微创医学

目的探讨微创经皮球囊扩张后凸椎体成术治疗老年骨质疏松性胸腰椎压缩性骨折的疗效。方法对确诊为老年骨质疏松性胸腰椎压缩性骨折的34例患者,采用球囊扩张后凸椎体成形术进行治疗,患者均无明显外伤史,共38个椎体受损,其中单椎体损伤30人,两个椎体损伤4人,T125个、L114个、L25个、L34个、L48个、L52个。均在X线透视下行双侧椎弓根穿刺,受损椎体先用球囊扩张,然后注入聚甲基丙烯酸甲酯骨水泥,每个椎体注入量为2~6.5 mL(平均4.2 mL)。术前和末次随访时疼痛视觉模拟评分(VAS),摄X线片测定椎体前缘压缩程度、椎体后缘压缩程度、椎体矢状面移位程度。结果术中术后未发生硬膜破裂脑脊液漏;术后1例腰背痛未彻底缓解,经对症治疗后治愈。平均随访18.4个月(12~26个月)。术后患者均未出现骨水泥渗漏,X线和CT片显示骨水泥弥散良好;患者无明显神经压迫症状,椎体高度恢复满意。末次随访时VAS评分为(2.12±1.23)分,明显低于术前的(7.27±1.04)分,差异具有统计学意义(P<0.05);椎体前缘压缩程度为(18.34±1.05)%,明显低于术前的(25.92±1.51)%,差异具有统计学意义(P<0.05);术前及末次随访时椎体后缘压缩程度和椎体矢状面移位程度比较差异均无统计学意义(P>0.05)。结论依据影像学评分结果,应用球囊扩张后凸椎体成形术微创治疗老年骨质疏松性胸腰椎压缩性骨折的临床效果满意。

Objective To evaluate the effectiveness and the value of balloon kyphoplasty in treating aged osteoporotic thoracolumbar vertebrae compressed fracture． Methods Thirty-four diagnosed patients with aged osteoporotic thoracolumbar vertebrae compressed fracture were treated with bolloon kyphoplasty． All cases had no obvious history of trauma． Thirty-eight vertebral bodies were involved，with 5 located in T12，14 in L1， 5 in L2，4 in L3，8 in L4，and 2 in L5，among which，4 patients had two injured vertebral bodies． Under the guide of X ray，after puncture through bilateral vertebral pedicles and an injection of 2 ～ 6． 5 ml of polymethylmethacrylate per vertebral body，balloon kyphoplasty was performed． Before and after operation， Visual Analogue Score were evaluated，and the anterior height and posterior height of fractured vertebral body and the sagittal displacement were measured．Ｒesults No cases had cerebrospinal fluid leakage; one case had no remission of waist-back pain，but the pain was released after symptomatic treatment． All 34 patients were followed up for 18． 4 months on average ( range，12 － 26 months) ． No cement leakage was found，all with good diffusion of cement on X-ray and CT film． The restoration of the height of vertebral bodies was satisfactory， without nerve compression symptoms or other complications． The Visual Analogue Score at last follow-up ( 2． 12 ± 1． 23) was significantly lower than that of preoperation ( 7． 27 ± 1． 04) ( P ＜ 0． 05) ． The compressive percentage of anterior height ( 18． 34% ± 1． 05%) of fractured vertebral body after operation was significantly lower than that before operation ( 25． 92% ± 1． 51%) ，( P ＜ 0． 05) ． There was no significant difference in posterior compressive percentage or sagittal displacement between pre-and post-operation ( P ＞ 0． 05 ) ． Conclusion Based on roentgenographic scores，balloon kyphoplasty is effective in the treatment of aged osteoporotic thoracolumbar vertebrae compressed fracture．