椎体成形术治疗后壁不完整的骨质疏松性椎体压缩性骨折

Percutaneous Vertebroplasty for the Treatment of Osteoporotic Vertebral Compression Fracture with Vertebral Body Wall Incompetence

目的研究经皮椎体后凸成形术（PKP）治疗后壁不完整的骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture，OVEF）的临床效果。方法自2010年1月起采用椎体成形术治疗笔者医院后壁不完整但无神经损伤的骨质疏松性椎体压缩性骨折24例，观察术前和末次随访时患者的骨水泥渗漏情况、Oswesny功能障碍指数（ODI）和临床影像学的改变。结果8例后壁不完整的骨质疏松性椎体压缩性骨折均成功完成手术，术后随访时间范围为6～12个月，平均随访时间10．6个月，3例出现骨水泥渗漏，其中有2例经椎旁渗漏，1例椎弓根穿刺通道渗漏，术前和末次随访时患者的Oswesny功能障碍指数（oswestry disability index，ODI），椎体前缘高度、椎体中间高度、Cobb角和病椎楔形角的差异有统计学意义（P〈0．05）。结论对于椎体后壁不完整的骨质疏松性椎体骨折，在掌握严格适应证和手术注意事项的情况下，经皮椎体成形术（PKP）治疗是可行的。

Objective To evaluate percutaneous vertebroplasty （PKE） for the treatment of osteoporotic vertebral compression fracture with vertebral body wall incompetence. Methods The group of 24 patients were treated by percutaneous kyphoplasty. The outcome was evaluated by the change in Oswestry disability index（ODI） and radiographic results between before the operation and the last follow - up respectively, bone cement leakage was record. Results Operations in all the 31 patients were completed smoothly. All patients were followed up for 6 - 12months,and the average time was 10.6 month. There were 3 vertebral bodies（ 12.5% ） , including 2 pare - vertebral type and 1 pedicle tye. None of the 3 cases was spinal canal leakage. Significant difference was found in ODI, anterior vertebral height, middle vertebral height, wedge angle and kyphotic angle between the final follow - up and before the operation （ P 〈 0.05 ）. Conclusion Percutaneous kyphoplasty is an safe and reliable method to treat osteoporotic vertebral compression fracture with vertebral body wall incompetence, but manipulation during the operation should be cautious