改良经皮椎体后凸成形术工作通道控制球囊扩张方向及其在临床中的应用

The application of modified working tube to control balloon dilatation in percutaneous kyphoplasty procedure

目的 ：自行改良经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）的工作通道控制球囊扩张方向,并应用其行PKP手术（controllable percutaneous kyphoplasty,C-PKP）治疗胸腰椎骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture,OVCF）,总结其治疗OVCF的优势。方法 ：将传统经皮椎体后凸成形术的工作通道末端2cm改为边缘圆钝的圆弧状和斜坡状缺口结构,通过调整工作通道方向控制球囊扩张方向。从2010年12月~2013年12月应用其治疗43例胸腰椎OVCF患者,并与同期收治的48例采用PKP治疗的OVCF患者比较。两组患者年龄、性别比、骨折部位、术前疼痛视觉模拟评分（visual analogue scale,VAS）、骨密度和骨折程度比较无统计学差异（P〉0.05）,具有可比性。比较两组患者术后3d及术后6个月时的VAS评分、楔形角和后凸角的恢复情况及术后骨水泥渗漏情况。结果：所有患者均顺利完成手术,术中8例发生骨水泥漏,其中C型骨水泥漏6例,B、S型各1例,均发生在传统PKP组,均未出现神经症状及血管栓塞等并发症;C-PKP组骨水泥渗漏发生率低于PKP组,差异有统计学意义（P〈0.05）。随访11.3±5.2个月（6~35个月）,两组患者术后3d及术后6个月的VAS评分、楔形角及后凸角与术前比较差异均有统计学意义（P〈0.05）,两组患者同一时间点的VAS评分、楔形角及后凸角比较差异均无统计学意义（P〉0.05）。结论：应用C-PKP治疗胸腰椎OVCF是一种有效方法 ,可降低骨水泥渗漏的发生率。

Objectives： To summarize the clinical outcome of self-making working tube and its orientation controlling in percutaneous kyphoplasty（C-PKP） for osteoporotic vertebral compression fracture（OVCF）.Methods： Modified C-PKP was designed to have a 2cm of sleeve tail shaped as arc and slope, which could control the expansion direction though adjusting the working tube. From December 2010 to December 2013,43 patients with thoracolumbar OVCF were treated by modified C-PKP, at the same time, 48 cases experienced conventional PKP, the two groups were compared in age, sex, bone density, compressional degree（P0.05）. The visual analogue scale（VAS） score, the correction of wedge angle and the kyphotic angle of the injured vertebra before operation, 3 days and 6 months after operation and the postoperative cement leakage were compared between two groups. Results： All the operations were performed successfully. There were 8 cases suffering from cement leakage during operation in the traditional PKP, type C was noted in 6cases, type B in 1 case, type S in 1 case, but no radicular symptom was noted. C-PKP had significant less rate of cement leakage than PKP（P0.05）. The patients were followed up for 11.3 ±5.2 months（6-35 months）.There were significant differences between the preoperative and postoperative VAS scores, the correction of wedge angle and the kyphotic angle of the injured vertebra in two groups at each follow-up time point（P0.05）, but there were no significant differences between two groups at the same time point（P 0.05）.Conclusions： C-PKP is an efficient way for thoracolumbar OVCF, which can decrease the incidence of cement leakage.