影响椎体后凸成形术治疗骨质疏松性椎体压缩性骨折疗效的医源性因素分析

目的分析医源性因素对椎体后凸成形术（KP）疗效的影响。方法采用同种型号单球囊双侧扩张KP治疗骨质疏松性单节段椎体压缩性骨折38例。分为标准手术组（23例）和非标准手术组（15例）。术前MRI显示骨折椎体在T1WI呈低信号,T2WI呈高信号,STIR序列呈高信号。排除非骨质疏松性骨折。手术疗效采用VAS评分、椎体高度的恢复和Cobb角的矫正度进行评估,同时比较骨水泥渗漏情况。结果所有患者术后疼痛均有明显缓解或消失。标准手术组：VAS评分由术前的（8.8±0.9）分降至术后的（2.6±1.3）分;椎体前缘高度恢复平均为（54.8±32.6）%,椎体中部高度的恢复平均为（61.2±22.4）%;手术前后X线侧位片显示Cobb角平均矫正14.9°（0°～37°）;椎体骨水泥灌注量平均为（4.65±1.32）（1.8～8）ml,骨水泥渗漏率为8.7%,主要渗漏至椎体血管内。非标准手术组：VAS评分由术前的（8.6±0.6）分降至术后的（3.3±1.5）分;椎体前缘高度恢复平均为（46.5±31.9）%,椎体中部高度的恢复平均为（60.1±27.6）%;手术前后X线侧位片显示Cobb＇s角平均矫正7.6°（0°～27°）;椎体骨水泥灌注量平均为（5.45±1.53）（1.5～8.5）ml,骨水泥渗漏率为33.3%,主要渗漏至椎体周围、椎间隙和血管内等。以上两组相比,除VAS评分改善情况无明显差异（P〉0.05）外,其他各项评价数据的差异均有统计学意义（P〈0.05或〈0.01）。结论手术穿刺技术和骨水泥灌注技术对KP的疗效有明显的影响;遵循操作技术标准和参加技术培训对提高手术安全性和手术疗效非常重要。

Analysis of the Latrogenic Factors on Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Objective To analyze the iatrogenic factors affecting effect of kyphoplasty（KP）.Me-thods Percutaneous bilateral transpedicular KP with single balloon was performed in 38 patients with only painful osteoporotic vertebral compression fractures（OVCF）.There were respectively 23 patients and 15 patients in standard surgery（SS） and nonstandard surgery（NSS） groups.MRI displayed low signal in T1WI and high signal in T2WI and STIR.Pain scores,vertebral body heights,Cobb＇s angles and cement leakages were measured for all patients.Results All patients experienced dramatic pain relief or disappearance after the procedures.In SS group and in NSS group,the main pain score（VAS） decreased from 8.8±0.9 and 8.6±0.6 preoperatively to 2.6±1.3 and 3.3±1.5 postoperatively（P0.05）.The vertebral body height restoration was（54.8±32.6）% and（46.5±31.9）% on the anterior border,（61.2±22.4）% and（60.1±27.6）% in the middle potion,the sagittal alignment was improved significantly,as the average correction of the Cobb＇s angle reached 14.9°（0°~37°） and 7.6°（0°~27°）.The rate of cement leakage was 8.7% and 33.3% in veins and soft tissues,around body,intervertebrally（P0.05）.The average volume of cement in one vertebral body was（4.65±1.32）（1.8~8.0）ml and（5.45±1.53）（1.5~8.5）ml.Conclusion It is significantly effective to the effect of KP for the surgical technique.It is important to increase the surgical security and clinical outcome for the standard surgical technique and normal professional training.