经皮椎体后凸成形术治疗重度骨质疏松性胸椎压缩骨折

[Treatment of severe osteoporotic thoracic vertebral compression fractures by percutaneous kyphoplasty].

作者信息

Liu Jie, Wang Jian

机构信息

Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, P.R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Apr;22(4):399-403.

PMID:18575436

Abstract

OBJECTIVE

To investigate clinical outcomes of percutaneous kyphoplasty with balloon in the treatment of severe osteoporotic thoracic vertebral compression fracture (SVCF).

METHODS

From May 2006 to July 2007, percutaneous unilateral kyphoplasty with single balloon was performed in 7 vertebras of 6 SVCF patients, with 2 injured vertebras in 2 males and 5 in 4 females, who were from 64 to 83 years old. The injured vertebras included 1 in T5, 2 in T8, 3 in T10 and 1 in T12 and the compression rates were 60% to 75% in 5 vertebras and > 75% in 2 vertebras. All the injured vertebras were old fractures and caused severe back pain, but without any neurotic symptoms and signs. The visual analogue scale (VAS) ranged from 6.5 to 9.0, 7.7 on average. The posterior vertebral walls were all intact in all patients under CT scan. The balloon was inset into the vertebra through pedicle of vertebral arch by percutaneous puncture under the guidance of C-type arm X-ray unit. The balloon was then extended to restore the vertebral body which was filled with bone cement later. The average volume of cement required was 3.5 mL (2.6 to 4.4 mL).

RESULTS

The pain was alleviated or completely relieved after the operation. The mean vertebral body height restoration was 9.7% +/- 1.4% on the anterior border. Two cement leakages were found on X-ray. One month after the treatment, the VAS was from 0 to 2.45, 1.32 on average, and there was significant difference compared with preoperation (P < 0.05). Three months after the treatment, the VAS was from 0 to 3, 2.13 on average, and there was no significant difference compared with 1 month after the treatment (P > 0.05). It was not found that the injured vertebras were compressed or deformed, and no new compressed fracture was found in consecutive vertebras.

CONCLUSION

Unilateral posterior-lateral puncture kyphoplasty with single balloon can relieve the pain and restore part of the vertebral height effectively with better outcomes.

摘要

目的

探讨球囊扩张椎体后凸成形术治疗重度骨质疏松性胸椎压缩骨折（SVCF）的临床疗效。

方法

2006年5月至2007年7月，对6例SVCF患者的7个椎体行经皮单侧单球囊椎体后凸成形术，其中男性2例，2个椎体受伤；女性4例，5个椎体受伤，年龄64～83岁。受伤椎体包括T5 1个、T8 2个、T10 3个、T12 1个，5个椎体压缩率为60%～75%，2个椎体压缩率>75%。所有受伤椎体均为陈旧性骨折，伴有严重背痛，但无神经症状和体征。视觉模拟评分（VAS）为6.5～9.0，平均7.7。CT扫描显示所有患者椎体后壁均完整。在C型臂X线机引导下经皮穿刺，通过椎弓根将球囊置入椎体内，然后扩张球囊恢复椎体高度，随后注入骨水泥。骨水泥平均用量为3.5 mL（2.6～4.4 mL）。

结果

术后疼痛缓解或完全消失。椎体前缘平均高度恢复率为9.7%±1.4%。X线检查发现2例骨水泥渗漏。治疗1个月后，VAS为0～2.45，平均1.32，与术前比较差异有统计学意义（P<0.05）。治疗3个月后，VAS为0～3，平均2.13，与治疗1个月后比较差异无统计学意义（P>0.05）。未发现受伤椎体再次压缩或变形，相邻椎体未出现新的压缩骨折。