单侧经皮椎体后凸成形术治疗骨质疏松性椎体爆裂骨折的安全性评价

Safety evaluation of unilateral percutaneous kyphoplasty in treating osteoporotic vertebral burst fracture

目的 探讨单侧经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体爆裂骨折的安全性.方法 2014年4月至2015年7月收治骨质疏松性椎体爆裂骨折25例25个椎体,其中男11例,女14例,中位年龄76.6（58.0～88.0）岁.术前常规拍摄正侧位X线片、CT三维重建扫描和MR脂肪抑制序列扫描,明确骨折部位和椎体后壁的完整性与否.术后第1天拍摄正侧位X线片、CT三维重建扫描观察骨水泥渗漏情况,出院后规律随访拍摄正侧位X线片.根据骨水泥渗漏分区进行术后骨水泥渗漏的部位统计,根据伤椎上位椎体上终板和下位椎体下终板测量后凸角,测量术前、术后伤椎前后壁的高度.结果 术后第1天、末次随访时疼痛视觉模拟量表（VAS）评分较术前降低[（2.8±1.2）、（2.4±1.6）分比（6.4±2.6）分],差异有统计学意义（P＜0.05）.术后第1天后凸角较术前降低,但差异无统计学意义（P＞0.05）;末次随访时后凸角也较术前降低,差异无统计学意义（P＞0.05）.术后第1天、末次随访时椎体前壁高度较术前升高[（21.7±5.0）、（21.4±4.1） mm比（20.3±3.8） mm],差异有统计学意义（P＜0.05）.术后第1天、末次随访时椎体后壁高度较术前增加,但差异无统计学意义（P＞0.05）.末次随访时上述各项数据与术后第1天比较,差异均无统计学意义（P＞0.05）.结论 单侧PKP治疗骨质疏松性椎体爆裂骨折安全可靠,清晰的影像显示器、熟练的穿刺技术、术中注意骨水泥推注时机是手术成功的必要因素.

Objective To explore the safety of unilateral percutaneous kyphoplasty （PKP） in treating osteoporotic vertebral burst fracture.Methods All 25 osteoporotic vertebral burst fracture cases （25 fracture segments） treated from April 2014 to July 2015 were analyzed retrospectively.In 25 cases,there were 17 males and 16 females,aged from 58.0 to 88.0 years with a mean age of 76.6 years.All patients included in the study had preoperative thoracic or lumbar X-rays,CT reconstruction and MR fatsuppression sequence scan in order to definite fracture sites and the integrality of the posterior wall of fracture vertebral.The unilateral PKP were performed by the same operator.All patients included in the study had postoperative thoracic or lumbar X-rays,and CT reconstruction to observe the bone cement leakage.After patients were out of hospital,X-rays were done regularly.The types of bone leakage were recorded.The pre-and post-operational anterior and posterior wall and the kyphotic angle were measured by one doctor.Results The scores of VAS at the first day after operation and the end of follow up decreased compared with the pre-operative scores：（2.8 ± 1.2）,（2.4 ± 1.6） scores vs.（6.4 ± 2.6） scores,and there were significant differences （P ＜ 0.05）.The kyphotic angle at the first day after operation and the end of follow up decreased compared with the pre-operative,but there were no significant differences （P ＞ 0.05）.The post-operative height of vertebral anterior wall increased at the first day after operation and the end of follow up compared with the pre-operative：（21.7 ± 5.0）,（21.4 ± 4.1） mm vs.（20.3 ± 3.8）mm,and there were significant differences （P ＜ 0.05）.The post-operative height of vertebral posterior wall increased at the first day after operation and the end of follow up compared with the pre-operative,but there were no significant differences （P ＞ 0.05）.The above index at the first day after operation and the end of follow up had no significant differences （P ＞ 0.05）.Conclusions The unilateral PKP in treating osteoporotic vertebral burst fracture is safe and reliable.Clear image display,skillful puncture techniques and suitable injection timing are necessary factors for a successful operation.