Wang Da-lin, Wang Li-ming, Xu Jie, Zeng Yi-wen, Wang Gang-rui, Zheng Sheng-nai
Department of Spine Surgery, Nanjing Medical University, Nanjing 210006, China.
Zhonghua Wai Ke Za Zhi. 2011 Mar 1;49(3):213-7.
To investigate the clinical efficacy and safety of biopsy and Kyphoplasty in the diagnosis and treatment of osteoporotic thoracolumbar vertebral fracture nonunion, and to explore the clinical characteristics of the disease.
From July 2005 to May 2010, the clinical data of 8 patients with nonunion of osteoporotic thoracolumbar vertebral fractures were studied. There were 3 males and 5 females, with the mean age of 73.5 years (range, 65 - 86 years). The fracture vertebrae were 3 cases in T(12), 4 in L(1), and 1 in L(2). All cases received radiography, CT and MRI examination. All patients were treated by using Kyphoplasty. Five patients were performed bone biopsy successfully, 3 patients were failed. The curative effect was evaluated by visual analogue scale (VAS), anterior vertebral height restoration at preoperative, postoperative and followed-up time.
All patients tolerated the procedure well with immediate relief of back pain after Kyphoplasty. No severe complications were found in all patients. Three cases had the pathologic appearance of sequestrum, 2 cases were sparse cancellous bone, 3 cases were abortive to biopsy. All the patients were followed up of 22.6 months (range, 3 - 37 months), the VAS was 9.5 before operation, 2.1 at the third day postoperatively, there were significant difference between the two phase (P < 0.05), and 2.3 at last follow-up, there were no difference between postoperation and follow-up phase (P > 0.05). And the height of compressed body recovered markedly. The vertebral height had a recovery rate of 67.2% postoperatively, 64.1% and at last follow-up, there were no difference between the two phase (P > 0.05).
Kyphoplasty is an effective and safe method in the treatment of osteoporotic throacolumbar vertebral fracture nonunion. Bone biopsy can play a further role of differential diagnosis.
探讨活检及椎体后凸成形术在骨质疏松性胸腰椎椎体骨折不愈合诊断与治疗中的临床疗效及安全性，并探究该疾病的临床特点。
研究2005年7月至2010年5月间8例骨质疏松性胸腰椎椎体骨折不愈合患者的临床资料。其中男性3例，女性5例，平均年龄73.5岁（范围65 - 86岁）。骨折椎体为T12 3例，L1 4例，L2 1例。所有病例均行X线、CT及MRI检查。所有患者均采用椎体后凸成形术治疗。5例患者骨活检成功，3例失败。通过视觉模拟评分法（VAS）、术前、术后及随访时椎体前缘高度恢复情况评估疗效。
所有患者对手术耐受性良好，椎体后凸成形术后背痛立即缓解。所有患者均未发现严重并发症。3例有死骨病理表现，2例为稀疏松质骨，3例活检未成功。所有患者随访22.6个月（范围3 - 37个月），术前VAS为9.5，术后第3天为2.1，两者差异有统计学意义（P < 0.05），末次随访时为2.3，术后与随访期差异无统计学意义（P > 0.05）。压缩椎体高度明显恢复。术后椎体高度恢复率为67.2%，末次随访时为64.1%，两者差异无统计学意义（P > 0.05）。
椎体后凸成形术是治疗骨质疏松性胸腰椎椎体骨折不愈合的一种有效且安全的方法。骨活检可起到进一步的鉴别诊断作用。
