经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床疗效分析

Clinical study of percutaneous kyphoplasty in the treatment of vertebral compression fractures

目的探讨和评估经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCFs)的疗效和安全性。方法选择行PKP治疗OVCFs 185例,共200个伤椎,男55例,女130例,中位年龄69岁,术前CT显示椎体后壁均完整。所有手术均在C形臂X线机引导下进行,术前、术后及最终随访时分别进行视觉模拟疼痛评分及Cobb角测量,观察患者术后疼痛缓解及压缩椎体高度恢复情况,术后随访1年以上。结果所有手术均顺利完成,无严重手术并发症。所有患者获得平均12.2个月随访周期,L1椎体骨折是骨质疏松骨折的好发部位,视觉模拟评分(VAS)由术前的(8.0±1.0)分下降至术后的(2.3±0.9)分,最终随访时为(2.1±0.9)分。术前伤椎前、中柱的平均高度由(14.4±2.0)mm增加至术后(24.5±1.6)mm,末次随访(24.5±1.8)mm,手术前后差异有统计学意义(P<0.05);Cobb角由术前的(22.5±2.1)°,矫正到术后的(8.0±1.9)°,最终随访时为(8.1±0.9)°,术后与术前、最终随访时与术前比较差异有统计学意义(P<0.05);术后与最终随访时差异无统计学意义(P>0.05)。结论经皮椎体后凸成形术具有微创、安全、临床疗效良好的优点,能有效缓解疼痛,矫正后凸畸形。

Objective To discuss and evaluate the clinical effect and security of percutaneous kyphoplasty （PKP） on osteopo- rotic compressive fracture （OVCFs） . Methods 185 OVCFs patients （vertebrae 200 ） treated with PKP were selected as the objects. The mean age of 130 females and 55 males was 69 years old. Before the operation, it was made sure that vertebra back wall was well by CT. All operations were conducted under the guidance of C - arm X - ray. Preoperative, postoperative and the last following - up were e- valuated by the VAS and the measure of Cobb to assess pain relief and the altitude recovery of vertebra body. The following - up period was one year or more. Results All cases were successfully treated without serious postoperative complication. During study all patients were following - up for an average of 12.2 months. The research found that L1 vertebra was the prediction site of osteoporotic fracture. Be- fore and after the operation ： the VAS of score reduced from 8.0± 1.0 to 2.3 ± 0. 9, the last followed - up scores was 2.1 ± 0.9 ; the aver- age height of vertebral increased from （ 14.4 ± 2.0） mm to （24.5 ± 1.6 ） mm, the last following - up result was （ 24.5 ± 1.8 ） mm; the correction of cobb from （22.5 ± 2.1 ） degree to （8.0 ± 1.9） degree, the last measurement was （8.1 ± 0.9） degree. There were signifi- cant differences between the preoperative and postoperative results （P 〈 0.05）. Conclusion The PKP can relive the pain effectively and correct kvohotic deformities, also have manv advantages, such as minimally invasive,good security and fine clinical result.