椎体内裂隙样变对经皮椎体后凸成形术疗效的影响

 目的 探讨椎体内裂隙样变对经皮椎体后凸成形术(percutaneous kyphoplasty，PKP)疗效的影响。方法 回顾性分析2009年12月至2011年12月，采用PKP治疗183例骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures，OVCFs)患者资料，根据影像学表现，将患者分为裂隙组和无裂隙组。裂隙组44例，男5例，女39例；年龄56～89岁，平均71.6岁。无裂隙组139例，男22例，女117例；年龄51～91岁，平均70.2岁。比较两组患者骨折椎体分布情况、骨水泥注入量、骨水泥渗漏发生率、渗漏类型、骨折椎体高度恢复情况等。采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index, ODI)评价疗效。结果裂隙组与无裂隙组在骨折椎体的分 布存在差异，裂隙组骨折椎体主要分布在T₁₁～L₂椎体，无裂隙组主要分布在T₁₁～L₅及T₇～₉。裂隙组和无裂隙组骨水泥注入量及渗漏率分别为3.4～5.6 ml和3.5～5.1 ml， 45.3%(24/53)和41.9%(72/172)，两项指标比较差异无统计学意义；但两组骨水泥渗漏类型存在差异，裂隙组主要在椎体周 围软组织渗漏，无裂隙组主要沿血管渗漏。两组术后骨折椎体高度均明显恢复，裂隙组较无裂隙组椎体前缘高度恢复明显。裂隙 组和无裂隙组术后VAS评分及ODI指数分别为(2.8±1.1)分和(2.4±0.7)分，29.3%±6.8%和27.6%±6.9%，两项指标比较差异 无统计学意义。结论 伴椎体内裂隙样变的OVCFs的骨折椎体主要分布在活动度较大的T₁₁～L₂椎体。采用 PKP治疗伴椎体内裂隙样变的OVCFs可获得满意的临床疗效，术后椎体前缘高度恢复明显。

The influence of intravertebral cleft on the clinical effect of percutaneous kyphoplasty

Objective To evaluate the influence of intravertebral cleft on the clinical effect of percutaneous kyphoplasty (PKP). Methods One?hundred and eighty three patients with OVCFs who underwent PKP (from December 2009 to December 2011) were divided into IVC group and non?IVC group according to their radiographic features. In IVC group, there were 5 males and 39 females, with an average age of 71.6 years (range, 56 to 89 years). And in non?IVC group, there were 22 males and 117 females, aged from 51 to 91 years (average, 70.2 years). The distributions of fractured vertebra body, bone cement injection volume, bone cement leakage incidence and types, the postoperative height of fractured vertebral body, as well as the visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups. Results The distributions of fractured vertebra body between two groups were different. Fractured vertebra body in IVC group mainly located from T₁₁ to L₂. Fractured vertebra body in non?IVC group located from T₁₁ to L₅, and from T₇ to T₉. The bone cement injection volume and leakage incidence had no significant difference between IVC group and non?IVC group (3.4-5.6 ml vs. 3.5-5.1 ml; 45.3% vs. 41.9%). However, the types of bone cement leakage were different. In the IVC group, bone cement mainly leaked into perivertebral soft tissues, while in the non?IVC group it mainly leaked along blood vessels. In both groups, the heights of the fractured vertebral bodies were significantly improved, and the restoration of vertebral height in IVC group was more evident than that in the non?IVC group. The postoperative VAS and ODI had no statistical difference between IVC group and non?IVC group (2.8±1.1 vs. 2.4±0.7; 29.3%±6.8% vs. 27.6%±6.9%). Conclusion The osteoporotic compression vertebral fracture mainly located in the range from T₁₂ to L₂ vertebra.The application of PKP could obtain a very good result in the treatment of OVCF with intravertebral cleft, moreover, the anterior vertebral height can increase remarkablely