经皮椎体后凸成形术治疗骨质疏松性压缩骨折

目的探讨经皮椎体后凸成形术(PKP)治疗骨质疏松性压缩骨折(OVCFs)的效果,了解并发症的原因的影响因素,并行针对性预防。方法回顾性分析2008年8月至2012年12月期间收治的经PKP治疗OVCFs患者315例的临床病历资料,并对每个患者行术后随访1年。分别统计手术时间、术中透视时间、骨水泥注入量、骨水泥渗漏、住院天数及住院费用;记录术后椎体复位情况、术前术后疼痛程度(VAS评分)、ODI指数、病变椎体前缘、中部高度变化及后凸畸形Cobb角情况来评估PKP治疗的疗效,分析并发症发生的原因。结果经PKP治疗后315例患者中294例患者腰痛症状缓解,治疗有效率93.3%。术后1天VAS评分(2.0±0.8)分,VAS评分缓解率74.8%、Oswestry功能障碍指数(22.3±4.2)分、前缘高度比值(14.3±6.7)%、中部高度比值(12.8±5.6)%、Cobb角(11.6±4.8)°均比术前明显改善。PKP治疗骨折患者中,21例发生并发症,骨水泥渗漏13例,均无严重神经损伤症状,7例椎旁软组织渗漏,1例椎间孔外渗漏,3例椎间盘渗漏。结论 PKP治疗OVCFs缓解疼痛效果较好,术前、术中、术后采取相应的防范措施,以预防或减少并发症的发生。

The analysis of the PKP treatment of osteoporosis compression fractures.

Objective To investigate the effect and failure causes for the percutaneous kyphoplasty （PKP） in the treatment of osteoporotic compression fractures （ OVCFs）, the complications and its prevention measures. Methods Retrospective analysis was performed in 315 cases including clinical medical records from August 2008 to December 2012 of the PKP treatment of osteoporosis compression fractures. All patients were followed up for 1 year. The operation time, intraoperative fluoroscopy time, leakage of bone cement, bone cement injection, hospitalization days and hospitalization expenses, recorded postoperative vertebral reset, extent of preoperative postoperative pain （ VAS score）, the ODI index, the lesion fanterior edge, central high protrusion deformity after change and Cobb Angle were analyzed and to evaluate the therapeutic effect of PKP treatment, investigate the causes of complications. Results 294 in 315 cases of patients with symptoms remission after the PKP treatment, treatment effective rate was 93.3%. Postoperative 1 day, VAS score was （2.0 ±0.8） points, VAS score remission rate was 74.8% and Oswestry disability index was （22.3 ± 4.2） points, frontal height ratio was （ 14.3 ± 6.7% ）. Middle height ratio is （ 12.8 ± 5.6% ）, Cobb Angle was （ 11. 6 ± 4. 8%）. Compared with the preoperative, these indexes was obviously improved. 21 cases had new complications, including 13 cases of bone cement leakage, 7 cases of paravertebral soft tissue leakage, 1 case of extraforaminal leakage and 3 cases of disc leakage. Conclusion PKP treatment OVCFs can obtain better pain relief effect. Preoperative, intraoperative and postoperative should adopt the corresponding preventive measures to prevent or reduce the occurrence of complications.