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球囊扩张椎体后凸成形术治疗越南患者胸腰椎骨质疏松性压缩骨折的安全性。

Safety of Balloon Kyphoplasty in the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures in Vietnamese Patients.

机构信息

Institute of Orthopedic Trauma, Viet Duc Hospital, Hanoi, Vietnam.

Social Affair Department, Viet Duc Hospital, Hanoi, Vietnam.

出版信息

Clin Orthop Surg. 2020 Jun;12(2):209-216. doi: 10.4055/cios19160. Epub 2020 May 14.

Abstract

BACKGROUND

The evidence for the efficacy and safety of balloon kyphoplasty (BKP) in treating the Vietnamese patients is sparse. There is no convincing evidence regarding BKP's efficacy in Vietnamese patients, especially in the patients with thoracic osteoporotic vertebral compression fractures (VCFs). This article aims to evaluate the outcomes of restoring the body height of the compressed thoracic vertebrae in patients undergoing BKP.

METHODS

We prospectively enrolled 65 consecutive patients with thoracic VCFs (73 vertebrae) due to osteoporosis who were treated with BKP between June 2018 and May 2019.

RESULTS

A trocar was inserted through the pedicle in 84.9% (62/73) and beside the pedicle in 15.1% (11/73). The mean amount of mixed cement injected was 4.1 ± 1.1 mL (range, 1.5-7 mL). Cement leakage was radiographically confirmed in 30.8% of 65 patients. Among patients with complications caused by cement extravasation, the leakage was through the anterior margin of the vertebrae in 15.4%, through the vertebral disc in 12.3%, and through the posterior margin of the vertebrae in 3.1%. In the last 3.1% of patients, there was no clinically notable lesions of the nerve roots or spinal cord. The mean visual analog scale score decreased significantly from 7.3 ± 1.1 preoperatively to 3.3 ± 0.6 at 24 hours after surgery, and then to 1.2 ± 1.1 at 3 months after surgery ( < 0.01). The mean reduction in Cobb angle measured on standing radiographs after treatment was 3.7°, showing statistical significance ( < 0.01).

CONCLUSIONS

BKP is a minimally invasive treatment effective for immediate pain relief, early motor rehabilitation, and humpback correction. The present study provided convincing evidence to support the use of BKP by spine surgeons and clinical specialists in treating osteoporotic thoracic VCFs in Vietnamese patients.

摘要

背景

球囊扩张椎体后凸成形术(BKP)治疗越南患者的疗效和安全性证据不足。BKP 对越南患者,尤其是胸腰椎骨质疏松性压缩性骨折(VCF)患者的疗效尚无确切证据。本文旨在评估 BKP 治疗胸腰椎 VCF 患者恢复压缩椎体高度的效果。

方法

我们前瞻性纳入 2018 年 6 月至 2019 年 5 月因骨质疏松症行 BKP 治疗的 65 例连续胸 VCF 患者(73 个椎体)。

结果

84.9%(62/73)的患者通过椎弓根插入套管,15.1%(11/73)的患者通过椎弓根旁插入套管。混合骨水泥注射量平均为 4.1±1.1 mL(范围 1.5-7 mL)。65 例患者中有 30.8%(20/65)的患者存在影像学证实的骨水泥渗漏。在因骨水泥外渗引起并发症的患者中,15.4%的渗漏发生在前缘,12.3%的渗漏发生在椎间盘内,3.1%的渗漏发生在椎体后缘。在最后 3.1%的患者中,没有神经根或脊髓的明显临床病变。术后 24 小时和 3 个月,患者的视觉模拟评分(VAS)从术前的 7.3±1.1 分别显著降低至 3.3±0.6 和 1.2±1.1(<0.01)。站立位 X 线片测量的 Cobb 角在治疗后平均减少 3.7°,具有统计学意义(<0.01)。

结论

BKP 是一种微创治疗方法,可有效缓解疼痛,促进早期运动康复,矫正后凸畸形。本研究为脊柱外科医生和临床专家在越南患者中应用 BKP 治疗骨质疏松性胸 VCF 提供了令人信服的证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a00f/7237258/ec2e24a5a278/cios-12-209-g001.jpg

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