体位复位与球囊扩张对椎体后凸成形术的复位效果

Effect of postural reduction and balloon dilation on correction of vertebral height by percutaneous balloon kyphoplasty

目的 探讨体位复位与球囊扩张对经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCF）术中复位效果.方法 2012年6月至2013年12月采用PKP治疗后壁完整的胸腰椎OVCF 47例患者（57个椎体）,所有患者都在全身麻醉下先行体位复位,比较手术中球囊扩张前、后伤椎前缘、中部高度丢失百分比、疼痛视觉模拟评分（VAS）及cobb角. 结果 本组患者椎体前缘、中部高度在体位复位前、球囊扩展后、术后均较术前改善,差异有统计学意义（P＜0.05）,而球囊扩张前、后差异均无统计学意义（P＞0.05）.术后cobb角（17.5°±7.2°）均较术前（22.8°±8.1°）降低,差异有统计学意义（P＜0.05）.术前、术后1d及末次随访的VAS评分分别为（8.5±0.4）分、（3.4±0.2）分、（3.1±0.3）分,术后及末次随访较术前明显下降,差异均有统计学意义（F=7.518,P =0.006）. 结论 PKP术中全身麻醉下的体位复位十分重要,而球囊扩张对椎体高度的恢复有部分作用,但效果不明显.

Objective To explore the effect of postural reduction and balloon dilation on the correction of vertebral height following balloon percutaneous kyphoplasty （PKP） for osteoporotic vertebral coinpressive fracture （OVCF）.Methods From June 2012 to December 2013,47 OVCF patients involving 57 fractured thoracolumbar vertebrae with intact posterior wall underwent PKP.In all patients postural reduction was performed under general anesthesia.The percentages of vertebral height loss before and after balloon dilation were compared.The curative effects were evaluated by comparing preoperative and postoperative visual analogue scale（VAS） scores and cobb angles.Results Compared with preoperation,the vertebral heights of anterior and middle columns were significantly improved after postural reduction,balloon dilation and PKP （P 〈 0.05）,but there was no significant improvement before and after balloon dilation （P 〉0.05）.The postoperative average cobb angle （22.8°± 8.1°） was significantly decreased compared with the preoperative one （22.8° ± 8.1°） （P 〈 0.05）.The VAS scores at preoperation,one day postoperation and the final follow-up were respectively 8.5 ± 0.4,3.4 ± 0.2 and 3.1 ± 0.3.The postoperative ones were significantly lower than the preoperative one （F =7.518,P =0.006）.Conclusions In PKP,postural reduction under general anesthesia plays an important role,but balloon dilation may exert an insignificant effect on restoration of vertebral height.