Pang D M, Yang J C, Gao H F, Fan Z X, Yin P
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2022 Sep 20;102(35):2793-2798. doi: 10.3760/cma.j.cn112137-20220408-00758.
To evaluate the safety and clinical efficacy of bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral burst fractures. It was a prospective study, 28 patients with osteoporotic thoraco-lumbar burst fractures who were treated in Beijing Chao-Yang Hospital from January 2021 to July 2021 were included, including 10 males and 18 females, with a median age of 73.6 years (range: 56.0-87.0 years). The X-ray radiographs, bone mineral density (BMD), CT three-dimensional reconstruction scan and MRI were taken and measured before operation to observe the fracture location and the posterior wall of the vertebral body, and further to determine the diagnosis. The X-ray radiographs and CT three-dimensional reconstruction scans were taken on the first day after operation and the last follow-up to observe whether there were bone cement leakage or not. The changes of kyphosis angle (KA), the height of anterior wall (HAW) and the height of posterior wall (HPW) before the operation, on the 1st day post operation and at the last follow-up were recorded. The visual analogue scale (VAS) of back pain and Oswestry dysfunction index (ODI) before the operation, 1 day post operation and at the last follow-up were used to evaluate the clinical effect of the operation. All the patients were followed up for (12.2±6.0) months. The HAW on the 1st day post operation [(22.5±2.0) mm] was significantly increased as compared with that before the operation [(21.2±2.4) mm] (<0.05). The HAW at the last follow-up [(18.9±1.6) mm] decreased signficantly as compared with that on the 1st day post opertion [(22.5±2.0) mm] (<0.05). The HPW was also significantly corrected after surgery (<0.05). At the end of the follow-up, the HPW [(27.2±1.3) mm] was comparable with that on the 1st day after surgery [(27.5±1.6) mm] (>0.05). The KA on the 1st day after the operation (14.2°±1.5°) decreased significantly when compared with that before the operation (18.8°±1.3°) (<0.05), but it was increased to 17.6°±1.4° at the last follow-up and was higher than that on the 1st day after the operation (<0.05). There were bone cement leakage in 5 cases and adjacent vertebral fracture in 1 case. The VAS and ODI scores were all significantly lower on the 1st day and at last follow-up than that before the operation (all <0.05). Bilateral PKP is effective, safe and reliable in the treatment of osteoporotic vertebral burst fracture. Careful evaluation of preoperative imaging data, accurate puncture and timing of bone cement injection are the key factors to ensure the success of the operation.
评估双侧经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体爆裂骨折的安全性及临床疗效。本研究为前瞻性研究，纳入2021年1月至2021年7月在北京朝阳医院接受治疗的28例骨质疏松性胸腰椎爆裂骨折患者，其中男性10例，女性18例，年龄中位数为73.6岁（范围：56.0 - 87.0岁）。术前进行X线片、骨密度（BMD）、CT三维重建扫描及MRI检查，测量并观察骨折部位及椎体后壁情况，以进一步明确诊断。术后第1天及末次随访时行X线片及CT三维重建扫描，观察有无骨水泥渗漏。记录术前、术后第1天及末次随访时后凸角（KA）、椎体前壁高度（HAW）及椎体后壁高度（HPW）的变化。采用术前、术后第1天及末次随访时的背痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评估手术临床效果。所有患者随访（12.2±6.0）个月。术后第1天的HAW[（22.5±2.0）mm]较术前[（21.2±2.4）mm]显著增加（<0.05）。末次随访时的HAW[（18.9±1.6）mm]较术后第1天[（22.5±2.0）mm]显著降低（<0.05）。术后椎体后壁高度也得到显著矫正（<0.05）。随访末期的椎体后壁高度[（27.2±1.3）mm]与术后第1天[（27.5±1.6）mm]相当（>0.05）。术后第1天的KA（14.2°±1.5°）较术前（18.8°±1.3°）显著降低（<0.05），但末次随访时增加至17.6°±1.4°，高于术后第1天（<0.05）。5例出现骨水泥渗漏，1例发生相邻椎体骨折。术后第1天及末次随访时的VAS和ODI评分均显著低于术前（均<0.05）。双侧PKP治疗骨质疏松性椎体爆裂骨折有效、安全且可靠。仔细评估术前影像资料、精确穿刺及把握骨水泥注入时机是确保手术成功的关键因素。
