PKP前后伤椎后凸纠正与脊柱整体力线改善的关系

The Relationship between Correction of Local Kyphosis and Overall Sagittal Alignment in Osteoporotic Vertebral Fracture Treated by Percutaneous Kyphoplasty

目的:评价PKP术后伤椎后凸角纠正与脊柱整体力线改善的关系。方法:回顾性分析2013年3月至2015年9月收治的采取PKP治疗的胸腰椎骨质疏松性压缩骨折患者70例,比较术前、术后骨折椎体的后凸角和C7矢状位比值的变化,分析两者有无相关性。结果:PKP前后伤椎后凸角纠正6.72±1.92度,其中单一椎体骨折伤椎后凸角纠正5.66±1.26度,单一胸椎骨折伤椎后凸角纠正5.97±1.12度,单一腰椎骨折伤椎后凸角纠正5.36±1.32度;PKP前后C7/SFD变化0.03±0.02,其中单一椎体骨折患者C7/SFD变化0.02±0.01,单一胸椎骨折患者C7/SFD变化0.02±0.01,单一腰椎骨折患者C7/SFD变化0.02±0.01。除单一腰椎骨折外,C7/SFD变化与伤椎后凸角纠正呈明显相关。PKP前后双椎骨折患者C7/SFD变化0.04±0.02,三椎骨折患者C7/SFD变化0.06±0.03,C7/SFD变化与骨折数目呈明显相关。单一胸椎与单一腰椎骨折比较,PKP前后伤椎后凸角纠正及C7矢状位比值改变均无统计学意义。结论:PKP术后骨折节段局部后凸畸形纠正越明显,脊柱整体力线改善越明显;随着PKP节段的增加,后凸畸形和脊柱整体力线改善更加明显。

Objective： To evaluate the relationship between correction of local kyphosis and overall sag- ittal alignment in thoracolumbar spinal osteoporotic vertebral fracture treated by percutaneous kyphoplasty. Methods： From Mar. 2013 to Sep. 20151 70 patients with osteoporosis vertebral compression fracture treated by PKP were included in the study. Preoperative and postoperative radiographs were analyzed to quantify local and overall spinal sagittal alignment correction. The correlation of local and overall spinal sagittal alignment （ the C7/SFD ratio ） correction was analyzed. Results： Measurements revealed that all the kyphoplastys re- duced kyphotie angle at the fractured vertebra by 6.72±1.92°; Single-level kyphoplasty reduced kyphotic an- gle at the fractured vertebra by 5.66± 1.26°; Single-level kyphoplasty reduced thoracic kyphotic angle at the fractured vertebra by 5.36 ± 1.32° ; Single-level kyphoplasty reduced lumbar kyphotic angle at the fractured vertebra by 5.36±1.32°. The C7/SFD ratio was reduced by 0.03±0.02 with all the kyphoplastys. Single-level kyphoplasty reduced the C7/SFD ratio by 0.02±0.01. Single-level kyphoplasty in thoracic fractures reduced the C7/SFD ratio by 0.02±0.01. Single-level kyphoplasty in lumbar fractures reduced the C7/SFD ratio by 0. 02±0.01. Except single-level lumbar fracture, the C7/SFD ratio was significantly correlated with local kyphot- ic angular reduction of fractured vertebra. Double-level kyphoplasty reduced the C7/SFD ratio by 0.04±0.02. Three-level kyphoplasty reduced the C7/SFD ratio by 0.06±0.03. The C7/SFD ratio was significantly correla- ted with local kyphotie angular reduction of fractured segments. Comparing single-level thoracic fracture with single-level lumbar fracture, local kyphotic angular reduction of fractured vertebra and the C7/SFD ratio have no sense of statistics. Conclusions： Better improvement was seen on the global sagittal spinal alignment with higher local kyphotic angular reduction after kyphoplasty. More fractured segments after kyphoplasty, higher local kyphotic angular reduction at the fractured vertebra and better improvement of the global sagittal spinal alignment.