单侧经横突-椎弓根穿刺椎体后凸成形术治疗伴有肋间痛的胸椎压缩骨折

Unilateral transverse process-pedicle puncture kyphoplasty for treatment of thoracic vertebral compression fractures with intercostal pain

目的探讨单侧经横突-椎弓根穿刺椎体后凸成形术治疗伴有肋间痛的骨质疏松性胸椎压缩骨折的临床疗效。方法 采用单侧经横突-椎弓根穿刺椎体后凸成形术治疗32例伴有肋间痛的骨质疏松性胸椎压缩骨折患者。记录手术时间、出血量、术中透视次数、骨水泥注入量、骨水泥渗漏率、骨水泥弥散面积率,比较术前、术后1d及末次随访时胸背部、肋间疼痛VAS评分、ODI、伤椎前缘高度、椎体Cobb角。结果 患者均获得随访,时间12~20个月。胸背部、肋间VAS评分、ODI术后1d均较术前降低(P<0.01),末次随访时进一步降低(P<0.01)。伤椎前缘高度术后1d较术前增加(P<0.01),末次随访时较术后1d无明显丢失(P>0.05)。椎体Cobb角术后1d较术前减小(P<0.01),末次随访时较术后1d无明显改变(P>0.05)。随访过程中有2例再发非手术椎骨折。结论 单侧经横突-椎弓根穿刺椎体后凸成形术治疗伴有肋间痛的骨质疏松性胸椎压缩骨折具有较好的疗效,能有效缓解肋间痛,恢复脊柱稳定性,是一种安全、有效的穿刺路径。

Objective To investigate the clinical effect of unilateral transverse process-pedicle puncture kyphoplasty in the treatment of osteoporotic thoracic vertebral compression fracture with intercostal pain. Methods The 32 cases of osteoporotic thoracic vertebral compression fractures with intercostal pain were treated with unilateral transverse process-pedicle puncture kyphoplasty.Time of operation,volume of bleeding,times of fluoroscopy,injection volume of bone cement,leakage rate of bone cement,bone cement dispersion area rate were recorded.The VAS of thoracic back pain and intercostal pain,ODI,anterior height of injured vertebrae and vertebral Cobb angle at the preoperation,1 d after operation and the last follow-up were compared. Results All patients were followed up for 12~20 months.The VAS of thoracic back pain and intercostal pain,ODI at 1 d after operation were lower than those before operation ( P <0.01),and further decreased at last follow-up ( P <0.01).The anterior height of the injured vertebrae at 1d after operation increased significantly than that at the preoperation ( P <0.01),and there was no significant loss at the last follow-up compared with that at 1 d after operation ( P >0.05).The kyphoid Cobb angle of the vertebrae at 1 d after operation decreased significantly than that at the preoperation ( P <0.01),but there was no significant change at the last follow-up compared with that at 1 d after operation( P >0.05).Two cases of nonoperative vertebrae had refractures during follow-up. Conclusions Unilateral transverse process-pedicle puncture kyphoplasty for the treatment of osteoporotic thoracic vertebral compression fractures with intercostal pain is effective,which can effectively relieve intercostal pain and restore spinal stability,is a safe and effective puncture method.