椎体后凸成形术治疗骨质疏松性椎体压缩性骨折分析

Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures

目的探讨椎体后凸成形术治疗骨质疏松性椎体压缩性骨折价值及并发症防范.方法回顾性分析2006年6月至2009年1月骨质疏松性椎体压缩性骨折68例,其中男21例,女47例,年龄62～82岁.用国产的椎体后凸成形手术套件,患者取俯卧位,在C型臂监测下,胸伤椎穿刺点位于横突肋凹与上关节突之间,腰伤椎位于椎弓根投影外上缘,即左侧9点钟或右侧3点钟确定穿刺位位置,穿刺针经椎弓根侧位确认穿刺针尖位于骨折椎体,正侧位确认位置无误后,按步骤进行手术操作.结果手术均获成功,2例骨水泥向椎间盘渗漏,2例向椎旁组织渗漏,4例7节椎体骨水泥渗漏至椎管内,并发症发生率为11.76%,其中1例手术第2天离床活动后出现左侧大腿前外侧疼痛,对症治疗后6 d好转外,余未引起临床症状;2例术中出现血压、脉搏下降,对症处理后好转;术后低热3例,所有患者在手术第2天离床活动.术后3～18月随访,伤椎最大塌陷处的平均高度由1.58 cm增加至2.13 cm,后凸Cobb角较术前平均缩小(12.3±3.4)°.结论经皮椎体后凸成形术治疗骨质疏松性脊柱压缩性骨折,可以迅速缓解疼痛,恢复骨折椎体部分高度,改善后凸畸形,提高患者生活质量.术前进针角度的测量,MRI及3DCT判断伤椎周壁骨质的完整性,全程监测骨水泥推注过程,能有效降低并发症的发生.

Objective To explore the application value of percutaneous kyphoplasty（PKP）in the treatment of osteoporotic vertebral compression fractures（OVCF）and the prevention of complications.Methods From June 2006 to January 2009,a totally of 97 vertebra with OVCF in 68 patients were treated by using domestic PKP tool system.There were 21 males and 47 females,with the age of 62～82 years.The puncture point was located between costal fovea of the transverse process and superior articular process for thoracic vertebra,and in lateral upper edge of the pedicle projection for lumbar vertebra.With the patients in prone position,the puncture needle was inserted into the fractured vertebral body via the lateral edge of pedicle under C-arm guidance.After the location of neddle tip was confirmed,the sugery was carried out according to the operative procedure.Results The operations were successful in all patients.The bone cement leaked into intervertebral disc in 2 cases,paravertebral space in 2 cases and spinal canal in 4 cases of 7 vertebra.The incidence of complication was 11.76%.1 case had got a pain in the anterolateral thigh after ambulation on the second postoperative day,which was relieved by symptomatic treatment 6 days later.2 cases which suffered from decreased blood pressure and weak pulse during the operation,were improved after treatment.Postoperative fever was found in 3 cases.All patients began to ambulate on the second day after operation and were followed up for 3-18 months.The average height of severe collapsed vertebra is increased from 1.58cm to 2.13cm.Compared with the preoperative measurement,Cobb angle was reduced 12.3 ° ± 3.4 on average.Conclusions The PKP in the treatment of OVCF can quickly relieve pain,recover the height of fractured vertebra,improve kyphosis and life quality.The measurement of needle angle,observation of vertebra with MRI and 3DCT,monitoring of bone cement injection whole process can effectively reduce the incidence of complications.