PKP在治疗多节段胸腰椎骨质疏松压缩性骨折方面的应用

The Applications of Percutaneous Kyphoplasty in the Treatment of Multi-level Thoracolumbar Osteoporotic Vertebral Compression Fractures

目的:探讨经皮椎体后凸成形术(PKP)治疗多节段骨质疏松性椎体压缩性骨折(OVCF)的疗效和安全性。方法:应用PKP治疗37例共112节胸腰椎多节段骨质疏松性椎体压缩骨折,分析患者术前、术中、术后的临床及影像学资料,采用模拟视觉评分(VAS)及Oswesty功能障碍指数(ODI)评价术前、术后疼痛缓解及日常活动功能恢复情况。结果:13例一次手术完成1节椎体,12例一次手术完成2～3节段椎体,12例两次手术完成3～4个节段椎体。1例术中出现一过性血压降低和呛咳。VAS评分术前为(8.55±1.22)分,术后1周为(2.12±1.09)分,术后3个月为(2.01±1.07)分;ODI值术前为83.02±11.14,术后1周为25.23±7.17,术后3个月为27.45±9.67,疼痛缓解及日常活动功能恢复明显。结论:初步的临床结果显示PKP是多节段骨质疏松性椎体压缩性骨折的有效治疗方法,单椎体信号改变者治疗效果好于多椎体信号改变者。多椎体信号改变者只选择第一责任椎的单节段PKP可能获得更好的效果;多节段患者同时选择第一和第二责任椎一次完成PKP术效果可能好于分次完成。一次治疗多椎体病变更为经济、适用。

Objective： To investigate the clinical efficiency and safety of percutaneous kyphoplasty for patients with multi-level osteoporotic vertebral compression fractures.Methods： 37 cases of multi-level osteoporotic vertebral compression fractures including 112 sections were reviewed.The outcome was evaluated carefully by pre-operatively,post-operatively and radiological material the Visual Analogue Scale（VAS） for pain relief,the Oswestry Disability Index（ODI） for the improvement activity of daily life respectively.Results： All procedures were performed successfully.13 patients have received 1 procedure in one session,12 patients have received 2～3 procedures in one session,12 patients have received 3～4 procedures in two sessions.1 patients had a transient low blood pressure,cough and dyspnea and recovered shortly.The VAS and ODI improved from a mean pre-operative score of 8.55±1.22 and 83.02±11.14 to a mean post-operative score of 2.12±1.09 and 25.23±7.17the first week after operation or 2.01±1.07 and 27.45±9.67 three months after-ward respectively.Pain relief and daily activities function recovered significantly.Conclusions： The preliminary clinical results show that PKP is a more effective treatment method in osteoporotic vertebral compression fractures,the Curative effect in the single vertebral signal changer is better than the person with many vertebral signal changed.Only choose the first responsibility vertebral may have a better result in the person with many vertebral signal changed.A finish of the first and second responsibility vertebral of a complete PKP may better than divide second complete.One treatment more economical and suitable in the person with many vertebral signal changed.