经皮椎体后凸成形术治疗骨质疏松性胸腰段骨折适应证的选择及并发症的评估

目的根据经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗骨质疏松性胸腰段骨折的疗效来探讨其适应证的选择,并对其并发症进行评估。方法 2009年5月～2010年3月,72例骨质疏松性胸腰段椎体骨折患者行PKP治疗。所选患者均为单节段椎体骨折,其中T1111例,T1229例,L124例,L28例。术前、术后3 d及末次随访时测量X线片椎体前缘丢失高度及Cobb角;术后X线及CT扫描判断骨水泥在椎体内的分布情况;采用疼痛视觉模拟量表（visual analogue scale,VAS）评分及Oswestry功能障碍指数（Oswestry disability index,ODI）综合评估手术疗效。结果所有患者随访12～18个月,平均15.8个月,伤椎前缘高度丢失比值由术前（45.8±9.8）%恢复至术后（21.5±5.4）%,手术前后差异有统计学意义（P〈0.05）;随访时为（24.2±5.5）%,与术后相比差异无统计学意义（P〉0.05）。Cobb角术前28.1°±2.8°恢复至术后19.2°±3.2°,手术前后差异有统计学意义（P〈0.05）;随访时为21.2°±2.7°,与术后相比差异无统计学意义（P〉0.05）。VAS评分及ODI术前分别为8.9±0.8、37.4±4.9,术后3 d分别为2.3±0.6、28.2±4.1,手术前后差异均有统计学意义（P〈0.05）;随访时分别为2.2±0.6、27.4±4.2,与术后相比差异均无统计学意义（P〉0.05）。结论 PKP安全可靠,近期疗效满意,适用于骨质疏松性胸腰段椎体骨折,适应证主要以骨密度值及椎体压缩形态判定,注射剂量及再骨折风险为并发症评估的重要指标。

Percutaneous kyphoplasty for osteoporotic thoracolumbar fractures: indications and complications

Objective To explore the indications and complications of percutaneous kyphoplasty(PKP) for osteoporotic thoracolumbar fractures according to clinical outcomes.Methods From May 2009 to March 2010,72 patients with osteoporotic thoracolumbar fractures underwent PKP.All the fractures affected single vertebra: T11 vertebral fracture in 11 cases,T12 in 29 cases,L1 in 24 cases,and L2 in 8 cases.The height of anterior border of the fractured vertebral body and Cobb’s angle were measured preoperatively,3 d postoperatively and at the final follow-up.The distribution of bone cement in the vertebral body was assessed by X-ray and CT scan.The surgical outcome was evaluated by visual analogue scale(VAS) score and Oswestry disability index(ODI).Results All the patients were followed up.The mean duration was 15.8 months(range 12-18 months).The loss ratio of height of injured vertebrae recovered from(45.8±9.8)% preoperatively to(21.5±5.4)% postoperatively,and there was significant difference between the 2 values(P<0.05).At the final follow-up,the ratio was(24.2±5.5)%,and there was no statistic difference between the ratio and postoperative one(P>0.05).The Cobb’s angle recovered from 28.1°±2.8° preoperatively to 19.2°±3.2° postoperatively,and there was significant difference between the 2 values(P<0.05).At the final follow-up,the angle was 21.2°±2.7°,and there was no statistic difference between the angle and postoperative one(P>0.05).The VAS score was 8.9±0.8,2.3±0.6 and 2.2±0.6 preoperatively,postoperatively and at the final follow-up.The ODI was 37.4±4.9,28.2±4.1 and 27.4±4.2 at the same time points.There was significant difference of VAS score and ODI between pre-operation and post-operation(P<0.05).But there was no statistic difference between post-operation and the final follow-up(P>0.05).Conclusion PKP is a safe and satisfactory technique.It is suitable for osteoporotic thoracolumbar fractures.The indications were mainly based on the bone mineral density and the degree of compression of vertebral body.The injection dose and refracture risk were the important indexes for assessing the complications.