球囊扩张后凸椎体成形术治疗骨质疏松性胸腰椎爆裂骨折

目的 探讨选择性应用球囊扩张后凸成形术治疗骨质疏松性胸腰椎爆裂骨折的临床疗效.方法 回顾性分析从2004年至2009年期间在我院治疗的符合纳入标准的29例使用球囊扩张后凸椎体成形术治疗骨质疏松性胸腰椎爆裂骨折患者的临床资料.其中女18例,男11例;年龄(55~78)岁,平均64.5岁.所有患者经骨密度检测均为骨质疏松症患者.均表现为骨折椎体局部疼痛,无双下肢神经症状.骨折椎体共33个:T8 2个,T10 1个,T11 7个,T12 11个,L1 9个,L2 3个.所有患者术中经单侧椎弓根穿刺椎体;单个椎体骨水泥注入量(3.25±0.76)ml.术前及末次随访时行疼痛视觉模拟评分(VAS),测量X线侧位片骨折椎体后凸角,CT或MRI上受损椎管狭窄指数,记录手术相关并发症.结果 所有患者均获随访,随访时间10-33个月,平均18个月.术后2例患者疼痛缓解不明显,对症治疗后治愈.术中3例患者出现骨水泥渗漏;1例渗漏至椎间盘,2例渗漏至椎体前方,渗漏率为10.34%;均无神经压迫症状及其他并发症.末次随访时VAS 评分为(2.342±1.13)分,较术前的(6.58±1.31)分明显降低,差异有统计学意义(P<0.05);后凸角为-3.36°±15.78°,较术前后凸角-5.32°±16.17°改善,差异有统计学意义(P<0.05);术前受损椎管狭窄指数(85.14%±10.12%)与末次随访时(84.07%±11.39%)相比,差异无统计学意义(P>0.05).结论 选择性应用球囊扩张后凸椎体成形术治疗骨质疏松性胸腰椎爆裂骨折,临床结果满意.

The osteoporosis thoracolumbar vertebrae burst fracture treated with balloon kyphoplasty

Objective To investigate the clinical effects of osteoporosis thoracolumbar vertebrae burst fracture optionally treated with balloon kyphoplasty. Methods From 2004 to 2009, 29 patients with osteoporotic thoracolumbar vertebrae burst fracture treated with balloon kyphoplasty were adopted by our hospital, who all met the inclusion criteria. Their clinical data were retrospectively analyzed. There were 18 females and 11 males with an average age of 64.5 years old （range; 55-78 years）. All patients displayed osteoporosis by bone density measurement with local pain of fractured vertebral body and without neurological symptom of lower limbs. There were 33 fractured vertebral bodies, including 2 patients in T8, 1 in T10, 7 in T11, 11 in Z12, 9 in L1 and 3 in L2. All patients underwent a unipedicular approach piercing vertebral body. The injected cement volume was 3.25±0.76ml per vertebral body. Preoperative and latest follow-up pain was evaluated with visual analogue scale （VAS）. Lateral X-ray radiograph of the posterior convex angle of the fractured vertebral body was measured. CT or MRI showed the stenosis index of the fractured vertebral canal and the complications were analyzed. Results All patients were followed up for an average period of 18 months （range; 10-33 months）. 2 patients had no obvious remission from pain postoperatively, whose pain was released after symptomatic treatment. 3 patients had bone cement leakage during the operation, among them leakage into the intervertebral disc in 1 patient and the anterior portion of the vertebral body in 2 patients. The leakage rate was 10.34%. There was not any nerve compression syndrome or other complications. The VAS score at last follow- up （2.342＋1.13） was obviously lower than the preoperative one （6.58~1.31）, and the differences were statistically significant （P〈0.05）. The postoperative posterior convex angle （-3.36±15.78） was improved comparing with the preoperative one （-5.32±16.17）, and the differences were statistically significant （P〈0.05）. There were not statistically significant differences between the preoperative stenosis index of the fractured vertebral canal （85.14%±10.12%） and the latest follow-up one （84.07%±11.39%）. Conelusions Based on radiographic results, the clinical outcomes of osteoporosis thoracolumbar vertebrae burst fracture optionally treated with balloon kyphoplasty are satisfied.