经皮椎体成形术治疗椎体压缩性骨折骨不连的临床随访研究

摘要

目的 探讨经皮椎体成形术或经皮椎体后凸成形术治疗椎体压缩性骨折骨不连术后至少2年的随访的影像学及临床疗效评估.方法 回顾分析2012-06-2013-12我院行PKP或PVP治疗并完成随访的44例椎体压缩性骨折骨不连患者.通过对患者后凸角(Cobb角)、椎体前后缘高度比、疼痛视觉模拟量表(visual analogure scale,VAS)评分及功能障碍指数(Oswestrydisability index,ODI)的变化评定手术疗效.结果 随访24-35个月,平均28.3个月.术后椎体的高度和后凸角度得到了很好的纠正.但是,随访发现恢复高度的椎体进行性的压缩(P＜0.05)和后凸角度的再加重(P＜0.05).术后患者的VAS和ODI评分均得到了不同程度的降低.但是在术后的2年均有增加.结论 椎体压缩性骨折骨不连的患者椎体内存在真空、假关节、或椎体内的水征现象,椎体成形术可能不能提供足够的稳定性和长时间维持稳定.术后存在进行性的椎体压缩现象.因此,笔者强烈推荐对PKP或PVP手术后的患者应进行长期随访,观察PKP或PVP的更远期疗效.%Objective To assess for at least 2 years the radiological and clinical outcomes of patients who underwent the treatment of percutaneous verteboplasty or percutaneous balloon kyphoplasty to treat nonunion of vertebral compression fractures.Methods All of 44 patients with nonunion of vertebral compression fractures in Xi'an Honghui Hospital from June 2012 to December 2013 were selected.We based on anterior trailing edge height ratio,kyphotic angle,visual analogue scale score and Oswestry disability index (ODI),to evaluate the surgical curative effect.Results The patients were followed up 24-35 months,an average of 28.3 months.The vertebral body height and Cobb angle were corrected significantly after PKP/PVP.However,the restored vertebral height recollapsed (P＜0.05),and the kyphotic angle became aggravated (P＜0.05) during the 2 years or longer of postoperative follow-up.Compared with preoperation,all patients had a good VAS and ODI postoperation.But the VAS and ODI at postoperative 2 years increased.Conclusion We should observe the long-term curative effect for nonunion of vertebral compression fractures who accepted PKP and PVP.