经皮椎体后凸成形术中分步推注骨水泥治疗椎体后壁破损的骨质疏松性椎体骨折

目的 探讨经皮椎体后凸成形术（PKP）治疗椎体后壁破损的骨质疏松性椎体骨折中减少骨水泥渗漏的方法.方法 对27例老年骨质疏松性骨折患者在PKP术中采用分步推注骨水泥的方法治疗椎体后壁破损36椎,观察患者手术前后疼痛视觉模拟评分（VAS）变化、椎体高度恢复情况及骨水泥渗漏情况.结果 27例均获得随访,时间12~48（27.3±6.2）个月.术后3 d及末次随访时患者VAS、椎体高度均较术前明显改善（P〈0.05）,末次随访时与术后3 d比较差异无统计学意义（P〉0.05）.术后5个椎体（13.8%）发生骨水泥渗漏,其中椎旁渗漏2个,椎间盘渗漏2个,椎管内渗漏1个.无肺栓塞发生,未出现脊髓和神经根损伤.结论 PKP治疗椎体后壁破损老年骨质疏松性椎体压缩性骨折中,采用分步推注骨水泥的方法可有效减少骨水泥渗漏.

Stage injection procedure in percutaneous kyphoplasty for the treatment of osteoporotic vertebral body compression fracture with posterior wall incompetence

Objective To investigate the preventive methods of the bone cement leakage in percutaneous kyphoplasty （PKP） for the treatment of osteoporotic vertebral body compression fracture with posterior wall incompetence. Methods 27 patients with 36 vertebrae which osteoporotic vertebral body compression fracture with posterior wall incompetence were treated with PKP by staged injection procedure. The outcome was evaluated by observing the change in visual analogue scale （VAS）, middle vertebral column height at 3 days after operation and last follow-up, and bone cement leakage was record. Results All patients were followed up for 12 - 48 （27.3 ± 6. 2） months. The middle vertebral column height, VAS score were significantly improved in 3 days postoperation and last follow-up compare with preoperation （P 〈 0.05）. There were no statistically significant differences between 3 days after operation and last follow-up （P 〉 0.05 ）. 5 （ 13.8% ） vertebral bodies had bone cement leakage, of these cases, 2 of paravertebral space leakage,2 of intervertebral leakage, and 1 of spinal canal leakage. There was no cement leakage resuhing in pulmonary embolism, radiculopathy or myelopathy. Conclusions It is effective to reduce the rate of cement leakage in PKP for the treatment of osteoporotic vertebral body compression fracture with posterior wall incompetence by stage injection procedure.