经皮椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折的疗效

Clinical efficacy of percutaneous kyphoplasty via extrapedicular approach for mid-thoracic vertebral compression fracture

背景:经皮椎体后凸成形术治疗胸腰段椎体骨质疏松性压缩骨折已成为常规手段,但用来治疗中上胸椎压缩骨折仍是一个挑战。目的:评估单侧椎弓根外入路行经皮椎体后凸成形术治疗中段胸椎骨质疏松性椎体压缩骨折的临床疗效。方法:选择2013年8月至2017年1月间经单侧椎弓根外入路行经皮椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折患者28例(38椎)。记录并比较患者术前、术后1周及末次随访时疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及椎体前缘高度。结果:28例患者均顺利完成手术,切口甲级愈合。所有患者均获得随访,随访时间7～24个月,平均随访(13.2±1.3)个月。4例患者椎体出现骨水泥渗漏,其中2例渗漏至椎体前缘,2例渗漏至椎间隙。无脊髓压迫症、肺栓塞及下肢深静脉血栓等严重并发症。患者术后1周及末次随访时疼痛VAS评分、ODI均较术前降低[(2.5±0.5)、(2.8±0.3)分vs(7.5±0.5)分,(34.2±1.5)%、(30.5±1.9)%vs(63.5±1.9)%],椎体前缘高度均较术前增加[(17.8±0.4)、(18.2±0.9)mm vs(12.7±1.3)mm],且差异均有统计学意义(P均<0.05);而患者术后1周与末次随访时疼痛VAS评分、ODI、椎体前缘高度差异均无统计学意义。结论:单侧椎弓根外入路经皮椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折,安全性高,并发症少,可明显改善伤椎椎体前缘高度,显著减轻患者背部疼痛,提高生活质量。

Background:Percutaneous kyphoplasty has become a classic procedure for osteoporotic vertebral compression fracture of low thoracic and thoracolumbar spine.However,kyphoplasty in middle and high thoracic levels is technically challenged.Objective:To evaluate clinical outcomes of percutaneous kyphoplasty via unilateral extrapedical approach in the treatment of mid-thoracic vertebral compression fractures.Methods:From August 2013 to January 2017,28 patients(38 vertebrae)with mid-thoracic osteoporotic fractures were treated by percutaneous kyphoplasty via unilateral extrapedicular approach.Vertebral anterior margin height,visual analogue scale(VAS)and Oswestry disability index(ODI)were recorded before operation,one week after operation and at the final follow-up.Results:Operation was successfully performed in all the 28 patients with primary wound healing.The average duration of follow-up was(13.2±1.3)months(range,7-24 months)in all the patients.Bone cement leakage occurred in 4 cases(the leakage reached the anterior edge of the vertebral body in 2 cases and to intervertebral space in the other two cases).No severe complications such as spinal cord compression,pulmonary embolism or deep venous thrombosis of lower extremities occurred.Compared with preoperative ones,VAS and ODI were significantly reduced at one week after operation and the final follow-up(7.5±0.5,2.5±0.5,2.8±0.3;63.5%±1.9%,34.2%±1.5%,30.5%±1.9%),while the vertebral anterior margin height was significantly increased([12.7±1.3]mm,[17.8±0.4]mm,[18.2±0.9]mm,P<0.05].However,there was no significant difference in the above-mentioned parameters at one week after operation versus those at the final follow-up(P>0.05).Conclusions:Unilateral extrapedicular kyphoplasty is safe and effective in treating mid-thoracic osteoporotic fractures.It can significantly release backache,restore vertebral anterior margin height.