三点穿刺法结合可控方向球囊技术经皮椎体后凸成形术治疗胸腰椎骨质疏松性压缩骨折

摘要

Objective To investigate the clinical efficacy of three-point puncture combined with controllable balloon percutaneous kyphoplasty (PKP) for treatment of osteoporotic vertebral compression fracture (OVCF).Methods From December 2010 to November 2013,37 OVCF patients with 43 fractured vertebrae were treated with three-point puncture combined with controllable balloon PKP.They were 11 males and 26 females,aged from 56 to 95 years (average 67 years).Clinical efficacy was evaluated and compared by visual analogue scale (VAS) scores and cobb angles in their X-ray films at preoperation,3 days postoperation and final follow-up visit.Results All the PKP operations were successful.The operation time ranged from 25 to 80 minutes (average,40 minutes).The cement injected into each vertebra was from 3 to 4.5 mL (average,3.8 mL).The cement was well distributed in the vertebrae without such complications as nerve injury or cement leakage into the spinal canal.Thirty-six patients with 42 fractured vertebrae were followed up for 3 to 35 months (average,11 months).At 3 days postoperation and final follow-up,the VAS scores were respectively 2.3 ± 0.3 and 1.9 ± 0.2 and the cobb angles were respectively 7.8° ± 0.7° and 8.7° ± 0.8°,significantly improved than those at preoperation (6.9 ± 0.8 and 18.5° ± 6.0°) (P ＜ 0.05).There were no significant differences in VAS score or cobb angle between 3 days postoperation and the final follow-up (P ＞ 0.05).Conclusion Three-point puncture combined with controllable balloon PKP is an efficient treatment for thoracolumbar OVCF.%目的 探讨采用三点穿刺法结合可控方向球囊技术经皮椎体后凸成形术(PKP)治疗胸腰椎骨质疏松性椎体压缩性骨折(OVCF)的手术技巧及临床疗效. 方法 2010年12月至2013年11月对37例(43个伤椎)胸腰椎OVCF患者采用术中三点穿刺法结合可控方向球囊技术经单侧椎弓根行PKP治疗,男11例,女26例;年龄56 ～ 95岁,平均67岁.通过比较术前、术后3d及未次随访时视觉模拟评分(VAS)和cobb角评价临床疗效. 结果 所有患者均顺利完成手术,手术时间25～ 80min,平均40 min;每个椎体注入骨水泥3.0～4.5 mL,平均3.8 mL,未出现神经损伤、骨水泥椎管内渗漏等并发症.36例42椎术后获3 ～ 35个月(平均11个月)随访.术后3d和未次随访时的VAS评分[(2.3±0.3)分和(1.9±0.2)分]和cobb角[(7.8°±0.7°)、(8.7°±0.8°)]较术前[(6.9±0.8)分和18.5°±6.0°]改善,差异均有统计学意义(P＜0.05),而术后3 d VAS评分和cobb角与末次随访时比较差异均无统计学意义(P＞0.05). 结论 采用三点穿刺法结合可控方向球囊技术PKP治疗胸腰椎OVCF是一种有效的方法.