经皮球囊扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩性骨折

The use of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures in the elderly patients

目的探讨经皮球囊扩张椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩性骨折的临床效果。方法对69例共93个老年骨质疏松性椎体压缩性骨折的患者,均行经皮球囊扩张椎体后凸成形术。观察指标为术前术后的疼痛视觉模拟评分(vasual analogue scale,VAS)、椎体高度的恢复及并发症发生情况。结果 93个椎体均经皮行双侧椎弓根穿刺成功完成手术。所有患者疼痛缓解,VAS术前平均为(7.52±0.49)分,术后第3天平均为(2.38±0.22)分;术后1个月VAS平均为(1.88±0.12)分。术前骨折椎体前缘高度平均为(15.65±0.68)mm,术后椎体前缘高度平均为(23.68±0.83)mm,术前术后差异有显著性(P<0.05)。骨水泥注射量每个椎体3.5～7.5 ml,平均5.5 ml。骨水泥少量渗漏到椎间隙1个椎体,沿手术通道反流至椎弓根2个椎体,均无临床症状,渗漏率为3.23%。结论经皮球囊扩张椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩性骨折,能迅速缓解疼痛,一定程度的恢复椎体高度,临床疗效确切。

Objective To investigate the efficacy of percutaneous kyphoplasty （PKP） in the treatment of osteoporotic vertebral compression fractures in the elderly patients. Methods Sixty-nine patients with 93 osteoporotic vertebral compression fractures received PKP. The pre- and post-operative visual analogue scale （ VAS）, vertebral height restoration, and complications were all observed. Results All the operations of 93 fractures were successfully performed by using percutaneous bilateral pedicle puncture. All the patients had pain relief. The pre-operative VAS was 7.52 ± 0.49. VAS after 3 days of operation was 2.38 ±0.22. VAS after 1 month of operation was 1.88 ＋ 0. 12. The pre-operative height of fractured vertebra was 15.65 ±0. 68 ram, compared to 23.68 ±0. 83mm of that post-operatively. The difference was significant （P 〈 0.05）. Each vertebra received a different volume of bone cement injection, from 3.5 to 7.5 ml, with an average of 5.5 ml. One case of bone cement leakage into the intervertebral space and 2 cases of anti-flow to vertebra pedicle along the surgical access were observed. No clinical symptoms were observed. The leakage rate was 3.23%. Conclusion PKP treatment for osteoporotic vertebral compression fractures has a curative effect on rapid pain relief and restoration of vertebral height to some extent.