双线中点法经皮椎体后凸成形术治疗重度骨质疏松性压缩骨折

Percutaneous kyphoplasty through the double-line midpoint approach in treating severe thoracolumbar vertebral osteoporotic compression fractures

目的探讨通过双线中点法行经皮椎体后凸成形术(PKP)治疗重度骨质疏松性椎体压缩骨折(OVCF)的安全性及临床疗效。方法回顾性分析2015年1月—2020年1月陆军军医大学大坪医院脊柱外科收治重度OVCF患者32例,男性7例,女性25例;年龄60~86岁,平均73.1岁,患者椎体压缩>75%。摔伤21例,扭伤3例,负重7例,无明显诱因1例。实施双线中点法PKP(术中调整正位C型臂X线机透视使椎体下缘保持重合,椎体上终板最低点连线与椎弓根外缘交点平行线为第一条线,椎弓根下缘平行线为第二条线,两者中点向外延伸至椎弓根外缘的交点为伤椎穿刺点)。记录手术时间、手术前后受伤椎体高度、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)变化、骨水泥弥散情况及有无严重并发症。结果手术时间25~59min,平均37.1min。术前椎体高度(6.03±1.03)mm,术后3d恢复至(14.96±1.28)mm,术后3个月(14.46±1.29)mm。出现骨水泥渗漏5例,均未向椎管内渗漏,包括椎体前方渗漏1例、沿椎旁静脉渗漏1例、上下椎间隙渗漏3例。术中推注骨水泥出现心率下降1例,出现术中血压明显升高2例,给予处理后均恢复术前水平,无心脑血管意外发生。所有患者未出现脊髓、神经及血管并发症。患者术后3d及3个月ODI(31.06±3.51)%、(30.50±3.37)%及VAS(2.43±0.55)分、(2.44±0.49)分均显著优于术前(72.91±5.20)%、(7.18±0.63)分(P<0.05)。结论双线中点法在严重塌陷的椎体均有较高的穿刺成功率及安全性,球囊复位技术可明显恢复急性重度压缩骨折患者的椎体高度,改善患者的症状和生活质量,具有较好的临床疗效。

Objective To investigate the safety and clinical efficacy of percutaneous kyphoplasty(PKP)in treating severe thoracolumbar vertebral osteoporotic compression fractures(OVCF)by the double-line midpoint approach.Methods A retrospective analysis was performed in 32 patients with severe osteoporotic compression fractures admitted to the Department of Spine Surgery,Daping Hospital,Army Medical University from Jan.2015 to Jan.2020.There were 7 males and 25 females,with an average age of 73.1 years(range,60-86 years).The vertebral compression of all the patients were>75%.There were 21 cases of falls,3 cases of sprains,7 cases of weight-bearing,and 1 case of no obvious cause.The details of the double-line midpoint method PKP were as follows:the double-line midpoint method PKP was performed(adjust the frontal C-arm X-ray fluoroscopy during the operation to keep the lower edge of the vertebral body coincident,the line parallel to the intersection of the upper endplate of the vertebral body and the outer edge of the pedicle as the first line,the parallel line of the lower edge of the vertebral root as the second line,and the intersection of the two midpoints extending outward to the outer edge of the pedicle is the entry point).The operation time,the height of the injured vertebral body before and after the operation,the visual analogue scale(VAS),the Oswestry dysfunction index(ODI)change,the dispersion of bone cement,and the presence or absence of serious complications were recorded.Results The operation time was 25-59 minutes,with an average of 37.1 minutes.The vertebral height was(6.03±1.03)mm preoperatively,(14.96±1.28)mm postoperatively,and(14.46±1.29)mm at 3 months postoperatively.Bone cement leakage occurred in 5 patients,including 1 case of leakage in the front of the vertebral body,1 case of leakage along the paravertebral vein,and 3 cases of leakage to the upper and lower intervertebral spaces.There was no leakage into the spinal canal.One patient had a decrease in heart rate during intraoperative bone cement injection,and two patients had a significant increase in intraoperative blood pressure.After treatment,all patients recovered well without cardiovascular or cerebrovascular accidents occurred.There was no spinal cord,nerve,or vascular complication in any patients.The ODI[(31.06±3.51)%,(30.50±3.37%)%]and VAS[(2.43±0.55)points,(2.44±0.49)points]of the patients at 3 days and 3 months after operation were significantly better than those before operation[(72.91±5.20)%,(7.18±0.63)points],with statistical differences(P<0.05).Conclusion The double-line midpoint method has a high puncture success rate and safety in severely collapsed vertebral bodies.Balloon reduction technique can obviously restore the vertebral body's height in patients with acute severe compression fractures and improve the symptoms and quality of life,thus presenting a good clinical effect.