and it is worth to explore its treatment. Objective： The purpose of this study is to explore the feasibility, clinical outcome of kyphoplasty for osteoporotic spinal burst fractures and whether spontaneous remodeling of the spinal canal occurs after kyphoplasty.Methods： A total of 18 patients with osteoporotic spinal burst fractures without neurological deficit were treated by ky- phoplasty between January 2008 and January 2009. Pain and disability were measured by visual analog scale （VAS） and Oswestry disability index （ODI） preoperatively, postoperatively and at the last follow-up. The bone block in spinal canal was also measured at the same time. The anterior, central heights of the compromised vertebral body, the kyphotie angle were measured preoperatively, postoperatively and at final follow-up.Results ： The average follow-up duration was 20.4 months （ range 12 - 33 ） in the 18 patients. No infection and pulmonary embolism happened. There was a little of cement leakage in one patient, but no clinical symptom occurred. The mean VAS score decreased from 8.2 ±1.3 preoperatively to 2.8 ± 0. 8 postoperatively （ P 〈 0. 05 ）, and it improved further to 3.0 ± 0. 8 at the last follow-up. The ODI scores were 67.4% ±7.7% , 37. 8% ±3. 1% and 38.9%±2. 6% preoperatively, post-operatively and at the last follow-up （ P 〈 O. 05 ）. The spinal canal compromise between pre- and post-operation had no statistical significant difference （ P 〉 0. 05 ）. The difference of bone block in spinal canal between pretreatment and post-treatment had statistical significance （ P 〈 0. 05 ）. No significant difference was noted in maintenance of the height restoration and kyphotic defonnity correction between postoperatively and at the last tollow-up.Conclusions： Kyphoplasty is a safe and effective method for the treatment of osteoporotic spinal burst fractures without neurological deficit. Spontaneous remodeling of the spinal canal also exists after treatment.