过伸体位下球囊多点扩张行经皮椎体后凸成形术治疗新鲜脊柱压缩性骨折的疗效研究

Clinical Effect of Percutaneous Kyphoplasty with Multiple Balloon Dilation in Hyperextension Position in the Treatment of Fresh Vertebral Compression Fractures

目的探讨过伸体位下球囊多点扩张行经皮椎体后凸成形术(PKP)治疗新鲜脊柱压缩性骨折的临床疗效。方法回顾性分析漯河医学高等专科学校第一附属医院2011年2月—2014年9月行PKP的新鲜脊柱压缩性骨折患者的临床资料。根据操作方法分为两组,过伸体位下多点球囊扩张行PKP的患者为观察组(36例),单次球囊扩张行PKP的患者为对照组(42例)。比较两组的手术时间、放射暴露时间、骨水泥注入量、骨水泥渗漏发生率、手术前后疼痛视觉模拟评分法(VAS)评分、伤椎相对高度、局部Cobb角。结果两组均顺利完成手术,随访时间18~24个月,平均22.8个月。观察组手术时间(48.3±5.1)min、放射暴露时间(4.6±1.7)min、骨水泥渗漏发生率13.9%(5例),对照组手术时间(41.9±3.7)min、放射暴露时间(4.1±1.2)min、骨水泥渗漏发生率14.3%(6例),两组间差异均无统计学意义(P>0.05)。观察组骨水泥注入量为(5.8±0.5)ml,大于对照组的(3.1±0.5)ml(P<0.05)。两组术后1周及术后1年伤椎相对高度及Cobb角比较,差异均有统计学意义(P<0.05)。结论过伸体位下球囊多点扩张行PKP,与普通PKP比较,在不明显延长手术操作时间、放射暴露时间及不增加骨水泥漏发生率的前提下,能够使新鲜椎体骨折复位有所改善,可部分改善后凸畸形,低压下增加骨水泥注入量,具有操作简单、安全的特点。

Objective To investigate the clinical effect of percutaneous kyphoplasty（ PKP） with multiple balloon dilation in hyperextension position in the treatment of fresh vertebral compression fractures. Methods The clinical data of 78 patients with fresh vertebral compression fractures receiving PKP from February 2011 to September 2014 were retrospectively analyzed. According to the surgical method,they were divided into the observation group（ n = 36,PKP with multiple balloon dilatation in hyperextension position） and control group（ n = 42,PKP with single balloon dilatation in prone position）. The duration of surgery,duration of radiation exposure,amount of bone cement injected,incidence of bone cement leakage,the visual analogue scale（ VAS）,relative height of the injured vertebrae and the local Cobb angle measured before and after surgery were compared between the two groups. Results Both groups underwent the surgery successfully,and received an average follow-up of 22. 8 months（ range 18 to 24 months）. The observation group and the control group were found with similar duration of surgery [（ 48. 3 ± 5. 1） min vs.（ 41. 9 ± 3. 7） min],similar duration of radiation exposure [（ 4. 6 ± 1. 7） min vs.（ 4. 1± 1. 2） ]as well as similar incidence of bone cement leakage [13. 9%（ 5/36） vs. 14. 3%（ 6/42） ]（ all P 0. 05）. The amount of bone cement injected in the observation group was much more than that in the control group [（ 5. 8 ± 0. 5） ml vs.（ 3. 1± 0. 5） ml]（ P 0. 05）. The relative height of injured vertebrae and local Cobb angle measured at 1 week after surgery and 1 year after surgery differed significantly between the two groups（ P 0. 05）. Conclusion Compared with the normal PKP surgery,PKP with multiple balloon dilation in hyperextension position is simple and safe,which can improve the reduction of the fractured vertebral body,partially ameliorate the kyphosis deformity,increase the amount of bone cement injected under low pressures without significantly prolonging the duration of surgery and radiation exposure and the incidence of bone cement leakage.