Li Chi-Huan, Chang Ming-Chau, Liu Chien-Lin, Chen Tain-Shung
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.
Clin Neurol Neurosurg. 2010 Oct;112(8):678-81. doi: 10.1016/j.clineuro.2010.05.006. Epub 2010 Jun 15.
There has been minimal literature reporting on results of osteoporotic burst fracture with spinal canal compromise treated with percutaneous vertebroplasty. Vertebroplasty for treatment of osteoporotic burst fracture is controversial. We want to clarify whether the osteoporotic burst fracture with spinal canal compromise is a contraindication to percutaneous vertebroplasty. To compare the clinical and radiological results between osteoporotic burst and compression fractures treated with percutaneous vertebroplasty.
From 2005 through 2006, 23 osteoporotic burst fracture patients with asymptomatic spinal canal compromise and 41 osteoporotic compression fracture patients underwent percutaneous vertebroplasty. Pre- and post-operative pain scores, functional and radiographic results and complications were analyzed.
The average canal compromise in study group was 15% (5-49%). The mean post-operative Oswestry Disability Index (ODI), Visual Analogue Score (VAS), kyphotic angle, vertebral body height measurement from the anterior, central and posterior part of the body are all significantly improved in both the study and control groups when compared to pre-operative data. However, there was no significant difference between study and control groups in pre- and post-operative ODI, VAS, kyphotic angle and improvement of body height. There were no significant differences (P=0.3797) in cement leakage rate between burst and compression groups (47.8% vs 36.6%). All the leakages were minor and without neurological deficit. The percentage of adjacent fractures in both groups also had no significant differences (39.1% in burst and 41.5% in compression group).
Osteoporotic burst fracture with asymptomatic spinal canal compromise is not a contraindication for percutaneous vertebroplasty. This procedure is suitable for both osteoporotic burst and compression fracture with careful surgical technique.
关于经皮椎体成形术治疗伴有椎管受累的骨质疏松性爆裂骨折的结果，相关文献报道极少。椎体成形术治疗骨质疏松性爆裂骨折存在争议。我们想要明确伴有椎管受累的骨质疏松性爆裂骨折是否为经皮椎体成形术的禁忌证。比较经皮椎体成形术治疗骨质疏松性爆裂骨折与压缩骨折的临床及影像学结果。
2005年至2006年，23例伴有无症状椎管受累的骨质疏松性爆裂骨折患者和41例骨质疏松性压缩骨折患者接受了经皮椎体成形术。分析术前及术后的疼痛评分、功能及影像学结果以及并发症。
研究组椎管平均受累程度为15%（5%-49%）。与术前数据相比，研究组和对照组术后的平均奥斯维斯特里功能障碍指数（ODI）、视觉模拟评分（VAS）、后凸角、椎体前部、中部和后部的椎体高度测量值均有显著改善。然而，研究组和对照组术前及术后的ODI、VAS、后凸角及椎体高度改善情况并无显著差异。爆裂骨折组与压缩骨折组的骨水泥渗漏率无显著差异（47.8%对36.6%，P = 0.3797）。所有渗漏均较轻微，且无神经功能缺损。两组相邻椎体骨折的发生率也无显著差异（爆裂骨折组为39.1%，压缩骨折组为41.5%）。
伴有无症状椎管受累的骨质疏松性爆裂骨折并非经皮椎体成形术的禁忌证。在手术操作技术谨慎的情况下，该手术适用于骨质疏松性爆裂骨折和压缩骨折。
