球囊扩张椎体后凸成形术治疗多节段骨质疏松性椎体压缩骨折疗效分析

摘要

目的 探讨球囊扩张椎体后凸成形术(balloon kyphoplasty,BKP)治疗多节段骨质疏松性压缩骨折的临床疗效.方法 2008年5月-2010年1月共28例(73节)多节段骨质疏松性椎体压缩骨折患者接受BKP治疗,所有患者均借助MRI信号变化来确定责任椎体,进而采用标准BKP治疗.术后观察患椎高度、局部后凸角及疼痛视觉模拟评分(visual analogue scale,VAS)改善状况,同时记录并发症的发生情况.结果 所有患者均顺利完成手术,术中未出现脊髓神经损伤.28例患者疼痛症状均得到有效缓解.VAS由术前的(8.01±2.33)分下降为术后的(2.75±1.95)分及末次随访时的(2.92±2.25)分,手术前后比较差异均有统计学意义(P＜0.05).患椎平均高度由术前(2.4±1.4)cm 恢复至术后(3.0±1.6)cm及末次随访时的(2.9±1.8)cm(P＜0.05);局部后凸角由(31.7±10.5)°矫正到术后(25.8±9.1)°及末次随访时的(26.3±10.4)°(P＜0.05).术中共8节椎体发生骨水泥渗漏,渗漏率10.9%.随访中出现2例椎体再骨折患者,均为邻近椎体骨折,再次行BPK治疗后好转.结论 BKP作为治疗多节段骨质疏松性椎体骨折的一种微创方法,能迅速缓解疼痛,改善后凸畸形,值得推广应用.%Objective To evaluate the curative effect of balloon kyphoplasty in the treatment of multiple segments of osteoporotic vertebral compressive fractures. Methods A total of 28 patients who had multiple segments of osteoporotic vertebral compressive fractures ( OVCF ) received balloon kyphoplasty( BKP ) treatment from May 2008 to Jan 2010. All patients undertook magnetic resonance imaging before the BKP procedure. The improvement of vertebral height, Cobb's angle, visual analogue scale ( VAS ) and complications were investigated. Results All operations were successfully performed and patients had a rapid and significant improvement in back pain after BKP. The VAS was reduced from ( 8. 01 ± 2. 33 )scores preoperatively to ( 2. 75 ± 1. 95 )scores postoperatively, and ( 2. 92 ± 2. 25 )scores at final follow - up( P < 0. 05 ). Vertebral body height was significantly increased from ( 2. 4 ± 1. 4 )cm preoperatively to ( 3. 0 ±1.6 )cm postoperatively, and ( 2. 9 ±1.8 )cm at final follow - up. There was significant differences when compared with preoperatively( P < 0. 05 ). The Cobb's angle improved from ( 31. 7 ± 10. 5 )° preoperatively to ( 25. 8 ±9. 1 )° postoperatively,and ( 26. 3 ± 10. 4 )° at final follow -up( P <0. 05 ). Cement leakage occurred in 8 vertebrae,the leakage rate was 10. 9% . In the follow -up, adjacent vertebral fracture occurred in 2 patients, which recovered after an extra BKP. Conclusion As a minimally invasive method in treating multiple segments of osteoporotic compression fractures, BKP could relieve the back pain quickly and rectify the kyphosis to some extent. So it can be widely used in clinical practice.