经皮椎体后凸成形术治疗重度骨质疏松骨折的疗效观察

Treatment of severe osteoporotic vertebral compression fracture with kyphoplasty

目的椎体后凸成形术（PKP）能有效缓解骨质疏松压缩骨折患者疼痛及恢复椎体高度，但对于椎体高度丢失在70％以上严重骨质疏松骨折患者，行PKP手术的可行性及疗效仍不确定。该研究通过比较不同程度椎体压缩性骨折行PKP术后椎体高度的恢复率和后凸角度变化以及临床结果，探讨PKP治疗压缩程度严重骨质疏松性骨折的可行性及效果。方法2013年1月-2014年1月总共559例（628个椎体）椎体压缩骨折合并疼痛症状接受PKP治疗患者，根据术前影像学检查结果，所有患者被分成3组，骨折时椎体前缘高度丢失率〉70％为第Ⅰ组，椎体前缘高度丢失率50％～70％为第Ⅱ组，椎体前缘高度丢失率30％～50％为第Ⅲ组。所有患者均行PKP术，术后至少随访1年以上。比较患者术前及术后骨折椎体疼痛程度，影像学及临床效果。结果3组患者术后较术前椎体高度均有明显恢复，第Ⅰ组相对于另外两组术后即刻椎体前缘高度恢复更明显。术后1年随访第Ⅰ组与第Ⅱ组椎体前缘高度差异无统计学意义，第Ⅲ组椎体前缘高度高于前两组。椎体高度的恢复及术后高度的再次丢失与患者骨密度（BMD）无相关性。患者骨折椎体部位疼痛术后即刻及术后1年随访较手术前均有缓解，术后1年随访3组疼痛差异无统计学意义。结论对于椎体前柱高度丢失〉70％骨质疏松压缩性骨折患者，PKP手术能明显缓解疼痛，恢复椎体前柱高度及后凸角。因此，PKP是治疗椎体压缩严舌骨席疏凇性骨折的有静方法．

Objective To compare the vertebral height restoration rate, kyphotic angle, and clinical results of patients who underwent kyphoplasty according to the degree of anterior vertebral height loss, and to determine the feasibility and effects of kyphoplasty on severely collapsed osteoporotic vertebral fractures. Methods According to radiographic findings, patients were divided into three groups. Patients with an anterior height compression ratio more than 70% at the time of fracture were divided into Group Ⅰ , patients with a compression ratio of 50%-70% were divided into Group Ⅱ, and those with a compression ratio of 30%-50% as Group Ⅲ .The patients＇ kyphotic angle, anterior vertebral height, and anterior vertebral height restoration ratio 1 year after surgery were compared. Pre- and postoperative pain around the fractured vertebra and the radiological and clinical results according to bone mineral density （BMD） were also compared. Reaults Group Ⅰ showed a greater extent of anterior height restoration immediately after surgery compared with the other groups, which decreased over time. All three groups showed significant restoration of the anterior vertebral height between pre-and postoperative values. The anterior vertebral height 1 year after surgery did not differ between Group Ⅰ and Group Ⅱ but was significantly higher in Group Ⅲ. There was no correlation between the BMD and restoration or decreased in all groups immediately and 1 year after surgery compared with preoperative levels, although the pain level 1 year after surgery did not differ significantly between the groups. Conclusions In patients with an anterior vertebral compression ratio more than 70% because of osteoporotic vertebral fracture, kypoplasty significantly improves the degree of pain, restored the anterior vertebral height, and maintained the kyphotic angle. Therefore, kyphoplasty can be a useful approach in patients with an anterior vertebral compression ratio more than 70%.