单球囊单侧穿刺经皮椎体后凸成形术治疗多椎体骨质疏松性压缩性骨折

目的探讨Ⅰ期应用单个球囊单侧穿刺多次扩张经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗多椎体骨质疏松性脊柱压缩性骨折的临床疗效。方法采用单球囊单侧穿刺PKP治疗骨质疏松性脊柱压缩性骨折25例共60个椎体。术后观察疼痛缓解及骨折复位情况,比较手术前后椎体高度和后凸角(Cobb角)的变化。结果所有患者均顺利完成手术。手术时间53～146min,平均30.4min/椎。术中球囊扩张压力为98～320Psi,平均183Psi;扩张体积2～4.5ml,平均3.25ml;扩张次数2～6次,平均3.3次,3例球囊术中破裂。骨水泥注射量2～5ml,平均3.5ml/椎,2例椎管内出现少量渗漏,1例发生椎旁渗漏,均无明显临床症状。患者VAS由术前的(7.5±1.0)分降低到术后的(3.2±0.7)分,椎体前缘高度、中线高度和Cobb角均较术前有明显改善,差异具有统计学意义(P0.05)。术后随访6～24个月,受访患者疼痛症状得到明显缓解,未见神经损伤等并发症发生。结论单侧穿刺单个球囊多次扩张PKP具有手术时间短、治疗费用低、疗效满意等优点,可用于治疗多发性骨质疏松性脊柱压缩性骨折。

Unilateral percutaneous kyphoplasty for multi-level osteoporotic vertebral compression fractures with single balloon

Objective To investigate the clinical therapeutic effect of unilateral percutaneous kyphoplasty （PKP） for multi-level osteoporotic vertebral compression fractures （OVCF） with single balloon.Methods Twenty-five OVCF patients with a total of 60 vertebrae were treated by unilateral PKP with single balloon method.Post-operative pain relief and reduction of the fracture were observed,as well as the improvement of height of vertebral body and Cobb＇s angle were measured.Results All procedure were uneventful.The operation time was 30.4 min/vertebra in average,from 53 to 146 min.The balloon＇s expansion pressures were from 98 to 320 Psi with 183 Psi in average,expansion volume were 2-4.5 ml with 3.25 ml in average,expansion frequency were 2-6 times with 3.3 times in average.During the procedure,the balloon rupture occurred in 3 cases.The volume of cement injection were 2-5 ml,3.5 ml/vertebra in average.During the procedure,there were 2 cases with intraspinal leakage and 1 case with paraspinal leakage,which led to no obvious clinical symptoms at all.The VAS were decreased from 7.5 ± 1.0 preoperatively to 3.2 ± 0.7 postoperatively,vertebral body height and Cobb＇s angle were improved significantly （P〈0.05）.After 6-24 months＇ follow-up,all patients obtained steady maintenance of pain relief effects,and no surgical complication occurred.Conclusion Unilateral PKP with single balloon can be used to treat multi-level OVCF for its advantage of short operative time,low cost and satisfactory effects.