骨水泥注入治疗无神经症状后壁不完整骨质疏松性椎体骨折:4年随访

Bone cement injection for incomplete posterior wall osteoporotic fractures without neurological symptoms:a 4-year follow-up

背景:目前临床上对于后壁破裂骨质疏松性骨折的治疗存在较大争议,部分学者认为是骨水泥强化的手术禁忌,适合行切开复位内固定治疗;但亦有部分学者认为骨质疏松容易导致内固定失败,在合适的条件下可以行微创骨水泥强化治疗。目的:探讨骨水泥强化治疗无神经症状后壁不完整骨质疏松性椎体骨折的临床疗效。方法:回顾性分析2011年1月至2013年6月苏州大学附属第一医院收治的,31例无神经症状后壁不完整骨质疏松性椎体骨折患者的病历资料,其中男12例,女19例,年龄为57-82岁,均进行椎体球囊扩张骨水泥强化治疗,术后评价骨水泥渗漏情况。治疗前及治疗后1 d、3个月、末次随访时,通过X射线片测量椎体平均高度及Cobb角度变化,采用目测类比评分及Oswestry功能障碍指数评价手术疗效。结果与结论:①31例患者中3例出现侧壁骨水泥渗漏,患者无明显神经症状;②31例患者获得平均(47.2±24.3)个月的随访,治疗后1 d、3个月及末次随访的椎体平均高度均高于治疗前(P<0.05),Cobb角均小于治疗前(P<0.05);治疗后1 d、3个月及末次随访的目测类比评分、Oswestry功能障碍指数均低于治疗前(P<0.05);③结果表明,椎体球囊扩张骨水泥强化治疗无神经症状后壁不完整骨质疏松性椎体骨折具有较高的安全性,能够有效缓解疼痛、提高椎体高度、减轻后凸畸形。

BACKGROUND:At present,there is considerable controversy in the treatment of osteoporotic patients with posterior wall rupture.Some scholars believe that it is a contraindication to bone cement augmentation and is suitable for open reduction and internal fixation;however,some scholars believed that osteoporosis can easily lead to failure of internal fixation,and minimally invasive bone cement augmentation can be performed under appropriate conditions.OBJECTIVE:To investigate the clinical effect of bone cement injection for incomplete posterior wall osteoporotic fractures without neurological symptoms.METHODS:Data of 31 patients(12 males and 19 females;age range:57 to 82 years old)with osteoporotic vertebral compression fracture with imcomplete posterior wall,which admitted to the First Affiliated Hospital of Soochow University from January 2011 to June 2013,were retrospectively analyzed.All patients were treated with balloon kyphoplasty,and the leakage of bone cement was evaluated.X-ray examination was carried out preoperatively,at 1 day,3 months postoperatively and the last follow-up to measure the height of vertebral body and Cobb angle.The curative effect was evaluated by visual analogue scale score and Oswestry dysfunction index.RESULTS AND CONCLUSION:(1)Three out of 31 patients affected sidewall bone cement leakage and the patients had no remarkable neurological symptoms.(2)All 31 patients were followed up for a mean time of(47.2±24.3)months.At 1 day and 3 months and the last follow-up after treatment,the mean height of the vertebral body was higher than that before treatment(P<0.05)and Cobb angle was smaller than that before treatment(P<0.05).Visual analogue scale score and Oswestry dysfunction index were lower at 1 day and 3 months and the last follow-up after treatment than those before treatment(P<0.05).(3)It is concluded that kyphoplasty is safe and effective in the treatment of osteoporotic vertebral compression fracture with incomplete posterior wall.It can dramatically relieve pain,increase the height of the vertebral body,and reduce kyphosis.