单侧穿刺椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折

目的：探讨单侧椎体后凸成形术（ percutaneous kyphoplasty ，PKP）治疗高龄骨质疏松性椎体压缩骨折（ osteo-porotic vertebral compression fracture ， OVCF ）的疗效。方法2011年1月～2013年6月采用PKP治疗高龄胸腰椎OVCF 58例共65个椎体，男18例（18个椎体），女40例（47个椎体），平均年龄78．1岁（75～87岁）。致伤原因均为低能量型损伤；患者腰背部持续疼痛，无脊髓、神经损伤表现；影像学表现为伤椎椎体后壁完整，非爆裂性骨折。伤椎部位T6～L4，其中58个椎体为T10～L2。术前和术后2 d对患者视觉模拟量表（ visual analog scale ， VAS）评分、Oswe-stry功能障碍指数（ Oswestry disability index ， ODI）以及伤椎相对高度进行统计学分析，随访伤椎高度丢失情况，记录骨水泥渗漏及随访期间伤椎再骨折和相邻椎体骨折情况。结果术后随访6～36个月，平均17．8月。术前和术后2 d VAS评分分别为8．21±0．72和2．94±0．83，ODI分别为（81．02±7．24）％和（27．35±6．11）％，伤椎前缘相对高度分别为（70．75±5．31）％和（82．14±4．90）％，伤椎中部相对高度分别为（71．72±4．54）％和（84．46±4．51）％；手术前后各项指标对比差异具有统计学意义（ P＜0．05）。末次随访伤椎前缘相对高度为（80．83±5．14）％，伤椎中部相对高度为（82．65±6．20）％，与术后2 d各项指标对比差异无统计学意义（ P＞0．05）。术中骨水泥渗漏5例共5个椎体，随访期间发生伤椎再骨折3例3个椎体、相邻椎体骨折4例4个椎体。结论单侧穿刺椎体后凸成形术治疗高龄OVCF可取得满意临床效果，有效缓解疼痛，改善功能。

Unipedicular percutaneous kyphoplasty for aged with osteoporotic vertebral compression fractures

Objective To evaluate the clinical outcomes of unipedicular percutaneous kyphoplasty(PKP) for the aged with osteoporotic vertebral compression fractures(OVCF). Methods A total of 58 patients underwent PKP from January 2011 to June 2013, Which included 18 males(18 vertebrae) and 40 females(47 vertebrae),with the average age of 78.1 years(range 75 to 87 years). All patients with serious back pain suffered from low energy injury. There was no clinical manifestation of spinal cord and nerve root injury, and no burst fracture or spinal canal involved situation on image. The levels of fracture ranged from T₆ to L₄, 58 vertebrae at thoracolumbar levels from T₁₀ to L₂. The visual analoy scale (VAS) score, Oswestry disability index (ODI), and velative height of the injured vertebra were evaluated preoperatively and 2 d postoperatively separately. The bone cement leakage were recorded. The vertebra height loss, refracture of the injured vertebra and new fracture of adjacent vertebra were evaluated at the final follow-up. Results All patients were followed up for an average of 17.8 months (range 6 months to 36 months). Preoperative and postoperative VAS score were 8.21±0.72 and 2.94±0.83, preoperative and postoperative ODI were (81.02 ± 7.24)% and (27.35 ± 6.11)%, preoperative and postoperative relative height of anterior and middle edge of increased from (70.75±5.31)% and (71.72±4.54)% to (82.14±4.90)% and (84.46 ±4.51)% respectively; the differences between pre- and postoperative data was statistically significant (P<0.05). At the final follow-up the relative height of anterior and middle edge of the injuried vertebrae were (80.83±5.14)% and (82. 65±6.20)%, there was no difference between the postoperative 2 d and the final follow-up. Of all patients, 5 vertebrae of 5 patients showed bone cement leakage, 3 patients suffered from refracture of the injured vertebra and 4 patients were complicated with adjacent vertebra fracture(4 vertebrae) at follow-up. Conclusion Unipedicular PKP is a minimally invasive procedure that has shown good effects on the treatment of the aged with OVCF, and it can relieve pain and improve function rapidly.