PKP技术治疗骨质疏松性椎体骨折不愈合的临床观察

Clinic evaluation of osteoporotic vertebral body nonunion compress fracture treated by PKP

目的探讨和评估经皮椎体后凸成形术﹙PKP﹚治疗骨质疏松性椎体压缩骨折不愈合的方法与临床疗效。方法自2006年3月~2011年3月,在局麻下行PKP技术治疗老年椎体压缩骨折不愈合患者28例34个椎体,术后进行AVS、ODI临床疗效和影像学评估。结果所有患者获得3~48个月﹙平均24.6个月﹚随访。23例术后腰背部疼痛消失,5例疼痛明显减轻,VAS由8.3±2.3减少到2.5±1.8,ODI评分由﹙76.5±13﹚%减少至﹙23.5±8﹚%,与手术前有显著性改善﹙〈0.001﹚。术后X线片及CT提示伤椎内骨水泥填充部位满意,无硬脊膜受压表现。测量X光片术前单椎体后突成角为平均23±8°,术后平均13±5°,改善角度平均10±3°。椎体高度术前平均1.3±0.6cm,术后平均2.1±0.7cm,高度增加平均0.8±0.3cm。手术前后后突角度及椎体高度的恢复均有显著性差异﹙〈0.001﹚。结论 PKP技术治疗骨质疏松性椎体压缩骨折不愈合是一种脊柱微创技术,适应于手术耐受性差的老年人,是治疗老年椎体压缩骨折不愈合的有效方法。

Objective To evaluate the clinical effect and methods of the percutaneous kyphoplasty﹙PKP﹚ technique in the treatment of osteoporotic vertebral body nonunion compress fracture.Methods From Mar 2006 to Mar 2011,28 aged patients with 34 nonunion compress fractures of osteoporotic vertebral body were treated by PKP.AVS and ODI and radiological evaluations were performed after operation.Results All 28 cases were followed up from 3 to 48 months,mean follow up time was 24.6 months.23 patients have immediate relief of pian,and 5 patients relife of pain mostly.The AVS decreased from 8.3±2.3 to 2.5±1.8,and ODI decreased from﹙76.5±13﹚% to﹙23.5±8﹚%,the clinic symptoms were improved significantly﹙ 0.001﹚compared with that of preoperation.X-ray and CT showed that the nonunion fractured vertebral bodies were well filled by bone cement with no neuro symptoms.The X-ray measurement showed that the average angle of single kyphotic vertebral body was23±8° before operation,and 13±5° after operation,the decreased angle was10±3°.The average vertebra height was 1.3±0.6cm before operation,and 2.1±0.7cm after operation,vertebral height increased 0.8±0.3 cm,the decresed kyphotic angle and increased vertebral height were significantly﹙ 0.001﹚.Conclusion The PKP is a spinal minimal invasive surgery,specially suitable for the aged patients whose opertive toleration is poor,and a method which is safe and effective for osteoporotic nonunion compress vertebra compress fracture.