神经导航和X线定位下球囊后凸椎体成形术治疗胸腰椎压缩性骨折

摘要

目的 分析比较神经导航辅助下和普通C臂X线定位下,经皮球囊扩张后凸椎体成形术(BKP)治疗老年骨质疏松性胸腰椎压缩性骨折的疗效.方法 回顾性分析2012年2月~2015年12月收治的38例老年骨质疏松性胸腰椎压缩性骨折的患者,随机采用神经导航定位(18例)和普通C臂X线透视定位(20例)进行BKP.其中单椎体损伤30例,两个椎体损伤8例;骨折位于T1210个,L114个,L26个,L35个,L48个,L53个.患者在神经导航定位下或X线透视下行双侧椎弓根穿刺,受损椎体先用球囊扩张,然后注入骨水泥.术前和末次随访时给患者行疼痛视觉模拟评分(VAS),摄X线片测定椎体前缘压缩程度、椎体后缘压缩程度.结果 38例患者的椎体骨水泥注入量为1.5~6.5 ml(平均4.18 ml).术后随访时间为12~36个月.神经导航组术后VAS评分为(1.62±0.93)分,低于术前的(7.67±1.94)分;椎体前缘压缩程度为(17.81±1.96)%,低于术前的(25.93±2.31)%;差异均有统计学意义(均P<0.005).X线定位组VAS评分为(1.83±1.21)分,低于术前的(8.12±0.38)分;椎体前缘压缩程度为(18.27±2.17)%,明显低于术前的(24.87±2.64)%,差异均有统计学意义(均P<0.005).结论 无论采取神经导航或普通C臂X线下定位,应用BKP治疗老年骨质疏松性胸腰椎压缩性骨折,影像学和临床都会取得满意的效果.%Objective To evaluate the effectiveness and the value of balloon kyphoplasty ( BKP) in treating aged osteoporosis thoracolumbar vertebrae burst fracture using neuronavigation and C arm X-ray.Methods The clinical data of 38 patients with thoracolumbar vertebrae burst fracture treated with the use of neuronavigation and C arm X-ray by BKP from February 2012 to December 2015,were analyzed retrospectively .46 vertebral bodies were involved,10 T12,14 L1,6 L2 ,5 L3 ,8 L4 and 3 L5 ,including 8 patients of both injured vertebral bodies .BKP through bilateral vertebral pedicles with polymethylmethacrylate was performed at the injection volume of 1.5~6.5 ml per vertebral body .Before and after operation ,the anterior height and posterior height of fractured vertebral body and the sagittal displacement were measured .Results All 38 patients were followed up 14.4 months on average ( range,12-36 months).No cement leakage was found with good diffusion of cement on X-ray film.The restoration of the height of vertebral bodies was satisfactory without nerve compression symptoms and other complications .In the Neuronavigation group and the X-ray group,the Visual Analogue Score at last follow-up (1.62 ±0.93,1.83 ±1.21) was significantly lower than that of preoperation (7.67 ±1.94,8.12 ±0.38) (all P <0.005).The compressive percentage of anterior height ( 17 .81% ±1 .96%, 18 .27% ±2 .17%) of fractured vertebral body after operation was significantly lower than that before operation (25.93%±2.31%, 24.87% ±2.64%) ( all P <0.005 ).Conclusion Based on roentgenographic scores, BKP is selectively used to treat aged osteoporosis thoracolumbar vertebrae burst fracture, and the radiographic and clinical results are satisfactory whether intraoperative neuronavigation or C arm X-ray localization.