球囊二次撑开扩张后凸成形术治疗后壁不完整的椎体压缩性骨折

Kyphoplasty with movement and secondary enlargement of balloon for compression fracture of vertebral body with im- complete posterior wall

目的探讨球囊在椎体内移动二次撑开扩张椎体后凸骨水泥成形术治疗后壁破裂但无移位的椎体压缩性骨折的临床疗效及适应证。方法回顾性分析2011年1月至2014年11月，采用球囊二次撑开扩张后凸成形术治疗且获得随访的29例（29椎）胸腰段及以下后壁不完整的椎体压缩性骨折患者资料，男10例，女19例；年龄55-86岁，平均71岁；摔伤19例，车祸8例，原因不明2例。患者以腰背部疼痛为主，伴支撑力下降，活动受限，双下肢无神经症状。骨折椎体均在T11及以下，其中T111例，T124例，L111例，L29例，L34例。患者施行球囊在椎体内移动二次撑开扩张，椎体后凸骨水泥成形术。术后即刻、术后1、3、6及12个月摄片，测量椎体高度、Cobb角度，采用视觉模拟评分（visual analogue score, VAS）及Oswestry功能障碍指数（Oswestry disability index, ODI ）评价疗效。结果29例患者手术时间（包括骨水泥成形凝固20rain）40±65min，平均（55±7）min；术中出血2～15ml，平均（5±2）ml；骨水泥注入量2．5～7．5ml，平均（5．5±0．5）m1。术后疼痛缓解，次日即可在腰围支具保护下离床活动。手术前VAS、ODI、椎体高度及Cobb角度分别与术后即刻、1、3、6及12个月比较，差异均有统计学意义。X线复查见骨水泥位置无改变或移位，椎体形态无变化，椎体高度及cobb角度维持术后状态，椎体后壁骨折愈合良好。CT见骨水泥形态不规则，但与骨质接合紧密，未见空腔及裂隙。结论球囊移动二次撑升扩张柞体后凸骨水泥成形术，对椎体后壁不完整但骨折块无明显移位且双下肢无神经症状的椎体压缩骨折具有良好的临床疗效，具有简单方便、即时止痛、恢复椎体高度、减小后凸畸形、改善患者预后的功效。

Objective To explore the clinical efficacy and indications of kyphoplasty with movement and secondary en- largement of balloon for the compression fracture of vertebral body with ruptured posterior wall. Methods A retrospective analy- sis was carried out on the data of 29 patients （10 males, 19 females; age range： 55-86 years old; mean age： 71 years old; 29 verte- bral bodies in total） who suffered from compression fracture of the thoracolumbar spine and below, and underwent kyphoplasty through the movement and secondary enlargement of balloon within the vertebral body and were followed up from January 2011 to November 2014. These patients had backache, accompanied by lowered support, limitation of movement, no symptom of nervous lesion on both lower extremities and no past history of balloon kyphoplasty. All fractured vertebral bodies were at T11 or below, ineluding 1 case at T11, 4 cases T12, 11 cases L1, 9 cases L2 and 4 cases L3. The causes of injury included fall （19 cases）, car accident （8 cases） and unknown reasons （2 cases）. All patients underwent kyphoplasty with the movement and secondary enlargement of bal- loon within the vertebral body. Photos were taken immediately after the surgery, at 1 month, 3 months, 6 months and 12 months, and these patients were assessed and analyzed in terms of vertebral height, Cobb angle, visual analogue score （VAS） and Oswestry disability index （ODI）. Results The operation time （including the fox,nation and solidification of bone cement） of 29 patients was 40 to 65 min and the mean time was 55±7 min; the blood loss during operation was 2 to 15 ml and the mean blood loss was 5±2 ml; the injected volume of bone cement was 2.5-7.5 ml and the mean volume was 5.5±0.5 ml. Post-operative pain was relieved and ambulation was performed under the protection of lumbar orthosis brace. Statstical analysis was conducted on VAS, ODI, vertebral height and Cobb angle before operation and at 1 month, 3 months, 6 months and 12 months after operation, showing statistically significant differences. X ray examination found that there was no alternation or displacement of bone cement location, and no change in vertebral morphology, the vertebral height and cobb angle remained the post-operative status, and posterior wall rupture of the vertebral body was recovered well. CT revealed that the morphology of bone cement was irregular and closely integrated with bone substance, and no cavity or fissure was seen. Conclusion Kyphoplasty with movement and secondary enlargement of bal- loon within the vertebral body has a good, definite clinical efficacy in treating compression vertebral fracture with incomplete pos- terior wall of the vertebral body without obvious displacement of fractured bone and symptom of nervous lesion on both lower ex- tremities. This surgery is easy to operate, and has an immediate analgesic effect, which could recover vertebral height as well as reduce kyphosis deformity and improve patient＇ s prognosis.