数字减影血管造影监控下椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效分析

Efficacy analysis on treatment of senile osteoporotic vertebral compression fractures by percutaneous kyphoplasty under surveillance of DSA

目的探讨数字减影血管造影(DSA)机监控下经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)的疗效。方法自2006年1月至2011年12月,在DSA监控下确定责任椎后,行椎体后凸成形术,治疗OVCF86例,共104个椎体,其中男26例,女60例,年龄67～94岁,平均83.3岁。骨折累及1个椎体共63例,2个椎体18例,3个椎体5例,观察患者手术前后视觉模拟疼痛评分(VAS)、健康调查简表(SF-36)评分的变化及椎体前缘高度的变化和矢状面Cobb角的变化。结果本组获随访7～38个月,平均16.9个月。86例114个椎体均顺利完成手术,无术中死亡,无发生肺栓塞及神经压迫症状。术后X线及CT扫描显示所有患者均获得脊柱稳定。VAS由术前(7.8±1.5)分降至术后第3天(1.8±1.2)分,末次随访为(1.9±1.3)分,术前与术后第3天、末次随访比较,差异均有统计学意义(P<0.01);SF-36评分由(246±103)分降至术后第3天(352±117)分,末次随访为(367±131)分,术前与术后第3天、末次随访比较,差异均有统计学意义(P<0.01);椎体前缘高度术前、术后第3天及末次随访分别为(8.4±1.4)mm、(13.8±1.6)mm和(13.8±1.5)mm,术前与术后第3天及末次随访比较,差异均有统计学意义(P<0.01);矢状面Cobb角术前、术后第3天及末次随访分别为(29.1±3.1)°、(20.7±2.3)°及(20.8±2.4)°。术前与术后第3天及末次随访比较,差异均有统计学意义(P<0.01)。结论 DSA监控下行PKP操作相对简便、灵活,增加穿刺的准确率,是一种治疗老年OVCF的微创手术,能够有效缓解骨质疏松性椎体骨折引起的疼痛,维持脊柱稳定性,恢复椎体高度,患者可早期下床活动,避免老年患者卧床的常见并发症,从而改善其生活质量,减少死亡率。是一种简单、安全、有效的新方法。

Objective To evaluate the therapeutic effect of percutaneous kyphoplasty （PKP）in treating senile osteoporotic vertebral body fracture （OVCF） under the monitoring of digital subtraction angiography （DSA） machine. Methods From January 2006 to December 2011, monitored by DSA searching for the targeted vertebral body,operated by the protruding after angioplasty to treat the senile of OVCF in 86 cases（ llg vertebral body in 86 cases） of which 26 cases of men,60 cases of women, aged from 67 to 94 years old, and the average was 83.3. Fracture involved one vertebral body in 63 cases, two vertebral body in 18 cases, and three vertebral body in 5 patients. The patients were observed by visual analogue score （VAS） and the MOS item short from health sur-vey （SF-36） score ratings change according to preoperative and postoperative and so on to the vertebral body height change and sagittal plane Cobb Angle change. Results The mean followed up period was 16. 9 months （7-38 months）. 86 cases （104 vertebral body）were successfully completed operated, no death case, no happen pulmonary embolism and nerve compression symptoms. The X-ray and CT scanning all showed that all patients were obtain the stability of the spine. The VAS of patients from （7. 8 ± 1.5 ） score preoperatively to （ 1.8 ± 1.2 ） score third days postoperatively （ P 〈 0. 01）,and then to（ 1.9 ± 1.3 ）score at final follow-up. There was statistically significant difference between the preoperative score and the score at third days postoperative or at final follow-up. The SF-36 of patients from（246 ±103 ） score preoperatively to（352 ±117） score third days postoperatively（P 〈 0. 01 ）, and then to（367 ±131 ） score at final follow-up. There was statistically significant difference between the preoperative score and the score at third days postoperative or at final follow-up. The mean height of the anterior vertebral body was（ 8.4 ± 1.4）mm preoperatively, （ 13. 8 ±1.6 ） mm third days postoperatively and （ 13.8 ±1.5 ）mm at final follow-up respectively. There was statistically significant difference between the preoperative and at third days postoperative or at final follow-up （P 〈 0. 01 ）. The sagittal plane Cobb angle was （29. 1 ±3.1 ）° preoperatively, （ 20.7± 2. 3 ）° third days postoperatively and （20. 8 ± 2.4 ）° at final follow-up respectively. There was statistically significant difference between the preoperative and at third days postoperative or at final follow-up （ P 〈 0. 01 ）. Conclusions DSA monitoring descending PKP operation relative simple, flexible,increase the puncture accuracy,it is a kind of treatment in senile of OVCF of minimally invasive surgery, can effectively alleviate pain casing by OVCF, maintain the spinal stability, restore vertebral body height, patients can be get out of bed early, avoid the common complications in elderly patients, so as to improve the quality of life and reduce mortality. It is a simple, safe and effective new method.