经皮椎体成形骨水泥注入治疗椎体重度压缩伴周壁破损性骨折

背景：经皮椎体成形已广泛应用于治疗老年骨质疏松性椎体骨折,然而椎体重度压缩伴椎体周壁破损性骨折因其骨水泥渗漏及穿刺风险增大而临床报道很少。目的：探讨应用经皮椎体成形骨水泥注入治疗椎体重度压缩伴周壁破损性骨折的可行性,并评价其临床效果。方法：选择2008-06/2010-09收治的22例椎体重度压缩伴椎体周壁破损骨折患者,伤椎椎体高度平均丢失68.5%,应用经皮椎体成形治疗。术后应用目测类比疼痛评分评价疗效,改良Stauffer-Coventry评定系统评定随访结果。结果与结论：全部病例顺利完成经皮椎体成形治疗,完成12个月随访。术后伤椎高度均有不同程度的恢复,至随访末期椎体高度无明显丢失。术后疼痛明显减轻或消失,测类比疼痛评分由术前平均8.8分降至术后平均2.2分。无症状性并发症及骨水泥材料宿主反应发生。提示椎体重度压缩伴椎体周壁破损性骨折应用经皮椎体成形治疗是安全可行的,且镇痛效果理想。

Percutaneous vertebroplasty with bone cement for severe vertebral compression fractures associated with peripheral wall damage

BACKGROUND:Percutaneous vertebroplasty has been widely used in the treatment of osteoporotic vertebral fractures; however, percutaneous vertebroplasty for severe vertebral compression fracture associated with vertebral body wall damage has an increased risk due to bone cement leakage and puncture, which is reported rarely in clinic.OBJECTIVE:To investigate the possibility of percutaneous vertebroplasty with bone cement for treatment of severe vertebral compression fractures associated with peripheral wall damage and to evaluate its clinical effect.METHODS:From June 2008 to September 2010, 22 patients with vertebral compression fracture associated with vertebral body wall damage were admitted. 68.5% vertebral body height was lost averagely. Then, patients underwent percutaneous vertebroplasty treatment. Postoperative visual analogue scale scores were evaluated, and modified Stauffer-Coventry assessing system was used to assess the follow-up results.RESULTS AND CONCLUSION:All patients were successfully operated, and followed for 12 months. Postoperatively, the injured vertebral height recovered to varying degrees, and no loss of vertebral body height was found at the end of follow-up. Postoperative pain was significantly reduced or disappeared, the average visual analogue scale scores were reduced from 8.8 to 2.2. Asymptomatic complications and bone cement materials versus-host reaction did not occur. These findings indicate that percutaneous vertebroplasty is safe and feasible to treat severe vertebral compression fractures associated with peripheral wall damage.