经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折早期效果

目的总结经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩性骨折的早期疗效。方法 2008年2月-2010年6月采用PKP治疗31例(31个椎体)骨质疏松性椎体压缩性骨折。男10例,女21例;年龄64～80岁,平均70.7岁。均为轻微外伤所致,病程1～13 d。病变椎体位于T128例、L19例、L212例、L42例。手术前后采用疼痛视觉模拟评分(VAS)评估临床症状;摄X线片测量病变椎体Cobb角及椎体前缘高度,行骨折复位及预防椎体塌陷评估。结果 31例均顺利完成手术,无严重手术并发症。术中透视见11例椎体(35.5%)出现骨水泥渗漏,其中渗漏至椎体前侧3例,椎体侧方4例,沿穿刺通道渗漏4例。患者均获随访,随访时间6～15个月,平均11个月。骨折愈合时间8～12周,平均11.5周。术前、术后3个月及末次随访时VAS评分分别为(8.1±1.2)、(2.5±0.6)、(2.3±0.8)分;Cobb角分别为(30.2±5.3)、(21.3±3.6)、(23.5±3.8)°;椎体前缘高度分别为(13.98±4.62)、(22.03±4.93)、(22.56±4.34)mm。术后VAS评分、Cobb角、椎体前缘高度均较术前显著改善,差异有统计学意义(P<0.05);术后3个月和末次随访时比较差异无统计学意义(P>0.05)。结论 PKP是治疗骨质疏松性椎体压缩性骨折的有效方法,能缓解疼痛、矫正后凸畸形、预防椎体塌陷。

Preliminary clinical results of percutaneous kyphoplasty to treat osteoporotic vertebral compressive fracture

Objective To investigate the preliminary effectiveness of percutaneous kyphoplasty(PKP) in treating vertebral compressive fractures in patients with osteoporosis.Methods Between February 2008 and June 2010,31 cases(31 vertebrae) of osteoporotic vertebral compressive fractures were treated with PKP.Of 31 cases,10 were male and 21 were female,aged from 64 to 80 years(mean,70.7 years).All fractures were caused by mild trauma with an disease duration of 1-13 days.A ected vertebrae included T12in 8 cases,L1in 9 cases,L2in 12 cases,and L4in 2 cases.The effectiveness was evaluated with visual analogue scale(VAS),the Cobb’s angle,and the anterior vertebral height.Results The operation was completed successfully in all cases,without serious postoperative complication.Cement leakage occurred in 11 cases(35.5%),including 3 cases at the anterior vertebral edge,4 cases at the lateral vertebra,and 4 cases at the puncture tunnel.All the cases were followed up 6-15 months(mean,11 months).The mean fracture healing time was 11.5 weeks(range,8-12 weeks).VAS score was decreased from 8.1 ± 1.2 preoperatively to 2.5 ± 0.6 at 3 months postoperatively and to 2.3 ± 0.8 at last follow-up;the Cobb’s angle was improved from(30.2 ± 5.3)° to(21.3 ± 3.6)° and(23.5 ± 3.8)° respectively;and the anterior vertebral height was increased from(13.98 ± 4.62) mm to(22.03 ± 4.93) mm and(22.56 ± 4.34) mm respectively.There were signi cant differences in VAS,the Cobb’s angle,and the anterior vertebral height between pre-and post-operation(P < 0.05),but there was no signi cant di erence between 3 months postoperatively and last follow-up(P > 0.05).Conclusion PKP is effective for osteoporotic vertebral compressive fractures,which can relieve pain effectively,correct kyphosis,and prevent collapse of vertebra.