经皮椎体后凸成形术治疗椎体骨质疏松性骨折的复位效果观察

Reduction of percutaneous kyphoplasty for osteoporotic vertebral fractures

目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗椎体骨质疏松性骨折的复位效果。方法 2004年6月～2009年2月采用PKP治疗椎体骨质疏松性骨折108例,其中多椎体骨折30例,骨折累及椎体后壁24例。局麻下扩张146个椎体,每椎注射2.5～6.5 mL,平均4.6 mL。根据术前、术后和末次随访X线片测量椎体高度和Cobb角恢复情况。结果患者术后平均随访24个月。球囊扩张程度明显大于椎体高度复位程度,术后伤椎前缘高度平均恢复2.7 mm(33.4%),伤椎中部高度平均恢复2.8 mm(丢失高度的37.8%),Cobb角平均矫正3.3°,单侧与双侧扩张无显著性差异;疼痛改善程度与复位无相关性。结论 PKP球囊在骨质疏松骨折椎体内扩张会使骨小梁压缩骨折,一般仅能使伤椎部分复位,复位程度与近期止痛效果无相关性。

Objective To analyze the reduction of pereutaneous kyphoplasty （PKP） for osteoporotic vertebral fractures. Methods From April 2004 to February 2009, 108 patients of osteoporotie fractures of thoracie or lumbar vertebrae were trea- ted with PKP under local anesthesia and fluoroscopic guidance. Multilevel was involved in 30 cases, and the posterior verte- bral wall was involved in 24 cases. A total of 146 vertebral bodies were expanded and injected with PMMA, with a mean volume of 4.6 mL （range 2.5-6.5 mL）. The reduction was evaluated with pre-, postoperative and follow-up X-ray films. Results Patients were followed up for an average of 2 years. In osteoporotic vertebral body, PKP predueed void whose height was much greater than the restoration of vertebral height. The mean correction of vertebral body height was 2.7 mm （33.4% of the lost height） in anterior part, 2.8 mm （37.8% of the lost height） in middle part, and the mean correction of Cobb＇ s angle was 3.3°. Partial or significant pain relief was experienced in all the patients with improved activity, which was not related to the rate of reduction. Conclusion During PKP, the trabeeula in the osteoporotie fractured vertebral body is expanded and compressed by the balloon, with partial reduction of collapsed vertebral body, that was not related to pain relief.