PKP低压渐进式球囊扩张复位法治疗重度骨质疏松性椎体压缩性骨折

摘要

Objective To evaluate the feasibility of balloon kyphoplasty (PKP) in the treatment of severe osteoporotic vertebral compression fractures(OVCF).Methods From July 2012 to September 2014,42 patients (57 vertebrae) with severe OVCF were selected and treated with PKP.The balloon was expanded at low pressure (the pressure was controlled at about 130 psi),and the expansion mode of the balloon was "expansion pause pressure drop and reexpansion".All patients were treated with standard anti-osteoporosis drugs.Results 42 patients were successfully completed the operation,the operation time was 27-59 min,an average of 39.3 min;bone cement injection volume was 2.8-4.7 ml,an average of 3.9 ml;bone cement leakage occurred in all cases,all of the paravertebral leakage.All patients were followed up for 21-49 months with an average of 31.2 months.3 d after operation and at the end of the follow-up,the vertebral height,Cobb angle and VAS score,SF-36 scale score were significantly improved(P＜0.05).Compared with postoperative 3 days,those indicators at the end of the follow-up had no significant changes(P＞O.05).Conclusion PKP is safe and effective in the treatment of severe OVCF with low pressure progressive balloon dilatation.%目的 探讨低压渐进式球囊扩张复位法行经皮椎体后凸成形术(PKP)治疗重度骨质疏松性椎体压缩性骨折(OVCF)的可行性.方法 自2012-07-2014-09,选择42例(57椎)重度OVCF患者,均行PKP手术治疗.术中球囊在低压下扩张复位(压力控制在130 psi左右),其扩张模式为“扩张-停顿-压力下降后-再扩张”的渐进方式,复位满意后缓缓填充拉丝期骨水泥.术后均予以规范的抗骨质疏松药物治疗.结果 42例患者均顺利完成手术,手术时间为27-59 min,平均39.3 min;骨水泥注入量为2.8-4.7 ml,平均3.9 ml;4例出现骨水泥渗漏,均为椎旁渗漏.所有患者获得随访21-49个月,平均31.2个月.术后3d与末次随访时,其伤椎高度、Cobb角及VAS评分、SF-36生活量表评分,均较术前有显著性改善(P＜0.05);末次随访时与术后3d对比,上述指标未见明显改变(P＞0.05).结论 低压渐进式球囊扩张复位PKP技术治疗重度OVCF安全,复位满意,疗效肯定.