Wang Jian, Zhang Nianchun, Liu Jie, Tian Huake, Chen Chao
Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Jan;23(1):68-71.
To explore the feasibility and efficacy of percutaneous kyphoplasty (PKP) for the treatment of severe osteoporotic vertebral compression fracture (OVCF), and to assess the clinical result of the PKP technique.
From May 2006 to October 2007, 12 patients with severe OVCF affecting more than 2/3 of the original vertebral body height were treated by using domestic PKP and percutaneous vertebroplasty (PVP) tool systems. There were 3 males and 9 females, with the age of 56-82 years and a mean disease course of 4.2 months (1-49 months). Eleven thoracic vertebra and 4 lumbar vertebra suffered from severe vertebral compression fractures, which included 3 extremely severe thoracic OVCF. Four thoracic vertebra and 3 lumbar vertebra had not severe OVCF. There were 4 cases of single vertebral compression fracture, 6 cases of double fractures, and 2 cases of triple fractures. Only single side PKP and PVP were performed via extrapedicular approach in thoracic vertebra, and via transpedicular approach in lumbar spine under fluoroscopic control. Eight patients with severe thoracic compression fractures and 4 with severe lumbar fractures were treated by PKP. Four patients with relatively mild thoracic compression fractures and 3 with lumbar fractures were treated by PVP.
The operation was successfully, 3 patients with extremely severe thoracic compression fractures received no intervention. The maximum expansion pressure of balloon was (1068 +/- 298) kPa, and the volume was (3.1 +/- 1.2) mL during operation. The average operative time of PKP was (44.9 +/- 10.6) minutes per vertebra, while the average operative time of PVP was (36.5 +/- 6.8) minutes per vertebra. The average volume of injected bone cement was (2.5 +/- 0.6) mL per thoracic vertebra, and (3.6 +/- 1.2) mL per lumbar vertebra. The mean hospitalization time were (3.7 +/- 1.6) days. Twelve cases were followed up 5-18 months (mean 8.6 months). The visual analogue scale scores were (2.35 +/- 0.61) points 2 days after operation and (2.89 +/- 1.07) points at last follow-up, there were statistically significant differences when compared with before operation (8.27 +/- 1.36) points (P < 0.01). Extravertebral leakage of the bone cement into the paravertebral tissue and/or disc occurred in 6 patients (9 vertebra) without significant symptom.
One side approach PKP is a safe and effective technique for treatment of severe OVCF with markedly relief of pain.
探讨经皮椎体后凸成形术（PKP）治疗重度骨质疏松性椎体压缩骨折（OVCF）的可行性和疗效，并评估PKP技术的临床效果。
2006年5月至2007年10月，采用国产PKP及经皮椎体成形术（PVP）工具系统治疗12例重度OVCF患者，椎体高度丢失超过原椎体高度的2/3。其中男性3例，女性9例，年龄56 - 82岁，平均病程4.2个月（1 - 49个月）。11个胸椎和4个腰椎发生重度椎体压缩骨折，其中包括3例极重度胸椎OVCF。4个胸椎和3个腰椎未发生重度OVCF。单椎体压缩骨折4例，双椎体骨折6例，三椎体骨折2例。胸椎仅通过椎弓根外侧入路在透视引导下进行单侧PKP和PVP，腰椎通过椎弓根入路进行。8例重度胸椎压缩骨折和4例重度腰椎骨折患者采用PKP治疗。4例相对轻度胸椎压缩骨折和3例腰椎骨折患者采用PVP治疗。
手术均成功，3例极重度胸椎压缩骨折患者未进行干预。术中球囊最大扩张压力为（1068±298）kPa，体积为（3.1±1.2）mL。PKP平均每椎体手术时间为（44.9±10.6）分钟，PVP平均每椎体手术时间为（36.5±6.8）分钟。胸椎平均每椎体注入骨水泥量为（2.5±0.6）mL，腰椎为（3.6±1.2）mL。平均住院时间为（3.7±1.6）天。12例患者随访5 - 18个月（平均8.6个月）。术后2天视觉模拟评分（VAS）为（2.35±0.61）分；末次随访时为（2.89±1.07）分，与术前（8.27±1.36）分比较差异有统计学意义（P < 0.01）。6例患者（9个椎体）骨水泥向椎旁组织和/或椎间盘外漏，但无明显症状。
单侧入路PKP是治疗重度OVCF安全有效的技术，可明显缓解疼痛。
