单侧椎体后凸成形术治疗多发性骨髓瘤相关多节段椎体压缩性骨折的临床观察

Clinical Observation on the Efficacy of Unipedicular Balloon Kyphoplasty in the Treatment of Multiple Myeloma-Related Vertebral Compression Fractures

目的：评价经单侧穿刺球囊扩张椎体后凸成形术（BKP）治疗多发性骨髓瘤（MM）相关的多节段椎体压缩性骨折的可行性与临床疗效。方法：2009年8月～2011年10月收集单纯采用经皮单侧穿刺BKP治疗MM所致的多节段椎体压缩性骨折患者共11例30个椎体。手术前后分别通过视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、SF-36各项指标评分、x线检查，以评价手术前后椎体疼痛的缓解、功能改善、患者满意度、椎体的高度及后凸Cobb角的恢复，以及骨水泥的渗漏情况。结果：11例患者共30个椎体均手术顺利。术中经单侧椎弓根注入骨水泥平均3．26mL／椎。平均手术时间19min／椎。每个椎体的平均透视19次。平均随访12．5个月，4例随访中死亡。术后各时期的VAS和ODI评分均较术前明显降低（P〈0．05）。术后SF-36大部分指标评分明显改善。术后椎体前缘、中线高度及Cobb角矫正较术前明显恢复（P〈0．05）。骨水泥渗漏率3．1％，但无明显的临床症状。结论：经单侧穿刺BKP治疗MM相关的椎体压缩性骨折手术时间短，较为安全，缓解疼痛迅速，明显改善后凸畸形，提高了患者生活独立能力和精神状态。

Objective： To evaluate the efficacy and feasibility of unipedicular balloon kyphoplasty for multiple myeloma-related vertebral fractures. Methods： From August 2009 to October 2011, a total of 30 multiple myeloma-related vertebral fractures in 11 patients were collected, and all the Vertebral Fractures were treated by unipedicular balloon kyphoplasty. We evaluated the level of pain, functional status and patient satisfaction by analyzing the data of visual analogue scale （VAS）, Oswestry disability index（ODI） score and SF-36 questionnair respectively before and after the operation, preoperative and postoperative radiographs were analyzed to evaluate the restoration of vertebral height, kyphotie angle and complication. Results： All the surgeries were performed successfully without any complications. Mean volume of bone cement injected into one centrum was 3.26 mL. The mean operation time of one level was 19 min. The mean fluoroscopy times of one level was 19. In the mean follow-up of 12.5 months, 4 patients died. Both VAS and ODI score decreased significantly in different follow-up period after the operation. Most of subscores measured by the SF-36 questionnair were significantly increased （P〈0.05）. Vertebral height and the mean kyphotic angle were improved （P〈0.05）. Cement leakage occurred at one level （3.1%）, but no any adverse symptoms. Conclusion： Unipedicular balloon kyphoplasty is effective and relatively safe for multiple myeloma-related vertebral fractures, and can improve qualities of living alone and mental state of patients.