摘要
目的探讨经皮球囊扩张后凸成形术（PKP）治疗合并退行性脊柱侧凸（DS）的胸腰椎骨质疏松性骨折的可行性与疗效。方法2009年3月至2010年2月应用PKP治疗20例朐腰椎骨质疏松性骨折（38个椎体）伴DS患者，男8例，女12例；年龄56-86岁，平均71．2岁。通过临床表现、X线片、磁共振成像（MRI）确定责任椎体26个。手术在C型臂X线机透视下进行，经双侧椎弓根穿刺建立工作通道，置入球囊扩张后持续透视监控下注入骨水泥强化椎体。观察患者术后症状改善、腰椎前凸和侧凸cobb成角的变化及功能恢复情况。结果20例患者均顺利完成手术，术后2d内疼痛均明显缓解，未发现并发症。20例患者术后获6-24个月（平均11个月）随访。术后3d腰椎前凸cobb角由术前平均10．6°±3．7°矫正至19．8°±3．4°，侧凸cobb角由术前平均17．5°±5．1°矫正至10．7°±2．6°，疼痛视觉模拟评分由术前平均（8．4±0．5）分减至（2．5±0．6）分，Oswestry功能障碍指数由术前平均48．6％±8．9％减至21．5％±5．2％，以上项目术前与术后3d比较差异均有统计学意义（P〈0．01）。结论术前CT三维重建确定穿刺责任椎的矢状面和冠状面倾斜角度，术中借助C型臂X线机正确定位后行PKP治疗伴DS的胸腰椎骨质疏松性骨折可行且疗效满意。治疗过程中应重视对责任椎的选择及X线的术中定位，
Objective To explore the feasibility of treating ostenporotic spinal fractures complicated with degenerative scoliosis （DS） with pereutaneous balloon kyphoplasty （PKP） in the aged patients. Methods From March 2009 to February 2010, we performed PKP for 20 aged patients with osteoporotic spinal fracture complicated with DS （38 vertebrae）. They were 8 men and 12 women, with an average age of 71.2 years （from 56 to 86 years） . MRI, X-ray and physical examination were conducted to identify 26 responsible vertebral bodies before the procedures. The pereutaneous insertion of 2 inflatable bone tamps into a fractured vertebral body was conducted transpedicularly under fluoroscopic guidance. Preoperative and post- operative complications, visual analogue scale （VAS） scores, and radiographic findings such as vertebral heights and cobb angles were recorded and analyzed. Results All the patients tolerated tile procedure well with immediate relief of back pain in 2 days. No complications occurred. They were allowed to walk next day after the procedure. There was no epidural leakage of the cement. They were followed for 6 to 24 months （average, 11 months） . The mean sagittal cobb angle improved from 10. 6° ± 3.7° preoperation to 19.8° ± 3.4° post-operation; the mean coronal cobb angle improved from preoperative 17.5°± 5. 1° to postoperative 10.7°±2.6° the mean VAS score decreased from preoperative 8.4 ± 0.5 to postoperative 2.5 ± 0. 6： the mean Oswestry score decreased from 48.6% ± 8.9% preoperatively to 21.5%± 5.2% postoperatively. There were significant differences between preoperation and postoperation （ P 〈 0. 01 ）. Conclusions PKP is feasible for the treatment of osteoporotic spinal fractures complicated with DC in the aged patients. It is im- portant to define the responsible vertebral bodies by means of preoperative three-dimensional CT reconstruction and to locate precisely with intraoperative navigation under fluoroscopic guidance.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第11期973-977,共5页
Chinese Journal of Orthopaedic Trauma
关键词
脊柱骨折
胸椎
腰椎
脊柱侧凸
椎体成形术
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Scoliosis
Vertebro- plasty
