单侧小球囊经皮穿刺后凸椎体成形术治疗中上段胸椎骨折的安全性及实用性

The safety and practicability of unilateral small balloon percutaneous kyphoplasty in the treatment of mid-upper thoracic vertebral fractures

目的探讨小球囊经皮穿刺后凸椎体成形术(PKP)治疗骨质疏松性中上段胸椎骨折和脊柱转移瘤中上段胸椎骨折的安全性及实用性。方法回顾性分析行PKP治疗的34例骨质疏松性中上段胸椎骨折或脊柱转移瘤中上段胸椎骨折患者(共38个椎体)的临床资料,记录患者的骨水泥量、骨水泥渗漏及弥散情况,对比术前、术后1 d、术后7 d的椎体高度、VAS评分、Oswestry功能障碍指数(ODI)评分。结果所有患者均顺利完成单侧小球囊PKP,术后复查见2例骨水泥椎间隙渗漏,1例椎体周围渗漏,但均未出现临床症状。29例患者骨水泥弥散情况达到弥散充分,3例为弥散一般,2例为弥散不佳。1例转移瘤患者在随访过程中再发骶1椎体病理性骨折。单个椎体平均注入骨水泥量为2.8~4.2 mL。术后1 d、7 d的VAS评分、ODI评分均低于术前,椎体高度高于术前,且术后7 d的VAS评分低于术后1 d,差异均有统计意义(均P<0.05)。结论采用小球囊PKP治疗骨质疏松性中上段胸椎骨折和脊柱转移瘤中上段胸椎骨折的安全性高,骨水泥可充分弥散,临床效果满意,值得临床推广应用。

Objective To investigate the safety and practicability of small balloon percutaneous kyphoplasty(PKP)in the treatment of osteoporotic mid-upper thoracic vertebral fractures and spinal metastases-related mid-upper thoracic vertebral fractures.Methods The clinical data of 34 patients(a total of 38 vertebral bodies)with osteoporotic mid-upper thoracic vertebral fractures or spinal metastases-related mid-upper thoracic vertebral fractures treated by PKP were retrospectively analyzed.The bone cement amount,leakage and diffusion were recorded,and the vertebral height,VAS score,and Oswestry disability index(ODI)score were compared before operation,1 day after operation,and 7 days after operation.Results All patients successfully completed the unilateral small balloon PKP.A postoperative review showed 2 cases of bone cement intervertebral space leakage and 1 case of perivertebral leakage,but with no clinical symptoms occurred.Bone cement diffused completely in 29 patients,averagely in 3,and poorly in 2.One patient with metastases had another pathologic fracture of the sacral 1 vertebra during follow-up.The average amount of bone cement injected into each vertebral body was 2.8-4.2 mL.The VAS scores and ODI scores 1 day and 7 days after operation were lower than those before operation,the vertebral heights were higher than that before operation,and the VAS score 7 days after operation was lower than that 1 day after operation,with statistically significant differences(all P<0.05).Conclusion Small balloon PKP in the treatment of osteoporotic mid-upper thoracic vertebral fractures and spinal metastases-related mid-upper thoracic vertebral fractures has high safety,with sufficient diffusion of bone cement and satisfactory clinical effect,which is worthy of clinical application.