重度椎体压缩骨折球囊扩张椎体成形治疗后的椎体复位

Vertebra reduction after treatment of severe vertebral compressive fractures by kyphoplasty

背景:重度椎体压缩性骨折,因其穿刺及复位困难,被认为是椎体成形及后凸成型的相对禁忌证。目的:探讨应用经皮穿刺球囊扩张椎体成形治疗重度椎体压缩骨折后的椎体复位。方法:重度椎体压缩骨折30例(42椎),患椎压缩程度为75%-83%。在数字减影血管造影引导下经皮穿刺进针,体位复位结合局部使用球囊扩张,复位满意后注入骨水泥。结果与结论:30例患者顺利完成治疗。椎体前缘、中部及后缘平均高度分别由治疗前(0.48±0.17)cm、(0.83±0.23)cm和(2.44±0.33)cm,增至术中(0.71±0.22)cm、(1.21±0.25)cm和(2.44±0.33)cm,治疗后椎体前缘、中部高度显著高于治疗前。治疗后目测类比评分显著低于治疗前。结果说明经皮穿刺球囊扩张椎体成形对重度骨质疏松椎体压缩骨折患者能有效缓解疼痛,恢复椎体高度。

BACKGROUND：Due to the puncture and difficult reduction, severe vertebral compressive fracture is considered to be the relative contraindication of vertebroplasty and kyphoplasty. OBJECTIVE：To investigate the vertebra reduction after the treatment of severe vertebral compressive fractures with percutaneous kyphoplasty. METHODS：Thirty patients （42 vertebral bodies） with severe compressive fractures were included. The compressive rate of the affected vertebral bodies was 75%-83%. The direction of percutaneous puncture was guided under digital subtraction angiography, and then postural reduction and local kyphoplasty were performed. After satisfactory reduction, bone cement was injected. RESULTS AND CONCLUSION：Al the 30 patients tolerated procedure wel . The mean height of the anterior, mid and posterior vertebral body was improved from （0.48±0.17） cm, （0.83±0.23） cm and （2.44±0.33） cm preoperatively to （0.71±0.22） cm, （1.21±0.25） cm and （2.44±0.33） cm respectively after operation. The postoperative height of the anterior, mid and posterior vertebral body was significantly higher than that before operation. The visual analogue scale score after treatment was significantly lower than that before operation. The results indicate that percutaneous kyphoplasty can ease pain, restore vertebral body height and improve quality of life of the patients with severe vertebral compressive fractures.