Feng Yuxu, Zhang Jue, Shen Yimin, Ren Yongxin, Yin Guoyong, Zhang Ning
Department of Orthopaedics, First Affiliated Hospital, Nanjing Medical University, Nanjing Jiangsu 210029, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Aug;26(8):972-6.
To investigate the feasibility and effectiveness of selective treatment of senile osteoporotic thoracolumbar burst fractures of Denis type B with kyphoplasty and Jack vertebral dilator.
Between August 2007 and May 2011, 30 patients (32 vertebra) with osteoporotic thoracolumbar burst fractures of Denis type B were treated with kyphoplasty and Jack vertebral dilator. There were 7 males and 23 females, aged 57-85 years (mean, 76.9 years). The injured vertebrae included T11 in 2 vertebrae, T12 in 11 vertebrae, L1 in 7 vertebrae, L2 in 5 vertebrae, L3 in 3 vertebrae, and L4 in 4 vertebrae. The visual analogue scale (VAS) score, Oswestry disability index (ODI), the anterior and middle height of the vertebral body, and the Cobb angle were assessed before and after operation.
The operation was completed smoothly in all cases; no cement leakage or intraoperative complication was found. Obvious back pain relief was achieved in all patients after operation. Thirty patients were followed up at 1 week and 6 months after operation. The VAS score was decreased from 8.2 +/- 1.3 before operation to 1.5 +/- 0.9 at 1 week after operation and 1.9 +/- 0.5 at 6 months after operation; the ODI was decreased from 82.4% +/- 15.0% to 17.8% +/- 9.5% and 23.0% +/- 8.6%; the anterior height of the vertebral body was increased from (19.5 +/- 3.2) mm to (24.8 +/- 3.0) mm and (24.0 +/- 2.6) mm; the middle height of the vertebral body was increased from (18.5 +/- 3.4) mm to (23.7 +/- 3.7) mm and (22.8 +/- 3.5) mm; the Cobb angle was decreased from (14.9 +/- 7.5)degrees to (7.6 +/- 6.0)degrees and (8.3 +/- 6.0)degrees; and there were significant differences in the VAS score, ODI, the anterior and middle height of the vertebral body, and the Cobb angle between at pre- and at post-operation (P < 0.05), but no significant difference between at 1 week and at 6 months after operation (P > 0.05).
Kyphoplasty with Jack vertebral dilator for selective treatment of senile osteoporotic thoracolumbar burst fractures of Denis type B can restore the anterior and middle height of the vertebral body, correct the Cobb angle, and relieve pain, and it has good short-term effectiveness and safety.
探讨经皮椎体后凸成形术联合Jack椎体撑开器选择性治疗Denis B型老年骨质疏松性胸腰椎爆裂骨折的可行性及有效性。
回顾性分析2007年8月至2011年5月间收治的30例（32个椎体）Denis B型老年骨质疏松性胸腰椎爆裂骨折患者的临床资料，均采用经皮椎体后凸成形术联合Jack椎体撑开器治疗。其中男7例，女23例；年龄57～85岁，平均76.9岁。损伤节段：T11 2个椎体，T12 11个椎体，L1 7个椎体，L2 5个椎体，L3 3个椎体，L4 4个椎体。分别于术前及术后采用视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、椎体前缘及中部高度、Cobb角进行评估。
所有患者手术均顺利完成，术中均未出现骨水泥渗漏及其他并发症。术后患者腰背部疼痛均明显缓解。30例患者均获随访，随访时间为术后1周及6个月。术后1周VAS评分由术前的8.2±1.3降至1.5±0.9，术后6个月降至1.9±0.5；ODI由术前的82.4%±15.0%降至术后1周的17.8%±9.5%，术后6个月降至23.0%±8.6%；椎体前缘高度由术前的（19.5±3.2）mm增加至术后1周的（24.8±3.0）mm，术后6个月为（24.0±2.6）mm；椎体中部高度由术前的（18.5±3.4）mm增加至术后1周的（23.7±3.7）mm，术后6个月为（22.8±3.5）mm；Cobb角由术前的（14.9±7.5）°降至术后1周的（7.6±6.0）°，术后6个月为（8.3±6.0）°。术前与术后VAS评分、ODI、椎体前缘及中部高度、Cobb角比较差异均有统计学意义（P<0.05），术后1周与术后6个月比较差异无统计学意义（P>0.05）。
经皮椎体后凸成形术联合Jack椎体撑开器选择性治疗Denis B型老年骨质疏松性胸腰椎爆裂骨折，可有效恢复椎体前缘及中部高度，矫正Cobb角，缓解疼痛，近期疗效确切，安全性高。
