经皮椎体后凸成形术治疗伴椎管狭窄的骨质疏松性椎体压缩骨折

目的探讨椎体骨折后骨块突入并导致椎管狭窄而无神经症状的骨质疏松性椎体压缩骨折(OVCF)是否为经皮椎体后凸成形术(PKP)的绝对手术禁忌证。方法从接受PKP治疗的OVCF患者中选取48例椎管狭窄无神经症状患者的临床资料进行分析。术前X线及MRI检查确定骨折节段。记录手术前后患者椎体后凸角、椎体高度、致椎管狭窄骨质的长度、VAS及ODI评分,并进行统计学分析。结果 48例患者行PKP治疗后,椎体后凸角减小,椎体高度增加,椎管无进一步狭窄,VAS及ODI评分降低,术后无神经症状产生,与术前资料相比较,所有观察指标差异均有统计学意义(P0.05)。19例患者出现骨水泥渗漏,但渗漏量极小,均局限在椎旁或是椎间盘内,未引起神经症状。结论骨折致椎管狭窄无神经症状的OVCF并非PKP的绝对手术禁忌证,结合术前完整的影像学资料分析以及术中连续的影像学监测,椎管狭窄无神经症状的OVCF患者可以安全接受PKP手术。

Osteoporotic vertebral compression fracture with spinal canal compromise treated with per-cutaneous kyphoplasty

Objective To explore whether spinal canal compromise that caused by the intruding bone of fractured vertebral body after osteoporosis vertebral compression fracture( OVCF) without neurological symptoms is an absolute contraindication for percutaneous kyphoplasty( PKP) . Methods Forty-eight OVCF patients whose spinal canals were compromised without neurological symptoms were chosen as research subjects from the patients treated in our hospital. The fracture sections were confirmed by X-ray, MRI preoperatively. The wedge angles, the first third, the middle third, and the last third vertebral body height, length of bone caused spinal canal compromise, VAS and ODI score were measured, recorded and analyzed before and after operation. Results After the treatment of PKP for 48 cases, the wedge angles of vertebral body decreased, the height of vertebral body increased, spinal canals were without fur-ther narrowed, VAS and ODI decreased. Compared with preoperative clinical data, the difference was statistically significant (P<0. 05). Nineteen patients had minor cement leakage, but all cement leakage were in lateral side of vertebral body or in intervertebral disc. The skin sensation and movement of 48 patients′ limbs were normal without neurological symptoms after operation. Conclusions OVCF with spinal canal compromise without neurological symp-toms is not an absolute contraindication for PKP. Combined with comprehensive preoperative image assessment and intraoperative continuous imaging monitoring, PKP can be performed on OVCF with spinal canal compromise patients safely.