局麻下单侧经皮椎体后凸成形术治疗骨质疏松性胸腰椎凹陷性骨折

摘要

目的探讨局麻下单侧经皮椎体后凸成形术治疗骨质疏松性胸腰椎凹陷性骨折的效果.方法2009年9月~2010年12月对45例骨质疏松性胸腰椎凹陷性骨折患者在局部麻醉下采用PKP治疗，观察术前、术后VAS评分；术前、术后以及术后一年椎体中央高度比和局部后凸Cobb角.结果45例患者均顺利完成手术.全部病例中1例骨水泥向上位椎间盘渗漏、1例骨水泥向椎体侧方渗漏，均未出现临床症状.患者术前、术后 VAS 评分分别为(8.32±1.07)分、(1.84±0.71)分，比较有显著性差异(<0.01).术后椎体中央高度比与术前比较明显增加(<0.05)，后凸Cobb角与术前比较无明显差异(>0.05).术后一年椎体中央高度比与术前比较仍有显著性差异(<0.05)，后凸Cobb角与术后比较无明显差异(>0.05).随访一年后，全部病例未出现伤椎再骨折和邻近椎体骨折.结论局麻下PKP治疗骨质疏松性胸腰椎凹陷性椎体骨折能迅速缓解疼痛，部分恢复椎体高度并维持治疗效果.%Objective To evaluate the clinical efficacy of unipedicular percutaneous kyphoplasty (PKP) for osteoporotic thoracolumbar concave fractures using local anesthesia. Method From September 2009 to December 2010, 45 cases with osteoporotic thoracolumbar single vertebral concave fracture underwent PKP. Preoperative and postoperative visual analog scale (VAS) scores, middle vertebral height rate and kyphosis Cobb's angle preoperatively, postoperatively and one year postoperatively were recorded and analyzed. Result All operations were performed successfully. Cement leakage into the inferior intervertebral disc occurred in 1 case and cement leakage into the paravertebral tissue occurred in 1 case. Both were asymptomatic. VAS scores preoperatively and postoperatively were (8.32±1.07) and (1.84±0.71) respectively, which showed statistically significant difference between them ( <0.01). The postoperative middle vertebral height ratio improved significantly compared with the preoperative ones ( <0.05), but there was no significant difference as for kyphosis Cobb's angle ( >0.05). There was still significant difference as for middle vertebral height ratio between the preoperative and the one year postoperative ( <0.05), and no significant difference as for kyphosis Cobb's angle be-tween the postoperative and the one year postoperative ( >0.05). No vertebrae refracture or adjacent vertebrae fracture was noted one year after operation. Conclusion Unipedicular PKP for osteoporotic thoracolumbar concave fractures using local anesthesia can relieve pain quickly, restore the height of fractured vertebrae and maintain the spinal alignment.