双侧经皮椎体后凸成形术对骨质疏松性椎体爆裂骨折的安全性及疗效评价

Evaluation of safety and clinical efficacy of bilateral percutaneous kyphoplasty in treatment of osteoporotic thoraco-lumbar burst fractures

目的探讨双侧经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体爆裂骨折的安全性以及临床疗效。方法将2021年1至7月于北京朝阳医院接受双侧PKP治疗的骨质疏松性胸腰椎爆裂性骨折患者纳入本前瞻性研究。共纳入28例患者28个椎体,其中男10例,女18例,中位年龄73.6岁(56.0~87.0岁)。患者术前拍摄正侧位X线片、骨密度、CT三维重建扫描和磁共振脂肪抑制序列扫描并进行观察,明确骨折部位及椎体后壁情况,进一步确定诊断。术后第1天及末次随访时拍摄正侧位X线片、CT三维重建扫描,观察骨水泥渗漏情况,通过X线片测量,比较术前、术后伤椎上位椎体上终板和下位椎体下终板后凸角度(KA)、伤椎椎体前缘高度(HAW)、伤椎椎体后缘高度(HPW)等指标变化情况。同时比较患者术前、术后疼痛视觉模拟评分(VAS)以及Oswestry功能障碍指数(ODI)情况,对手术临床疗效进行评估。结果所有患者均获随访,随访时间(12.2±6.0)个月。术前HAW为(21.2±2.4)mm,术后HAW为(22.5±2.0)mm,差异有统计学意义(P<0.05),末次随访时HAW为(18.9±1.6)mm,低于术后(P<0.05)。术后HPW也较术前明显矫正(P<0.05)。末次随访时HPW与术后比较差异无统计学意义[(27.2±1.3)mm比(27.5±1.6)mm,P>0.05]。术前KA为18.8°±1.3°,术后KA为14.2°±1.5°,术后KA明显矫正(P<0.05),末次随访时KA为17.6°±1.4°,较术后增大,差异具有统计学意义(P<0.05)。5例发现骨水泥渗漏,1例发现邻近椎体骨折。术后第1天、末次随访时疼痛VAS评分及ODI均较术前降低,差异均有统计学意义(均P<0.05)。结论双侧PKP治疗骨质疏松性椎体爆裂骨折治疗效果肯定且安全可靠,仔细评估术前影像学资料,精准的穿刺及把握骨水泥推注时机是保证手术成功的关键因素。

Objective To evaluate the safety and clinical efficacy of bilateral percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral burst fractures.Methods It was a prospective study,28 patients with osteoporotic thoraco-lumbar burst fractures who were treated in Beijing Chao-Yang Hospital from January 2021 to July 2021 were included,including 10 males and 18 females,with a median age of 73.6 years(range:56.0-87.0 years).The X-ray radiographs,bone mineral density(BMD),CT three-dimensional reconstruction scan and MRI were taken and measured before operation to observe the fracture location and the posterior wall of the vertebral body,and further to determine the diagnosis.The X-ray radiographs and CT three-dimensional reconstruction scans were taken on the first day after operation and the last follow-up to observe whether there were bone cement leakage or not.The changes of kyphosis angle(KA),the height of anterior wall(HAW)and the height of posterior wall(HPW)before the operation,on the 1st day post operation and at the last follow-up were recorded.The visual analogue scale(VAS)of back pain and Oswestry dysfunction index(ODI)before the operation,1 day post operation and at the last follow-up were used to evaluate the clinical effect of the operation.Results All the patients were followed up for(12.2±6.0)months.The HAW on the 1st day post operation[(22.5±2.0)mm]was significantly increased as compared with that before the operation[(21.2±2.4)mm](P<0.05).The HAW at the last follow-up[(18.9±1.6)mm]decreased signficantly as compared with that on the 1st day post opertion[(22.5±2.0)mm](P<0.05).The HPW was also significantly corrected after surgery(P<0.05).At the end of the follow-up,the HPW[(27.2±1.3)mm]was comparable with that on the 1st day after surgery[(27.5±1.6)mm](P>0.05).The KA on the 1st day after the operation(14.2°±1.5°)decreased significantly when compared with that before the operation(18.8°±1.3°)(P<0.05),but it was increased to 17.6°±1.4°at the last follow-up and was higher than that on the 1st day after the operation(P<0.05).There were bone cement leakage in 5 cases and adjacent vertebral fracture in 1 case.The VAS and ODI scores were all significantly lower on the 1st day and at last follow-up than that before the operation(all P<0.05).Conclusions Bilateral PKP is effective,safe and reliable in the treatment of osteoporotic vertebral burst fracture.Careful evaluation of preoperative imaging data,accurate puncture and timing of bone cement injection are the key factors to ensure the success of the operation.