压力引导式经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

Pressure-guided percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture

目的探讨压力引导式经皮椎体后凸成形术(PKP)治疗合并周壁破损的骨质疏松性椎体压缩性骨折(OVCF)的临床疗效及骨水泥渗漏情况。方法回顾性分析2015年9月-2018年9月采用压力引导式PKP治疗的89例合并周壁破损的OVCF患者临床资料,依据术前CT显示的椎体周壁破损部位进行分组,前壁并侧壁破损46例(A组),前壁并终板破损20例(B组),前壁、侧壁并后壁破损23例(C组)。记录所有患者术前骨密度、术中骨水泥用量、手术时间及住院时间。测量手术前后X线片上病变节段椎体前缘高度、中央高度及伤椎后凸Cobb角等参数,评估伤椎恢复情况;在术后CT上观察骨水泥渗漏情况。采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估临床疗效。结果所有手术顺利完成,患者随访3~20(11.60±5.58)个月。手术时间30~90(60.30±10.62)min,住院时间4~8(6.10±1.01)d。3组患者术后1 d和术后3个月的椎体前缘高度、椎体中央高度、伤椎后凸Cobb角、VAS评分、ODI较术前明显改善,差异均有统计学意义(P<0.05)。3组骨水泥注入量和骨水泥渗漏率组间比较差异无统计学意义(P>0.05)。A组发生骨水泥渗漏6例,4例沿椎前渗漏,2例沿椎体侧方渗漏;B组发生2例,均沿上终板渗漏至椎间隙;C组发生3例,2例沿椎前渗漏,1例沿椎体侧方渗漏。所有患者切口均一期愈合,无骨水泥致脏器栓塞、神经根受压等并发症发生。结论压力引导式PKP治疗合并周壁破损的OVCF,临床疗效及影像学指标恢复满意,骨水泥渗漏率低,值得临床推广。

Objective To investigate the clinical efficacy and leakage of bone cement of pressure-guided percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fracture(OVCF) with cortical disruption.MethodsFrom September 2015 to September 2018,the clinical data of 89 patients diagnosed as having OVCF combined with cortical disruption were retrospectively analyzed.According to the different sites of the cortical disruption by CT before operation,46 patients with anterior and lateral border disruption were included in group A,20 with disruption of the anterior border and endplate in group B,and 23 with disruption of anterior,lateral and posterior borders in group C.The preoperative bone mineral density,intraoperative bone cement injection,operation time and hospital stay of all the patients were recorded.The recovery of the injured vertebra was evaluated by measuring the height of the anterior vertebrae,central vertebrae and the Cobb’s angle of the kyphosis before and after surgery,and the cement leakage was observed on postoperative CT.The visual analog scale(VAS) score and Oswestry disability index(ODI) were used to evaluate the clinical efficacy.ResultsAll the operations were successfully completed,and the patients were followed up for 3-20(11.60±5.58)months.The operation time was 30-90(60.30±10.62)min,and the hospital stay was 4-8(6.10±1.01)d.The height of the anterior and central vertebrae,Cobb’s angle of the kyphosis,VAS scores and ODI of the 3 groups were significantly improved compared with those before surgery,all with statistically significant differences(P < 0.05).There was no statistically significant difference between the 3 groups in the bone cement injection and leakage rate(P > 0.05).In group A,there were 6 cases of bone cement leakage,4 of anterior vertebra leakage and 2 of lateral vertebra leakage;2 in group B both along the upper endplate leakage to intervertebral space;3 in group C,2 of anterior vertebra leakage and 1 of lateral vertebra leakage.All the incisions healed in the first stage.There were no other complications such as visceral embolism and nerve root compression caused by bone cement.Conclusion The clinical efficacy and imaging index of pressure-guided PKP in the treatment of OVCF with cortical disruption are satisfactory,and the leakage rate of bone cement is low,thus being worthy of wider clinical application.