单边靶点穿刺分期灌注骨水泥经皮椎体成形术治疗伴椎体内裂隙征之骨质疏松性胸腰椎骨折

目的通过改进微创经皮椎体成形术(percutaneous vertebroplasty,PVP)的操作方法,探讨PVP治疗伴椎体内裂隙征(intravertebral cleft,IVC)的骨质疏松性胸腰椎骨折的临床疗效。方法采用单边靶点穿刺及分次分期灌注骨水泥的PVP技术治疗伴IVC征的胸腰椎骨折26例,测量术前、术后2 d及末次随访时疼痛视觉模拟评分(VAS评分)、Oswestry功能障碍指数(ODI)、椎体前缘高度比值及后凸角(Cobb角)的变化,并进行比较,评估该方法的临床疗效。结果 26例患者均获6~12个月随访。本组手术时间30~45 min,骨水泥注射量3~7 mL,平均4.5 mL。VAS评分、ODI评分、椎体前缘高度比值以及Cobb角术前与术后相比均有明显改善(P0.05)。但术后2 d及末次随访以上四项指标相比无明显统计学差异(P0.05)。发生骨水泥渗漏6例(23.1%),其中椎间盘渗漏2例,椎体前缘渗漏2例,侧方渗漏1例,椎管内渗漏1例,未出现神经损伤及肺栓塞等严重并发症。结论通过单边靶点精确穿刺及分次分期灌注骨水泥的PVP技术可明显减轻伴IVC征骨质疏松性胸腰椎骨折患者的胸腰背痛,并能部分复位,改善后凸畸形,具有创伤小、疗效好等优点,并可有效减低骨水泥渗漏发生率。

Unipedicular fractional staged percutaneous vertebroplasty in the treatment of patients with osteoporotic thoracolumbar vertebral body fracture complicated with intravertebral cleft

Objective To study the clinical efficacy of percutaneous vertebroplasty（PVP） in the treatment of osteoporotic thoracolumbar vertebral body compression fractures combined with intravertebral clefts by improving the surgery′s operation method. Methods Twenty-six patients with osteoporotic thoracolumbar vertebral body fracture complicated with intravertebral clefts underwent unipedicular fractional staged PVP. VAS, Oswestry Dysfunctional Index（ODI）, Cobb angle, and height of the injured vertebra were evaluated preoperatively, 2 days postoperatively, and the final follow-up separatively, and a comparison among three different times was made to assess the therapeutic efficacy of the improved PVP. Result The duration of follow-up ranged from 6-12 months. The operation time ranged from 30-45 minutes, the bone cement injection volume averaged 4.5 mL （range, 3 to 7 mL）. VAS, ODI, height of the injured vertebra, and Cobb angle were significantly improved after operation （P＜0.05）, but no statistical difference was detected between the 2 days postoperatively and the final follow-up results （P＞0.05）. Six bone cement leakage were recorded, with a rate of 23.1%, including 2 cases of intradiscal leakage,2 cases of anterior vertebral leakage, 1 case of lateral leakage, and 1 case of intraspinal leakage. No spinal cord iatrogenic injury or pulmonary embolism was recorded. Conclusion Unipedicular fractional staged PVP can obviously decrease the thoracolumbar pain, partially relocate the fracture, improve kyphosis, and effectively attenuate the incidence of bone cement leakage, with benefits of less trauma and excellent effect.