“蛋壳”技术在经皮球囊扩张后凸成形术治疗严重骨质疏松性椎体压缩骨折中的应用

Application of eggshell technology and Percutaneous Balloon Ky- phoplasty for severe osteoporotic vertebral compression fractures

目的探讨蛋壳技术在经皮球囊扩张后凸成形术治疗老年严重骨质疏松性椎体压缩骨折的可行性和疗效。方法分析从2009年6月-2013年12月，采用蛋壳技术在经皮球囊扩张后凸成形术治疗老年人严重胸腰椎骨质疏松性压缩骨折43例46个椎体。局麻／全麻下经后路单侧椎弓根穿刺置入病椎，球囊缓慢扩张椎体，小剂量（0．5～1．0mL）骨水泥注入撑开的空腔，再次插入球囊并撑开椎体高度，使之形成一薄的骨水泥蛋壳，撤出球囊，再次注入骨水泥填充。观察患者的视觉疼痛模拟评分（VAS）、活动能力评分、椎体高度测量及Cobb’S角测量。结果所有手术都顺利完成，无严重手术并发症。VAS评分由术前的（7．9±0．8）分下降至术后的（3．5±0．8）分（P〈0．05），活动能力评分由术前的（3．5±0．6）分改善到术后的（1．3±0．4）分（P〈0．05），椎体高度由术前的（13．5±2．0）mm增加到术后的（31．24±1．5）mm（P〈0．05），Cobb’s角由术前的（31．8°4±6．9°）矫正到术后的（18．2°4±5．8°）（P〈0．05），差异均有统计学意义。所有患者门诊随访1～5个月，平均3．8个月，未出现椎体压缩、新发和相邻节段的骨折，临床表现明显改善。结论蛋壳技术在经皮球囊扩张椎体后凸成形术中的应用是治疗老年严重骨质疏松性椎体压缩骨折的一种快速有效方法，具有可行性。

Objective To investigate the feasibility and efficiency of a technique of ＂eggshell＂ technology and percutaneous balloon kyphoplasty in treating senile severe osteoporotic vertebral compression fractures. Methods Data from June 2009 to December 2013 who suffered from senile severe osteoporotic thoracolumbar vertebral com- pression fractures, using the posterior invasive percutaneous balloon kyphoplasty for 43 patients with 46 vertebral bodies. Under local/general anesthesia in posterior unilateral pedicle vertebral puncture into disease body, first the use of distraction with balloon slowly, then injected low dose（ from 0.5 to 1 mL） bone cement into the distraction of vertebral body,inserted balloon again and increased vertebral height, and it become the bone cement ＂eggshell＂, pull out ballon, at last injection of bone cement filling into the spreading disease vertebral body. The clinical effectsby observing the changes of visual analog scale, locomotive activity scale, height of vertebral bodies and the Cobb＇ s angle. Results All the patients were successfully treated and no severe complication occurred. Visual analog scale decreased from （ 7.9 ± 0.8 ） preoperatively to （ 3.5 ± 0.8 ） postoperatively（ P 〈 0.05 ）. Locomotor activity scale im- proved from （3.5 ±0. 6） preoperatively to （ 1.3 ± 0.4） postoperatively （ P 〈 0.05 ）. The height of vertebral body increased from （ 13.5 ± 2.0） mm preoperatively to （ 31.2 ± 1.5 ） mm （ P 〈 0.05 ）. The Cobb＇ s angle improved from （31.8 ± 6.9） ° preoperatively to 18.2°± 5.8° （ P 〈 0.05 ） postoperatively （ P 〈 0.05 ）. There were statisti- cally significant differences between each other. All patients were followed up for 1 to 5 months, with an average of 3.8 months, in the outpatient service, and haven＇t found vertebral compression, new and adjacent segment frac- ture, clinical manifestation were significant improved. Conclusion ＂Eggshell＂ technology and posterior percutane- ous balloon kyphoplasty is a fast, effective and feasible method for senile severe osteoporotic vertebral compression fractures.