Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, China.
Eur J Pain. 2020 Mar;24(3):659-664. doi: 10.1002/ejp.1516. Epub 2020 Jan 27.
Osteoporotic thoraco-lumbar burst fractures with serious pain are very common, and the optimal treatment of burst fractures without any neurological deficits has not yet been properly codified. The objective of this study was to evaluate prospectively the clinical effects and pain relief of unilateral percutaneous kyphoplasty (PKP) on osteoporotic thoraco-lumbar burst fractures.
Forty-six patients with osteoporotic thoraco-lumbar burst fractures were treated by PKP in our hospital from January 2016 to January 2017. The height of posterior wall (HPW), the height of anterior wall (HAW) and kyphotic angle (KA) were measured via x-ray radiographs before surgery, one day after surgery and at final follow-up. Visual analogue scale (VAS) score and the oswestry disability index (ODI) score were evaluated preoperatively, postoperatively and at final follow-up. All the patients with osteoporotic thoraco-lumbar burst fractures were treated by unilateral PKP. Radiological evaluation (anteroposterior and lateral x-ray radiographs and CT) was performed.
All patients were followed-up, and the mean follow-up was 28.8 ± 7.0 months. The preoperative HAW was 20.1 ± 2.3 mm, and the HAW was significantly improved to 22.9 ± 2.4 mm after operation (p < .05), and at the final follow-up, the HAW was 19.9 ± 2.1 mm, which was lower than the postoperative HAW. The HPW was also significantly corrected after surgery (p < .05). There were no significant differences between postoperative HPW and HPW at the final follow-up (p > .05). The KA was significantly corrected after operation (p < .05), but relapse occurred at the final follow-up, and at the final follow-up, the average of KA was 19.4 ± 1.6 degree. The VAS and ODI were significantly improved at the final follow-up compared to the preoperative period (p < .05). Cement leakage was found in eight patients, and adjacent vertebral fracture (VF) was found in two patients.
Our results showed that unilateral PKP acquired satisfactory treatment effect and pain relief in the management of osteoporotic thoraco-lumbar burst fractures. Meticulous evaluation of preoperative images and careful repetitious injection of cement are important to prevent cement leakage.
Our present results showed that unilateral PKP was an effective method to obtain satisfactory pain relief in the management of osteoporotic thoraco-lumbar burst fractures. It may a good indication for the patients with osteoporotic thoraco-lumbar burst fractures, and the patients could not tolerate the serious acute pain by conservative treatment.
伴有严重疼痛的骨质疏松性胸腰椎爆裂骨折非常常见，对于无神经缺损的爆裂骨折的最佳治疗方法尚未得到妥善规范。本研究的目的是前瞻性评估单侧经皮椎体后凸成形术（PKP）治疗骨质疏松性胸腰椎爆裂骨折的临床效果和止痛效果。
2016 年 1 月至 2017 年 1 月，我院采用 PKP 治疗 46 例骨质疏松性胸腰椎爆裂骨折患者。术前、术后 1 天及末次随访时拍摄 X 线片测量后凸角（KA）、后凸角（HPW）、前壁高度（HAW）。术前、术后及末次随访时采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分进行评估。所有骨质疏松性胸腰椎爆裂骨折患者均采用单侧 PKP 治疗。行 X 线正侧位及 CT 影像学评价。
所有患者均获随访，平均随访时间为 28.8±7.0 个月。术前 HAW 为 20.1±2.3mm，术后明显改善至 22.9±2.4mm（p<0.05），末次随访时 HAW 为 19.9±2.1mm，低于术后 HAW。术后 HPW 也明显纠正（p<0.05）。术后 HPW 与末次随访时无显著差异（p>0.05）。术后 KA 明显矫正（p<0.05），但末次随访时复发，末次随访时 KA 平均为 19.4±1.6 度。与术前相比，术后 VAS 和 ODI 明显改善（p<0.05）。8 例患者出现骨水泥渗漏，2 例患者出现相邻椎体骨折（VF）。
我们的结果表明，单侧 PKP 治疗骨质疏松性胸腰椎爆裂骨折可获得满意的疗效和止痛效果。术前仔细评估影像学资料，反复仔细注入骨水泥，可防止骨水泥渗漏。
本研究结果表明，单侧 PKP 是治疗骨质疏松性胸腰椎爆裂骨折获得满意止痛效果的有效方法。对于不能耐受严重急性疼痛的骨质疏松性胸腰椎爆裂骨折患者，是一种较好的治疗方法。
