Foo Leon Siang Shen, Yeo William, Fook Stephanie, Guo Chang Ming, Chen John Li Tat, Yue Wai Mun, Tan Seang Beng
Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore 169608.
Eur Spine J. 2007 Nov;16(11):1944-50. doi: 10.1007/s00586-007-0438-3. Epub 2007 Jul 21.
To describe our centre's results, experience and technical points learnt with the SKy Bone Expander System for osteoporotic vertebral compression fractures (VCFs). Forty consecutive patients with painful single level T12 or L1 osteoporotic VCF who had failed conservative management for more than 3 months had 40 single level SKy Bone Expander kyphoplasties performed. Using local anaesthesia with patients in a prone, hyper-lordotic position, a unilateral, percutaneous, intra-pedicular approach was employed. Once correctly positioned, the SKy Bone Expander was expanded, creating a void. It was subsequently contracted, removed and bone cement injected. Pre-kyphoplasty and 12-month post-kyphoplasty radiological and functional outcomes were recorded. Statistical analysis was by Wilcoxon Signed Ranks Test. Median percentage increase in anterior, middle and posterior vertebral body heights at 12-month post-operative was 51.25% [inter-quartile range (IQR) 17.21-93.22], 52.29% (IQR 26.50-126.17) and 9.84% (IQR 4.94-19.26) respectively, while median percentage decrease in kyphotic angle was 30.77% (IQR 17.06-46.61). There was no significant vertebral body correction loss at 12-month post-operative. Visual analogue score, North American Spine Society and Short Form-36 scores for physical functioning and bodily pain scores improved by medians of 5.0 (IQR 3.0-8.0), 1.45 (IQR 0.68-2.90), 20.5 (IQR 0.0-40.8) and 10.0 (IQR 0.0-20.0) respectively. All P-values were <0.001. There were eight adjacent/remote level VCFs, three cases of cement extravasation and one case of the SKy Bone Expander being unable to be contracted and withdrawn from the vertebral body. It was left in situ. This is the first reported incidence of such a complication. The SKy Bone Expander System appears to be a viable alternative to balloon tamp kyphoplasty. Important technical considerations include proper device positioning within the vertebral body before expansion, single use of devices, familiarity with salvage procedure and injection of bone cement under close image intensifier guidance to prevent cement extravasation.
描述我们中心使用SKy骨扩张器系统治疗骨质疏松性椎体压缩骨折（VCF）的结果、经验及所学到的技术要点。连续40例因疼痛性单节段T12或L1骨质疏松性VCF而保守治疗失败超过3个月的患者接受了40例单节段SKy骨扩张器椎体后凸成形术。采用局部麻醉，患者取俯卧、过伸位，采用单侧经皮椎弓根入路。SKy骨扩张器正确定位后进行扩张，形成一个空腔。随后将其收缩、取出并注入骨水泥。记录椎体后凸成形术前及术后12个月的影像学和功能结果。采用Wilcoxon符号秩和检验进行统计分析。术后12个月椎体前、中、后高度的中位数百分比增加分别为51.25%[四分位数间距（IQR）17.21 - 93.22]、52.29%（IQR 26.50 - 126.17）和9.84%（IQR 4.94 - 19.26），而后凸角的中位数百分比减小为30.77%（IQR 17.06 - 46.61）。术后12个月椎体矫正无明显丢失。视觉模拟评分、北美脊柱协会评分以及简明健康状况调查量表（Short Form - 36）的身体功能和身体疼痛评分的中位数分别改善了5.0（IQR 3.0 - 8.0）、1.45（IQR 0.68 - 2.90）、20.5（IQR 0.0 - 40.8）和10.0（IQR 0.0 - 20.0）。所有P值均<0.001。有8例相邻/远处节段VCF，3例骨水泥渗漏，1例SKy骨扩张器无法收缩并从椎体中取出，遂将其留在原位。这是首次报道的此类并发症发生率。SKy骨扩张器系统似乎是球囊扩张椎体后凸成形术的一种可行替代方法。重要的技术要点包括在扩张前将器械正确放置在椎体内、器械一次性使用、熟悉补救操作以及在影像增强器密切引导下注射骨水泥以防止骨水泥渗漏。
