经皮椎体成型术治疗胸腰椎骨质疏松性爆裂骨折

Percutaneous vertebralplasty for lumbar and thoracic osteoporotic vertebral burst fractures

目的探讨经皮椎体成型术治疗胸腰椎骨质疏松性爆裂骨折的安全性、有效性,以及骨水泥渗漏特点。方法采用经皮椎体成型术(percutaneous vertebralplasty,PVP)治疗的单椎体胸腰椎骨质疏松性椎体爆裂骨折(osteo-porotic vertebral burst fracture,OVBF)患者107例。采用VAS评分评价临床疗效,采用椎体前缘及中柱压缩比描述椎体高度,统计术后出现骨水泥渗漏患者的骨水泥渗漏类型及渗漏率。结果所有患者均获得3个月以上随访,VAS评分术后3 d较术前有明显改善(P<0.05),末次随访时较术前及术后3天有明显改善(P<0.05);末次随访时椎体前缘高度及中柱高度较术前均有明显下降(P<0.05)。骨水泥总体渗漏率61.7%,所有渗漏均为无症状渗漏。无骨水泥通过椎体后壁破损的皮质发生渗漏。结论 PVP是胸腰椎骨质疏松性椎体爆裂骨折安全有效的治疗措施。相对于椎体后壁破损的皮质,骨水泥更易通过椎基静脉孔及与椎基静脉相通的椎旁静脉发生渗漏。

Objective To explore the security, effectiveness and characteristics of cement leakage of percutaneous vertebralplasty for lumbar and thoracic osteoporotic vertebral burst fractures. Methods From May 2013 to Feburary2015, 107 patients with osteoporotic vertebral burst fracture underwent PVP. VAS score was used to assess clinical results.Compression rates of the anterior and middle vertebral height were used to assess the injured vertebral body height. The cement leakage rates and types of patients with postoperative cement leakage were analyzed. Results All patients were followed-up for more than 3 months. VAS score showed signigicant improvement at 3 days postoperatively compared to that before surgery（P〈0.05）. At final follow-up, VAS score showed signigicant improvement compared to those preoperatively and 3 days postoperatively（P〈0.05）. At the final follow-up, both anterior and middle vertebral body height significantly decreased compared to those preoperatively（P〈0.05）. Total cement leakage rate was 61.7% and no symptom was found in those patients. No cement leakage was observed from the posterior fractured body cortex. Conclusion PVP is a secure and effective treatment for lumbar and thoracic osteoporotic vertebral burst fractures. Cement leakage is more likely from the basivertebral foramen and paravertebral veins rather than from the posterior fractured body cortex.