中国修复重建外科杂志

中国修复重建外科杂志

椎体后凸成形术治疗骨质疏松胸椎椎体重度压缩性骨折

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探讨单侧球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)在高龄骨质疏松性胸椎重度压缩性骨折(severe vertebral compression fracture,SVCF)的应用及临床疗效。 方法 2006 年5 月- 2007 年7 月,采用单侧球囊扩张PKP 治疗高龄骨质疏松性椎体SVCF 6 例(7 个椎体),其中男2 例(2 个椎体),女4 例(5 个椎体);年龄64 ~ 83 岁。均为陈旧性骨折。压缩骨折椎体:T5 1 例,T8 2 例,T10 3 例,T12 1 例,椎体压缩比为60%~ 75%者5 个椎体,gt; 75%者2 个椎体。胸背部疼痛明显,视觉疼痛模拟评分法(visual analogue scale,VAS) 评分为6.5 ~ 9.0 分,平均7.7 分。均无神经症状及体征。术前CT 示椎体后壁均完整。在C 臂X 线机透视下,采用经皮椎体后外侧入路穿刺,在伤椎内植入1 枚球囊,扩张使椎体部分复位后,将骨水泥填充椎体扩张所形成的空腔内。灌注骨水泥2.6 ~ 4.4 mL,平均3.5 mL。 结 果 患者手术顺利,术后疼痛明显减轻或消失。术后3 d X 线片复查未见椎体进一步压缩、变形,骨水泥分布均匀,椎体高度恢复9.7% ± 1.4%。2 例发生骨水泥渗漏,但均无神经受损等不适症状发生。术后1 个月VAS 评分0 ~ 2.45 分,平均1.32 分,与术前比较差异有统计学意义( P lt; 0. 05)。术后3 个月所有患者于门诊复查,患者对手术效果均满意;VAS 评分0 ~ 3 分,平均2.13 分,与术后1 个月比较差异无统计学意义(P gt; 0.05);X 线片检查未见病变椎体压缩、变形,相邻椎体也未见有新的明显压缩骨折。 结论 PKP 治疗高龄骨质疏松性脊柱SCVF 可有效缓解疼痛,部分恢复椎体高度,疗效满意。

To investigate cl inical outcomes of percutaneous kyphoplasty with balloon in the treatment of severe osteoporotic thoracic vertebral compression fracture (SVCF). Methods From May 2006 to July 2007, percutaneous unilateral kyphoplasty with single balloon was performed in 7 vertebras of 6 SVCF patients, with 2 injured vertebras in 2 males
and 5 in 4 females, who were from 64 to 83 years old. The injured vertebras included 1 in T5, 2 in T8, 3 in T10 and 1 in T12 and the compression rates were 60% to 75% in 5 vertebras and gt; 75% in 2 vertebras. All the injured vertebras were old fractures and caused severe back pain, but without any neurotic symptoms and signs. The visual analogue scale (VAS) ranged from 6.5 to 9.0, 7.7 on average. The posterior vertebral walls were all intact in all patients under CT scan. The balloon was inset into the vertebra through pedicle of vertebral arch by percutaneous puncture under the guidance of C-type arm X-ray unit. The balloon was then extended to restore the vertebral body which was filled with bone cement later. The average volume of cement required was 3.5 mL (2.6 to 4.4 mL). Results The pain was alleviated or completely rel ieved after the operation. The mean vertebral body height restoration was 9.7% ±1.4% on the anterior border. Two cement leakages were found on X-ray. One month after the treatment, the VAS was from 0 to 2.45, 1.32 on average, and there was significant difference compared with preoperation (P lt; 0. 05). Three months after the treatment, the VAS was from 0 to 3, 2.13 on average, and there was no significant difference compared with 1 month after the treatment (P gt; 0.05). It was not found that the injured vertebras were compressed or deformed, and no new compressed fracture was found in consecutive vertebras. Conclusion Unilateral posterior-lateral puncture kyphoplasty with single balloon can rel ieve the pain and restore part of the vertebral height effectively with better outcomes.

关键词: 骨质疏松; 椎体重度压缩性骨折; 后凸成形术

Key words: Osteoporosis; Severe vertebral compression fracture; Kyphoplasty

引用本文: 刘杰,王建. 椎体后凸成形术治疗骨质疏松胸椎椎体重度压缩性骨折. 中国修复重建外科杂志, 2008, 22(4): 399-403. doi: 复制

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