人工植骨结合二次球囊扩张在椎体后凸成形术中骨水泥外渗中的临床应用

Clinical application of artificial bone graft combined with the two balloon dilation in prevention of cement extravasation in percutaneous kyphoplasty

目的 探讨人工植骨结合二次球囊扩张治疗骨质疏松性脊柱压缩骨折术中骨水泥外渗的临床疗效.方法 回顾性分析经单侧椎弓根穿刺球囊扩张椎体后凸成形术（PKP）治疗的60例骨质疏松性胸腰椎压缩骨折患者的临床资料.其中术中发现造影剂外渗15例（T113例,T123例,L15例,L2 2例,L4 1例,L51例）,将人工骨压成粉末,调成稠糊状,使用骨水泥推注器将其注入椎体中,二次行球囊扩张后,在X线机透视下将牙膏状骨水泥缓慢注入椎体内.术后观察有无骨水泥外渗,以及后凸畸形Cobb角和疼痛视觉模拟（VAS）评分改善情况.根据疼痛缓解程度评定疗效.结果 15例患者均完成手术.术后第3天复查X线片显示各病椎体高度恢复良好,椎体内骨水泥充填良好,分布均匀,无椎间、椎旁及椎管内骨水泥外渗.后凸畸形Cobb角平均矫正10.1°±2.4°,VAS评分平均降低（6.2±0.2）分,与术前比较,差异均有统计学意义（tCobb角=16.299,tVAS评分=120.062,P值均＜0.01）.术后15例获随访4～24周,平均19周.术后4周复查X线片显示各病椎体高度无明显丢失,邻椎无新鲜骨折,患者疼痛症状消失或明显缓解,可正常行走,其中疗效优2例、良13例.结论 人工植骨结合二次球囊扩张可有效预防球囊扩张PKP治疗骨质疏松性胸腰椎压缩骨折术中骨水泥外渗,其术后远期临床疗效还有待进一步观察.

Objective To explore the clinical efficacy of cement extravasation prevention by artificial bone graft combined with the two balloon dilation for the treatment of osteoporotic vertebral compression fractures.Methods Clinical data of 60 cases with osteoporotic thoracolumbar vertebral compression fracture treated by the unilateral pedicle puncture percutaneous kyphoplasty （PKP） were retrospectively analyzed,including 15 cases（T11 3 cases,T12 3 cases,L1 5 cases,L2 2 cases,L4 1 case,L5 1 case） of contrast agent extravasation found in operation.The artificial bone was pressed into powder and tuned into a thick paste ; the thick paste was injected into the vertebral body by the injector.After the second balloon dilatation,bone cement like toothpaste was injected into the vertebral body slowly in X-ray fluoroscopy.Postoperative bone cement extravasation and kyphosis Cobb angle as well as visual analogue scale （VAS） score improvement were observed.According to the degree of pain reliesing evaluate the clinical curative effect.Results All 15 patients were completed the operation.The third day after the operation,the review X-ray showed a good recovery of vertebral height of each disease,the vertebral bone cement filling was good,evenly distributed,without intervertebral,paraspinal or spinal bone cement extravasation.The average Cobb angle of kyphosis was corrected 10.1 ° ± 2.4°,and the average VAS score was reduced by 6.2 ± 0.2.Compared with preoperation,the differences were statistically significant （tCobb =16.299,tvAs =120.062,all P values 〈 0.01）.Fifteen cases were followed up for 4 weeks to 24 weeks,with an average of 19 weeks.The fourth week of the postoperative,X-ray showed that no significant vertebral height of each disease was missing,no new adjacent vertebral fracture was found.The efficacy was evaluated the fourth week after surgery,the symptoms of pain was disappeared or obviously improved,and the patients could walk normally.Among them,2 cases were excellent,13 cases were good.Conclusions Artificial bone graft combined with the two balloon dilation is effective for cement extravasation prevention in the treatment of osteoporotic thoracolumbar compression fracture by PKP balloon dilation,but the postoperative clinical efficacy needs further observation.