经横突-椎弓根单侧穿刺椎体后凸成形术治疗胸腰椎骨质疏松性压缩骨折

目的:探讨经横突-椎弓根单侧穿刺椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗胸腰椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的手术技巧及临床疗效。方法:2009年1月～2011年3月,共对26例胸腰椎OVCF患者经横突-椎弓根单侧穿刺行PKP治疗,其中男9例,女17例;年龄56～78岁,平均66岁。共有伤椎35个。术前疼痛视觉模拟评分(visual analogue scale,VAS)为7.96±0.95分,后凸Cobb角为18.42°±5.98°,骨折椎体前缘高度为19.08±2.28mm,中部高度为17.02±1.72mm。术后2d及末次随访时行VAS评分,并摄X线片测量后凸Cobb角和伤椎前、中柱高度,评价患者临床疗效。结果:患者均顺利完成PKP手术,手术时间15～75min,平均34min;每个椎体注入骨水泥3～6ml,平均4.8ml。未出现神经损伤、骨水泥椎管内渗漏等并发症,伤椎内骨水泥分布良好。23例患者获得随访,随访时间12～36个月,平均29个月。术后2d及末次随访时的VAS评分分别为2.42±0.39分和2.01±0.37分,Cobb角分别为7.77°±0.77°、8.71°±0.81°;伤椎前缘高度分别为22.00±1.73mm、21.28±1.24mm,中部高度分别为20.80±0.75mm、19.64±1.12mm,与术前比较差异均有统计学意义(P<0.05),术后2d与末次随访时比较VAS评分差异有统计学意义(P<0.05),Cobb角、伤椎体前缘和中部高度差异均无统计学意义(P>0.05)。结论:经横突-椎弓根单侧穿刺椎体后凸成形术是治疗胸腰椎骨质疏松性压缩骨折的一种有效方法。

Percutaneous kyphoplasty by unilateral transverse process-pedicle approach for treatment of thoracolumbar osteoporotic vertebral compression fracture

Objectives:To explore the surgical technique and clinical efficacy of percutaneous kyphoplasty(PKP) by unilateral transverse process-pedicle approach for treatment of thoracolumbar osteoporotic vertebral compression fracture(OVCF).Methods:From January 2009 to March 2011,26 patients with thoracolumbar OVCF were treated with PKP by unilateral transverse process-pedicle approach.There were 9 male patients and 17 female patients,aged 56-78 years(average 66 years) and 35 fractured vertebrae.In preoperation,the visual analogue scale(VAS) score was 7.96±0.95,the Cobb angle was 18.42°±5.98°,the anterior and medium height of fracture vertebra were 19.08±2.28mm and 17.02±1.72mm.At 2 days of postoperation and final follow-up,clinical efficacy was evaluated by VAS,and Cobb angle,anterior/medium height of vertebra were measured in X-ray films.Results:All the PKP operations were successful.The operation time was 15-75min(average 34min).The cement injected into every vertebra was 3-6ml(average 4.8ml).Cement was well-distributed in vertebrae without complications such as nerve injury,cement leakage into spinal canal.23 patients were followed up for 12-36 months(average 29 months).At 2 days of postoperation and final follow-up,the VAS score was 2.42±0.39 and 2.01±0.37 seperately,the Cobb angle was 7.77°±0.77° and 8.71°±0.81°,the anterior height of vertebrae was 22.00±1.73mm and 21.28±1.24mm,the medium height was 20.80±0.75mm and 19.64±1.12mm.Compared with the preoperation,there were significant defferences in all the evaluations(P<0.05).Between the 2 days of postoperation and the final follow-up,there was significant defference in the VAS score(P<0.05),but no significant defference in the Cobb angle and the anterior/medium height of vertebrae(P>0.05).Conclusions:PKP by unilateral transverse process-pedicle approach is an efficient way to the treatment of thoracolumbar OVCF.