球囊成形术治疗多节段骨质疏松椎体压缩骨折的效果观察

目的：评估球囊成形术( Percutaneous Kyphoplasty,PKP)治疗多节段骨质疏松椎体压缩骨折( Osteoporot-ic vertebral compressive fractures,OVCF)的临床效果及并发症。方法选取2008年2月—2013年7月解放军180医院73例多节段OVCF患者,其中2节段OVCF 60例,3节段OVCF 13例,共159节椎体。对新鲜骨折椎体行PKP治疗。术前术后采取视觉模拟评分( Visual analogue scale/score,VAS)和Oswestry功能障碍指数( Oswestry disability index, ODI)评分评估患者症状改善情况。采用椎体压缩程度、椎体高度恢复程度、术后1年后凸丢失程度等指标评估影像学疗效。所有患者术后行CT平扫,了解骨水泥分布及渗漏情况。结果临床症状缓解率达到95.89%(70/73),术后CT扫描显示总渗漏发生率为31.51%。术后1周、1年VAS评分和ODI评分均较术前降低(P<0．01),术后1年VAS评分和ODI评分较术后1周降低(P<0．01)。结论 PKP是治疗多节段OVCF的有效手段,能够获得良好的止痛效果,但存在较高的骨水泥渗漏发生率和远期再次骨折的风险,需要抗骨质疏松药物辅助治疗。

Clinical Effect of PKP in Treatment of Patients with Multi-segmental Osteoporotic Vertebral Compressive Frac-tures

Objective To investigate clinical effect and complication of percutaneous kyphoplasty (PKP) in treatment of multi-segmental osteoporotic vertebral compressive fractures ( OVCF) . Methods A total of 73 patients with osteoporotic vertebral compressive fractures OVCF during February 2008 and July 2013 were recruited in this study, which included 60 patients with two-segmental OVCF and 13 patients with three-segmental OVCF, and there were 159 vertebral bodies altogether. All new fractured vertebral bodies were treated with PKP. Conditions of symptom improve-ment were evaluated by Visual analogue score ( VAS) and Oswestry disability index ( ODI) sore before and after surgery. Radiographic outcomes were evaluated using indexes such as vertebral compression degree, restoration degree of vertebral height and kyphosis losing degree in postoperative 1 year. Conditions of distribution and penetrance of bone cement were studied by postoperative computed tomography scan. Results Symptomatic relief rate of patients were 95. 89% (70/73), and postoperative computed tomography scan showed that the total penetrance of bone cement was 31. 51%. Values of VAS and ODI score in postoperative 1 week and 1 year were lower than those before operation(P<0. 01), and values of VAS and ODI score in postoperative 1 year were lower than those in postoperative 1 week (P<0. 01). Conclusion PKP can effectively treat multi-segmental OVCF with satisfactory analgesic effect, but incident rates of bone cement leak-aging and second fracture are high, and therefore anti-osteoporotic medication should be supplemented.