摘要
[目的]探讨椎体后凸成形术治疗无神经症状的骨质疏松性胸腰段爆裂性骨折的可行性及其疗效。[方法]椎体后凸成形术试行治疗25例无神经症状的骨质疏松性胸腰段爆裂性骨折(Margel分型属A3型)。术中采用骨水泥分次灌注及C型臂X线机动态观察技术。术前、术后及术后12个月时采用疼痛视觉模拟评分(visual analogscore,VAS)评估疼痛程度、Oswsetry功能障碍指数(oswsetry disability index,ODI)评估患者日常生活功能。并测量术前、术后及12个月时骨折椎体前缘高度、中部高度、Cobb角及椎管内骨块占位比例。[结果]术后患者症状迅速缓解,无神经损伤的并发症发生。4例患者少量骨水泥渗漏且无症状性并发症。患者VAS评分由术前8.2分降为术后2.8分(P<0.05),术后12个月随访时维持在3.0分。ODI评分由术前的68.2%±6.6%改善为术后的35.3%±2.8%,术后12个月随访时仍能维持。椎体前缘高度从61.5%±13.9%纠正为术后的85.3%±10.6%(P<0.05),中部高度由73.0%±19.3%纠正为83.3%±7.4%。Cobb角由术前的21.7°±7.8°改善为8.6°±6.6°。随访时椎体高度及Cobb角未见明显丢失。椎管内骨块占位率术前为20.1%±4.1%,而术后为17.8%±1.3%(P>0.05)。[结论]椎体后凸成形术治疗无神经症状的骨质疏松性胸腰段爆裂性骨折是可行的,其疗效是满意的。骨水泥分次灌注及C型臂X线机动态观察技术可能有助于避免或减少骨水泥渗漏。
[Objective]To explore the feasibility and clinical outcome of kyphoplasty in the treatment of painful osteoporotic thoracolumbar burst fractures without neurological deficit.[Method]A total of 25 patients with painful osteoporotic thoracolumbar burst fractures（type-A3） without neurological deficit were treated by kyphoplasty.During kyphoplasty,modified techniques including staged bone cement injection and dynamic fluoroscopic monitoring were used.Pain was measured using self-reporting visual analogue pain scale（VAS） preoperatively,postoperatively and at 12-month follow-up.Disability was measured using the Oswestry disability questionnaire（ODI） preoperatively,postoperatively and at 12-month follow-up.The height of the compromised vertebral body,the kyphotic angle and the spinal canal compromise were measured preoperatively,postoperatively and at 6-month follow-up.[Result]Operations were completed smoothly,with exception of 4 patients with less cement leakage but with no clinical symptom.Pain relief was achieved within 24 hours postoperatively.Mean VAS score in these patients decreased from 8.2±1.3 pre-operatively to 2.8±0.8 post-operatively（P0.05）,and it improved further to 3.0±1.2 at 12-month follow-up.The ODI score varied from 68.2%±6.6% pre-operatively to 35.3%±2.8% post-operatively（P0.05）.Improvement was maintained at 12-month follow-up.After operation,the height of anterior vertebrae（Ha） were restored from 61.5%±13.9% to 85.3%±10.6%,the height of midline vertebrae（Hm）from 73.0%±19.3% to 83.3%±7.4%,the kyphotic angle from 21.7°±7.8° to 8.6°±6.6° and the spinal canal compromise from 20.1%±4.1% to 17.8%±1.3%.At 12-month follow-up,maintenance of the height restoration and kyphotic deformity correction was found.The spinal canal compromise had no statistical significant difference pre-and post-operatively.[Conclusion]Kyphoplasty is a relatively safe and effective method for the treatment of painful osteoporotic thoracolumbar burst fractures without neurological deficit.Modified techniques including staged bone cement injection and dynamic fluoroscopic monitoring may help to avoid or reduce cement leakage.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第22期1873-1876,共4页
Orthopedic Journal of China
基金
卫生部公益性行业专项基金(编号:200802152
201002018)
江苏省临床医学中心(编号:LG200601)
