椎体后凸成形术治疗非骨质疏松性椎体压缩性骨折

目的:观察经皮椎体后凸成形术(PKP)治疗非骨质疏松性椎体压缩性骨折(VCF)的疗效。方法:本组胸腰椎VCF42例,累及T11～L2共42个椎体。男11例,女31例。年龄50～58岁,平均53.5岁。术前骨密度检查提示骨量减低,但均未达到骨质疏松症的诊断标准。在"C"臂机引导下,经皮穿刺将一中空管道置入伤椎椎弓根建立工作通道,利用球囊液压扩张的原理使伤椎骨折复位。取出球囊,经工作通道用推杆向空腔内低压注入MIIGX3人工骨。采用疼痛视觉类比评分(VAS)、止痛药使用评分、伤椎高度及胸腰椎后凸角度等指标评估PKP术的疗效。结果:42例患者术后疼痛明显缓解,术后6周患者可佩戴腰围离床活动。术前VAS评分8.20.65分,术后2天降低到2.40.78分,末次随访时2.6±0.67分(P<0.01)。止痛药使用评分由术前的1.6±0.48分下降到术后2天的0.23±0.52分,末次随访时0.24±0.55分(P<0.01)。术后X线检查,压缩骨折的椎体高度恢复满意,术前椎体前、中份高度分别为22.13.6mm及21.82.9mm,术后2天明显改善到25.22.8mm及25.13.2mm,末次随访时为24.93.5mm及24.83.7mm(P<0.01)。胸腰段脊柱后凸Cobb角术前为17.5°±5.5°,术后2天改善为13°±4.5°,末次随访时为13.5°±5.5°(P<0.01)。结论:PKP治疗非骨质疏松性VCF,是一种安全、复位可靠、止痛效果确切的微创脊柱外科技术。

Percutaneous Kyphoplasty for Non-osteoporotic Vertebral Compression Fracture

Objective:To evaluate the efficacy of percutaneous kyphoplasty in treating non-osteoporotic vertebral compression fractures.Methods:42 cases (11 male and 31 female) of vertebral compressive fractures (range 50 to 58,average 53.5 years old),were treated with percutaneous kyphoplasty under "C" armed imaging guiding. Preoperative bone mineral density examinations showed a reduction of bone mass,but failed to meet the diagnostic criteria for osteoporosis. The inflatable bone tamp was inserted into the fractured vertebral body transpedicularly in a minimally invasive way. The balloon was inflated,elevating the endplate and restoring vertebral body height and then confirmed by "C" armed imaging. The balloon was deflated and withdrawn,leaving a cavity within the vertebral body. The cavity was then filled with MIIGX3 artificial bone. The clinical effect was evaluated by observing the changes of visual analog scale (VAS),the use of pain-killer scale,the Cobb's angle and the height of vertebral bodies.Results:The back pain was marked relieved postoperatively. In the six weeks after the procedure,the patients were allowed to get off bed. VAS pain score improved from 8.2 0.65 preoperatively to 2.4 0.78 postoperatively and 2.6±0.67 at the last follow up(P<0.01). The use of pain-killer scale were improved from1.6±0.48 preoperatively to 0.23±0.52 postoperatively and 0.24±0.55 at the last follow up(P<0.01). The mean height of the anterior edge vertebral body was from 22.1 3.6mm preoperatively to 25.2 2.8mm postoperatively and 24.9 3.5mm at final follow-up (P<0.01). The media vertebral bodies was increased from 21.8 2.9mm to 25.1 3.2mm,and at final follow-up 24.8 3.7mm (P<0.01). The mean kyphosis was improved from 17.5°±5.5° to 13°±4.5°,and 13.5°±5.5° at final follow-up (P<0.01).Conclusion:Percutaneous kyphoplasty for non-osteoporotic vertebral compression fracture could restore the height of fractured vertebra; relieve pain immediately,which should be a safe and effective minimal invasion spinal intervention.