椎体后凸成形术治疗重度骨质疏松性椎体压缩性骨折

目的探讨经皮球囊扩张椎体后凸成形术治疗重度骨质疏松性椎体压缩性骨折的临床疗效。方法 2005年1月至2009年1月,对45例椎体压缩程度〉75%的重度骨质疏松性椎体骨折患者实施经皮球囊扩张椎体后凸成形术治疗。根据椎体压缩骨折形态,选择单侧或双侧球囊扩张椎体成形术。测量术前、术后1d及末次随访时站立位X线片椎体前缘高度的变化,并采用视觉模拟数字法（VAS）及Oswestry功能障碍指数（ODI）综合评估手术疗效。结果随访18～48个月,平均21.7个月,伤椎前缘高度由术前的（18.7±3.1）%恢复至术后的（51.4±2.3）%,差异有统计学意义（P〈0.01）;随访时为（50.2±2.7）%,与术后相比差异无统计学意义（P〉0.05）。VAS及ODI评分术前分别为8.1±1.4、91.1±2.3,术后分别为2.6±0.9、30.7±7.1,差异有统计学意义（P〈0.01）;随访时分别为2.1±0.5、26.1±5.1,与术后相比差异无统计学意义（P〉0.05）。3例发生骨水泥渗漏,未出现临床症状。1例术后发生其他椎体骨折。结论椎体后凸成形术治疗重度骨质疏松性椎体压缩性骨折安全、可行、有效。

Kyphoplasty for Severe Osteoporotic Vertebral Compression Fractures

Objective To evaluate the clininal efficacy of kyphoplasty for severe osteoporotic vertebral compression fractures.Methods Forty-five patients with severe osteoporotic compressive fractures were treated by kyphoplasty from Jan 2005 to Jan 2009.The compressive rate of the fractured vertebral bodies was more than 75%.According to the morphology of the vertebral compression fracture bodies the unilateral or bilateral balloon kyphoplasty were selected.The anterior vertebral height was measured on a standing lateral radiograph at pre-operative,post-operative（one day after operation） and final follow-up time.A visual analog scale（VAS） and the Oswestry disability index（ODI） were chosen to evaluate pain status and functional activity.Results The mean follow-up was for 21.7 months（in range from 18 to 48 months）.The anterior vertebral body height of fracture vertebra was restored from preoperative（18.7±3.1）% to postoperative（51.4±2.3）%,the follow-up period（50.2±2.7）%.There was a significant improvement between preoperative and postoperative values（P0.01） and no difference between postope-rative and final follow-up（P0.05）.The VAS was 8.1±1.4 at preoperative,2.6±0.9 at postoperative,2.1±0.5 at final follow-up time;and the ODI was preoperative 91.1±2.3,postoperative 30.7±7.1,follow-up period 26.1±5.1.There was statistically significant improvement in the VAS and ODI in the post-operative assessment compared with the pre-operative assessment（P0.05）,while there were no statistically significant differences between postoperative and the final follow-up time（P0.05）.Asymptomatic cement leakage occurred in three cases.New vertebral fracture occurred in one case.Conclusion The study suggests that balloon kyphoplasty is a safe and effective procedure in the treatment of severe osteoporotic vertebral compression fractures.