经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的评价球囊扩张椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效和安全性。方法自2008年8月至2011年7月采用椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折30例42椎，患者均有腰背部疼痛。取俯卧位调节手术床使椎体骨折部位过伸，达到满意的闭合复位后，经皮双侧或单侧椎弓根穿刺球囊扩张，填充骨水泥。随访观察患者的疼痛、日常功能以及影像学改变情况。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度，进行统计学分析。利用Oswestry评分、视觉模拟评分（visualanaloguescale，VAS）评定临床疗效。观察有无骨水泥渗漏等并发症。结果术后随访6～24个月，平均10个月。术后伤椎处疼痛均明显缓解，VAS评分从术前平均（8．45±0．48）分降至术后平均（2．45±0．52）分，椎体高度明显恢复，后凸畸形得到矫正。随访期间疗效满意，伤椎高度无明显丢失。未出现严重的骨水泥渗漏并发症。术后椎体高度及伤椎后凸角度与术前比较有统计学差异（P〈0．05），术后VAS及Oswestry评分与术前比较有统计学差异（P〈0．01）。结论球囊扩张椎体后凸成形术治疗骨质疏松脊柱压缩性骨折，能有效恢复椎体高度和矫正后凸畸形，能迅速缓解疼痛，减少骨折并发症，提高患者生活质量。

Percutanous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Objective To analyze the clinical results and safety of kyphoplasty via balloon expansion for osteo porotic vertebral compression fracture. Methods 30 patients suffered from osteoporotic vertebral compressive frac- ture and serious back pain were treated by kyphoplasty. There were 42 vertebra fracture totally. Patients were treated with postural reduction by extending the operating table,then percutaneous bilateral or unilateral transpedicular re duction of the endplate was performed ,and bone cement was injected. The pain ,daily function and radiographic results were compared before and after operation,and the results were evaluated by statistical analysis,according to the con cept of estimated vertebral height and kyphotic angle of the vertebral fractures by radiographs. Visual analog scale （VAS） ,Oswestry scores and vertebra shape changes were recorded. The complications were analysed. Results Pa tients were followed up for 6-24 months （average 10 months）. All patients reported significant alleviation of pain af ter treatment. VAS scores reduced. During the period of follow-up,postoperative outcomes were satisfactory. There was no notable vertebral height loss. There were no serious complication of bone cement leakage. Vertebral height, kyphotic angle of the vertebral fractures ,Oswestry and VAS scores showed significant difference （P〈0.05 ,P〈0.05, P〈0.01,P〈0.01）. Conclusion Percutanous kyphoplasty for osteoporotic vertebral compression fractures can pro- vide significant pain relief and restore the vertebral height and kyphotic angle. It can reduce fracture complication and improve the patients＇life quality.