椎体裂隙征对经皮椎体后凸成形术疗效的影响

The Effect of Percutaneous Kyphoplasty in Osteoporotic Thoracolumbar Vertebral Compression Fractures with Vertebral Body Splitting Sign

目的探讨椎体裂隙征对经皮椎体后凸成形术(percutaneous kyphoplasty,PVP)治疗骨质疏松性椎体压缩骨折的疗效影响。方法回顾分析我院2014年5月~2016年5月行PVP术治疗的骨质疏松性胸腰椎压缩性骨折患者96例,根据患者是否合并椎体裂隙征分为裂隙组32例和无裂隙组64例。比较两组患者的临床疗效、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、伤椎前缘相对高度、伤椎矢状面Cobb角以及术中骨水泥注入量、分布形态和渗漏情况。结果治疗1月后,无裂隙组和裂隙组临床有效率分别为98.4%和90.6%,组间比较差异无统计学意义(P>0.05);两组患者术后VAS、ODI评分明显下降,Cobb角及伤椎前缘相对高度明显改善,与术前比较均有统计学差异(P<0.05);但组间VAS、ODI、Cobb角及伤椎前缘相对高度比较,差异均无统计学差异(P>0.05)。无裂隙组患者术中骨水泥注入量明显少于裂隙组(P<0.05);术中骨水泥弥散不佳仅1例,明显少于裂隙组5例(P<0.05);术中骨水泥渗漏仅2例,明显少于裂隙组6例(P<0.05)。结论 PVP治疗骨质疏松性胸腰椎压缩性骨折时,无论伤椎内是否存在裂隙,均能取得满意的临床疗效。而椎体裂隙征的存在会增加骨水泥注入量,出现骨水泥弥散不佳及骨水泥渗漏发生率较高等问题。因此,术中应尽量使骨水泥填满裂隙,结合抗骨质疏松治疗,同时避免骨水泥椎管内渗漏,预防畸形矫正丢失及术后再骨折的出现。

Objective To study the effect of percutaneous kyphoplasty（PVP） in osteoporotic vertebral compression fractures（OVCF） with vertebral splitting sign. Methods A total of 96 patients with osteoporotic thoracolumbar vertebral compression fractures underwent PVP were analyzed retrospectively from May 2014 to May 2016. All cases were divided into vertebral splitting group（n = 32） and non-splitting group（n = 64） according to OVCF with concomitant vertebral splitting or not. The clinical efficacy,pain visual analog scale,Oswestry dysfunction index,the relative height of the anterior vertebrae of the enrolled vertebrae,the angle of the Cobb of the injured vertebrae,the amount of bone cement injected,the distribution of the cement and the leakage rate of cement were compared between the two groups. Results The effective rate was 96. 2 % and 90. 6 % respectively in the vertebral splitting group and non-splitting group 1 month after the PVP,and there was no statistical difference between the two groups（P 0. 05）.The VAS and ODI were decreased,and the Cobb angle and the relative height of anterior injured vertebrae were improved after the operation than those before operation in both groups（P 0. 05）. However,there was no statistical difference in post-operative VAS,ODI,Cobb angle and relative height of anterior injured vertebrae between the two groups（P 0. 05）. The injected amount of bone cement was lower in non-splitting group than that in splitting group（P 0. 05）. The poordistribution and the leakage of cement were found in 1and 2 cases respectively in non-splitting group,and found in 5 and 6 cases respectively in splitting group,there were statistical differences between two groups in them（P 0. 05）. Conclusions PVP can achieve satisfactory clinical results in the treatment of osteoporotic thoracolumbar vertebral compression fractures with or without vertebral splitting. However,the amount of bone cement infusion may increase,and the poor bone cement diffusion and high incidence of bone cement leakage would appeared in the patients with vertebral splitting,so the managements were performed necessarily with stuffing the vertebral splitting during the operation,avoiding cement spinal leakage,deformity correction lost and re-fracture,and anti-osteoporosis treatment after the operation.