CT引导下经皮穿刺椎体后凸成形治疗骨质疏松性椎体压缩性骨折

目的:探讨CT引导下经皮穿刺球囊扩张椎体后凸成形治疗骨质疏松性椎体压缩性骨折的临床价值。方法:经皮椎体后凸成形术治疗的57例患者,累及69个椎体。在CT引导下,经皮穿刺两侧椎弓根,使用球囊扩张,改善椎体高度和使椎体内造成空腔,注入骨水泥。结果:69个压缩椎体其前缘和中部的压缩程度术前为(15.36±3.27)mm和(11.24±3.16)mm,术后为(10.89±3.23)mm和(5.17±1.98)mm,手术前后差异有显著性意义(P<0.01)。Cobb角由术前的26.89°±6.41°,矫正至术后18.13°±3.45°,手术前后差异有显著性(P<0.01),表明压缩程度有明显改善。骨水泥向椎间隙少量渗漏3例,向椎体侧旁软组织少量渗漏4例,向椎体后缘、后纵韧带前面少量渗漏1例,渗漏发生率11.69%(8/57),无1例导致临床症状。结论:CT引导下球囊扩张椎体后凸成形术治疗疏松性椎体压缩性骨折具有创伤小、并发症少、恢复快、穿刺定位准确、止痛效果明显、矫正后凸畸形特点。该手术属非血管性介入,多排螺旋CT三维重建引导下对骨科临床手术有较好指导价值。

CT-guided percutaneous kyphoplasty in the therapy of osteoporosis vertebral compression fractures

Objective：To investigate the clinical value of percutaneous kyphoplasty with balloon under the three-dimensional CT navigation for treatment of osteoporosis vestebul compression fractures.Methods：CT-guided percutaneous vertebroplasty was carried out in 57 patients with 69 vertebral compression fractures.One inflatable balloon was inserted into the fractured vertebral body via pedicle on both sides alternatively,to expand the vertebral body and form the cavity,then bone cement filled.Results：Percutaneous kyphoplasty were successful in all 55 patients.The pre-treatment mean the loss heights of the anterior and mid portion of the vertebral body was（15.36±3.2） mm and（11.24±3.16） mm reduced to（10.89±3.23） mm and（5.17±1.98） mm respectivly in the post treatment.The results showed statistically significant difference（P0.01）.The Cobb angle in average preoperatively was 26.89°±6.41° corrected to 18.13°±3.45° postoperatively.And also the results was significantly difference on statistics（P0.01）.There were 3 cases with leakage of bone cement to vertebral space occurred,4 cases to perevertebral and one case to posterior edge of vertebra in front of posterior longitudinal ligament.Leakage rate was 11.69%（8 / 57）.No any case led to clinical symptoms.Conclusion：Three-dimensional CT-guided balloon kyphoplasty treatment of osteoporosis vertebral compression fractures has an advantage of less trauma and less complications,relatively faster recovery,accurate positioning acpuncture,obviously relieved pain and correction of the kyphotic deformity.This therapy procedure is a non-vascular interventional.It has a great clinical value to use multi-slice spiral CT three dimensional reconstruction to guide percutaneous kyphoplasty.