摘要
目的探讨经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗无神经脊髓症状的骨质疏松性椎体爆裂骨折的临床疗效及安全性。方法回顾性分析我院2013年1月-2015年6月采用双侧入路PKP治疗骨质疏松性椎体爆裂骨折31例资料,记录手术时间、透视次数、骨水泥用量、住院时间及骨水泥渗漏情况。术前、术后1天、末次随访采用疼痛视觉模拟评分（visual analog score,VAS）评估疼痛程度,Oswestry功能障碍指数（Oswestry disability index,ODI）评估患者日常生活功能;术前、术后1天及末次随访在X线侧位片上测量伤椎高度和椎体后凸角,观察术后1天及末次随访椎体高度恢复率和后凸角矫正率。结果手术均顺利完成。术中骨水泥渗漏10例,均无相关神经或脊髓症状。术后随访12-21个月,（14.2±3.5）月。术后1天和末次随访的VAS评分[（2.5±0.8）分,（1.1±0.6）分]较术前[（6.8±0.9）分]明显降低（t=20.393、30.178,P=0.000）,末次随访的VAS评分较术后1天降低（t=8.237,P=0.000）;术后1天和末次随访的ODI（37.2%±4.4%,17.6%±6.3%）较术前（72.9%±6.6%）明显降低（t=25.053、33.575,P=0.000）,末次随访的ODI较术后1天降低（t=14.140,P=0.000）;术后1天和末次随访的伤椎高度[（18.8±1.5）mm,（18.5±1.6）mm]较术前[（15.6±1.5）mm]明显增高（t=7.158、6.883,P=0.000）,但末次随访的伤椎高度较术后1天无明显变化（t=0.847,P=0.194）;术后1天和末次随访的椎体后凸角（7.1°±2.5°,7.4°±2.8°）较术前（14.6°±2.6°）明显减小（t=9.160、10.018,P=0.000）,但末次随访的椎体后凸角较术后1天无明显变化（t=0.800,P=0.936）;末次随访椎体高度恢复率（49.5%±2.7%）较术后1天（50.0%±2.6%）无明显变化（t=0.737,P=0.464）;末次随访后凸角矫正率（50.7%±6.5%）较术后1天（51.9%±5.3%）无明显差异（t=1.945,P=0.058）。随访过程中未见伤椎及邻近椎体再骨折等并发症。结论运用PKP治疗无神经脊髓症状的老龄骨质疏松性椎体爆裂骨折,疗效可靠,且相对安全。
Objective To investigate the clinical efficacy and safety of percutaneous kyphoplasty（ PKP） in the treatment of osteoporotic vertebral burst fractures without neurological symptoms. Methods A retrospective analysis of 31 patients with osteoporotic vertebral burst fractures from January 2013 to June 2015 in our hospital treated by using bilateral approach PKP. The operation time,X-ray times,bone cement dosage,hospital days and bone cement leakage were recorded. The visual analogue scale（ VAS） at preoperative,postoperative 1 day,and the last follow-up was used to evaluate the degree of pain. The Oswestry disability index（ ODI） was used to assess the patient＇s daily living functions. The measurement of vertebral height on lateral radiographs and vertebral kyphosis at preoperative,postoperative 1 day and the last follow-up was observed. The vertebral height restoration rate and the kyphosis correction rate at preoperative,postoperative 1 day and last follow-up were recorded. Results All the operations were successfully completed. There were 10 cases of bone cement leakage,without nerve or spinal cord symptoms. The patients were followed up for 12- 21 months,with an average of（ 14. 2 ± 3. 5） months. The VAS scores were significantly lower at postoperative 1day and the last follow-up [（ 2. 5 ± 0. 8） points,（ 1. 1 ± 0. 6） points] than preoperative [（ 6. 8 ± 0. 9） points]（ t = 20. 393 and30. 178,P = 0. 000）. The VAS scores were significantly lower at the last follow-up than that of postoperative 1 day（ t = 8. 237,P =0. 000）. The ODI scores at postoperative 1 day and the last follow-up（ 37. 2% ± 4. 4%,17. 6% ± 6. 3%） were significantly decreased as compared with the preoperative（ 72. 9% ± 6. 6%）（ t = 25. 053 and 33. 575,P = 0. 000）. The ODI scores at the last follow-up were lower than that of the postoperative 1 day（ t = 14. 140,P = 0. 000）. The injured vertebral height at postoperative 1 day and the last follow-up [（ 18. 8 ± 1. 5） mm,（ 18. 5 ± 1. 6） mm] was significantly increased as compared with preoperative [（ 15. 6 ±1. 5） mm]（ t = 7. 158 and 6. 883,P = 0. 000）. But at the last follow-up,the height of the injured vertebra was not significantly changed as compared with that of postoperative 1 day（ t = 0. 847,P = 0. 194）. The vertebral kyphosis at postoperative 1 day and the last follow-up（ 7. 1° ± 2. 5°,7. 4° ± 2. 8°） was decreased significantly as compared with the preoperative（ 14. 6° ± 2. 6°）（ t = 9. 160 and 10. 018,P = 0. 000）. But at the end of the follow-up the vertebral kyphosis had no obvious change as 1 day after surgery（ t =0. 800,P = 0. 936）. The vertebral height restoration rate at the last of the follow-up（ 49. 5% ± 2. 7%） had no significant change as compared to the 1 day after operation（ 50. 0% ± 2. 6%）（ t = 0. 737,P = 0. 464）. The kyphosis correction rate at the last of the follow-up（ 50. 7% ± 6. 5%） had no significant difference as compared to the 1 day after operation（ 51. 9% ± 5. 3%）（ t = 1. 945,P = 0. 058）. No complications such as vertebral and adjacent vertebral fracture occurred during the follow-up. Conclusion PKP can be used in the treatment of osteoporotic vertebral burst fractures without neurological symptoms,which is reliable and relatively safe.
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第12期1103-1107,共5页
Chinese Journal of Minimally Invasive Surgery
基金
四川省科技厅支撑项目(编号:2015SZ0190)
国家科技支撑项目(编号:2012BAK21B01-02)
关键词
经皮椎体后凸成形术
骨质疏松
椎体爆裂骨折
Percutaneous lumbar vertebral body
Osteoporosis
Vertebral burst fracture
