[1]孙育良①,熊小明**,何本祥①,等.经皮椎体后凸成形术治疗骨质疏松性椎体爆裂骨折[J].中国微创外科杂志,2016,16(12):1103-1107.
　Sun Yuliang,Xiong Xiaoming*,He Benxiang,et al.Percutaneous Kyphoplasty for Osteoporotic Vertebral Burst Fractures[J].Chinese Journal of Minimally Invasive Surgery,2016,16(12):1103-1107.
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经皮椎体后凸成形术治疗骨质疏松性椎体爆裂骨折()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
16
期数:
2016年12期
页码:
1103-1107
栏目:
临床研究
出版日期:
2016-12-20

文章信息/Info

Title:
Percutaneous Kyphoplasty for Osteoporotic Vertebral Burst Fractures
作者:
孙育良①; 熊小明**; 何本祥①; 宋偲茂; 邓轩赓; 万趸; 石华刚
四川省骨科医院脊柱科，成都610041
Author(s):
Sun Yuliang;  Xiong Xiaoming*;  He Benxiang;  et al.
*Department of Spine Surgery, Sichuan Province Orthopedics Hospital, Chengdu 610041, China
关键词:
经皮椎体后凸成形术; 骨质疏松; 椎体爆裂骨折
Keywords:
Percutaneous lumbar vertebral body; Osteoporosis; Vertebral burst fracture
文献标志码:
A
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。
Abstract:
ObjectiveTo investigate the clinical efficacy and safety of percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral burst fractures without neurological symptoms. MethodsA 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.ResultsAll 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 1 day 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 and 30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.ConclusionPKP can be used in the treatment of osteoporotic vertebral burst fractures without neurological symptoms, which is reliable and relatively safe.

参考文献/References:

[1]周毅，海涌，苏庆军,等.椎体后凸成形术治疗骨质疏松椎体压缩性骨折疗效分析.中国骨质疏松杂志，2012,18(5):429-433.
[2]McConnell CT,Wippold FJ,Ray CE,et al.ACR appropriateness criteria management of vertebral compression fractures.J Am Coll Radiol,2014,11(8):757-763.
[3]Bouza C,López-Cuadrado T,Almendro N,et al.Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe: a meta-analysis of randomized controlled trials.Eur Spine J,2015,24(4):715-723.
[4]Walter J,Haciyakupoglu E,Waschke A,et al.Cement leakage as a possible complication of balloon kyphoplasty is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)? Acta Neurochir,2012,154(2):313-319．
[5]Krappinger D,Kastenberger TJ,Schmid R.Augmented posterior Instrumentation for the treatment of osteoporotic vertebral body fractures.Opertive Orthop Traumat,2012,24(1):4-12.
[6]Robinson Y,Heyde CE,Forsth P,et al.Kyphoplasty in osteoporotic vertebral compression fractures:guidelines and technical considerations.J Orthop Surg Res,2011,6:43-50.
[7]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年).中华骨质疏松和骨矿盐疾病杂志，2011,4(1):2-17.
[8]熊小明，宋偲茂，万趸，等.CT影像数据指导单侧入路经皮椎体后凸成形术治疗椎体压缩性骨折.中国矫形外科杂志，2012,20(22):2035-2038.
[9]谢晓明，肖建军，罗锡勇.关节镜手术为主综合治疗膝关节骨性关节炎临床分析.中国现代医生，2013,51(16):143-146.
[10]刘臻，邱勇.Oswestry功能障碍指数在腰痛患者中的国际化应用现状.中国脊柱脊髓杂志，2008,18(7):550-553.
[11]顾宇彤，姜晓幸，董健，等.经伤椎微创椎弓根钉内固定术治疗胸腰椎爆裂性骨折.中国骨与关节外科，2014,7(5):408-411.
[12]顾宇彤，梁朝革，张亮，等.微创椎弓根钉内固定联合磷酸钙骨水泥椎体成形术治疗胸腰椎爆裂性骨折.中国临床医学,2015,22(2):181-185.
[13]Papanastassiou ID,Phillips FM,Van Meirhaeghe J,et al.Comparing effects of phoplasty vertebroplasty,and non-surgical management in a systematic review of randomized and non-randomized controlled studies.Eur Spine J,2012,21(9):1826-1843.
[14]董双海，田纪伟，王雷，等.应用经皮椎体成形术及经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折.中华创伤杂志，2011,27(3):236-240.
[15]陈亮，杨惠林，唐天驷,等.椎体后凸成形术骨水泥椎间隙内渗漏的随访分析.中华骨科杂志，2008,28(12):1015-1018.
[16]Lin EP,Ekholm S,Hiwatashi A,et al.Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.Am J Neuroradiol,2004,25(2):175-180.
[17]Yang H,Pan J,Sun Z,et al.Percutaneous augmented Instrumentation of unstable thoracolumbar burst fractures:our experience in preventing cement leakage.Eur Spine J,2012,21:1410-1412．
[18]Gill GB,Kuper M,Chin PC,et al.Comparing pain reduction following kyphoplasty and verteroplasty for osteoporotic vertebral compression fractures.Pain Physician,2007,10(4):583-590.
[19]吕振华，杨中华，崔青，等.小剂量骨水泥椎体成形术治疗骨质疏松伴椎体压缩性骨折.中国矫形外科杂志，2010，18(12):1043-1044.
[20]王磊升，吕世桥，谭江威，等.单侧经皮椎体后凸成形术治疗有“真空裂隙征”的骨质疏松椎体骨折.中国微创外科杂志，2011,11(4):338-341．
[21]Oh T,Scheer JK,Fakurnejad S,et al.Minimally invasive spinal surgery for the treatment of traumatic thoracolumbar burst fractures.J Clin Neurosci,2015,22(1):42-47.
[22]卢公标，李咸周，杜琳，等.经皮椎体后凸成形术治疗原发骨质疏松性胸腰段椎体爆裂骨折的临床疗效观察.中国微创外科杂志,2015,15(1):50-53.

备注/Memo

备注/Memo:
基金项目：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））**通讯作者，E-mail：2841710476@qq.com①（成都体育学院，成都610041）
更新日期/Last Update: 2017-03-09