单侧经皮椎体后凸成形术治疗骨质疏松性胸腰椎体压缩骨折疗效分析

Efficacy analysis of unilateral puncture in percutaneous kyphoplasty for patients with osteoporotic vertebral compression fracture

目的：探讨单侧椎弓根入路经皮椎体后凸成形术（ PKP）治疗骨质疏松性胸腰椎体压缩骨折的临床疗效。方法：2009年12月～2012年12月，应用单侧PKP对42例（45个椎体）骨质疏松性胸、腰椎体压缩骨折的患者进行治疗，术前、术后及随访期间进行模拟视觉评分（ VAS）及日本矫形外科协会（ JOA）评分，对其疗效和脊柱后凸角度的改善进行评估。结果：与术前比较，患者术后腰背部疼痛明显缓解，术后VAS评分较术前明显降低（7．62±0．8vs 2．04±1．34，P＜0．01）；手术24小时后可离床活动，功能改善明显，JOA评分较术前明显增高（15．21±3．49 vs 21．86±3．66，P＜0．01）；X光片确认术后脊柱后凸成角显著减小（20．24°±7．6°;5vs 9．22°±3．32°，P ＜0．01），显示后凸畸形得到有效纠正。术后有2例出现骨水泥渗漏，在随访期内，除1例患者病变椎体在塌陷，其余患者无其他并发症发生。结论：单侧PKP治疗老年骨质疏松性椎体压缩骨折，症状缓解明显，脊柱后凸成角改善理想，具有良好的治疗效果，但应注意并发症的发生。

Objective：To evaluate the clinical outcomes and efficiency of unipedicular percutaneous kyphoplasty （ PKP） for senile os-teoporotic vertebral compression fracture .Methods：A total of 42 patients （ 45 vertebrae ） with osteoporotic thoracic vertebra and thoracic vertebra compression fracture underwent unipedicular PKP from December 2009 to December 2012 were reviewed retrospectively .The pre-and post-operational visual analogue scales （ VAS） ,The Japanese Orthopaedic Association （ JOA） back pain scores and local verte-bral Cobb＆#39;s angles of all cases were measured and evaluated .Results：Compared with pre-operation ,the symptom of back pain in all patients was obviously decreased , the VAS score decreased significantly post -operation（7.62 ±0.8vs 2.04 ±1.34,P〈0.01） .All patients could stand up and walk 24 hours after the operation ,and the functions of spine and lower limbs were obviously improved ,the JOA score in-creased significantly （15.21 ±3.49 vs 21.86 ±3.66,P〈0.01）.By X-ray,The vertebral Cobb＇s angle after operation was significantly decreased （20.24°±7.6°;5 vs 9.22°±3.32°,P〈0.01）,and this indicated that the deformation of spine kyphosis was effectively correc -ted.Bone cement leakage occurred in 2 cases.In the follow up period,postoperative vertebral collapse occurred in 1 case.The rest of the patients with no other complications occurred .Conclusion：Unipedicular PKP for senile osteoporotic vertebral compression fracture should have a better efficacy：ideal remission of symptoms and satisfactory improvement of spine kyphosis ,but should pay attention to the occur-rence of complications .