摘要
目的探讨经皮后凸成形术(PKP)治疗脊柱稳定爆裂骨折的临床效果。方法对2007年11月至2012年8月北京协和医院骨科PKP临床资料数据库中225例连续病例中接受单一节段椎体PKP手术的179例患者的资料进行回顾分析。179例患者中43例(女36例,男7例)为脊柱稳定爆裂骨折(A组),136例(女108例,男28例)为椎体压缩骨折(B组)。评估A组患者的术前和术后视觉模拟疼痛评分(VAS)、Beck指数以及骨水泥渗漏和神经系统合并症;比较A组与B组VAS术后2d及3个月的缓解率、骨水泥渗漏率以及神经系统合并症。结果 A组术前VAS为5～10分,平均(8.65±0.98)分;手术椎体后凸角为11～36°,平均(20.8±5.76)°;Beck指数为0.32～0.81,平均(0.623±0.06);术后VAS为0～4分,平均(2.46±1.09);椎体后凸角为8～38°,平均(23.18±9.83)°;Beck指数为0.46～0.87,平均(0.6±0.11)。A组中16例(34.9%)出现骨水泥渗漏;1例(2%)术后5周再次外伤后出现神经症状,行后路椎管减压、内固定术。平均随访13.4个月,再发椎体骨折13例(30.2%),再次行PKP者8例(18.6%)。末次随访32例患者的VAS评分为0～4分,平均(1.49±1.18)分。A组与B组VAS评分、术后2d及3个月缓解率、骨水泥渗漏率比较差异均无统计学意义。结论对骨质疏松性脊椎稳定爆裂骨折采用PKP治疗,术后早期临床效果与治疗压缩骨折相当,骨水泥渗漏率与压缩骨折相似,但存在一定的神经损伤风险。建立更为准确的安全标准是PKP在椎体爆裂骨折中应用的关键。
Objective To evaluate the efficacy and safety of percutaneous kyphoplasty （ PKP） in the treatment of vertebral burst factures. Methods 179 patients treated with PKP were included,and divided into group A （ 43 stable vertebral burst fracture （ VBF） ,female 36,male 7） and group B （ 136 compression fractures,female 108,male 28） . The visual analog scale （ VAS） ,cobb angle of fractured vertebra and Beck index was evaluated before and 2 days and 3 months after PKP,while VAS （ before and 2 days and 3 months after PKP） ,cement leakage and neurological compromise were compared between group A and B. Results In group A,before PKP,the average visual analog scale （ VAS） was 8. 65 ± 0. 98 （ 5 ～ 10） ,and the average vertebral cobb angle was 20. 8 ± 5. 76° （ 11 ～ 36°） with the average Beck index （ 0. 623 ±0. 06） ; after PKP,VAS was 2. 46 ±1. 09 （ 0 -4） ,the vertebral cobb angle was 23. 18 ± 9. 83° （ 8-38°） and Beck index 0. 6 ± 0. 11 （ 0. 46 ～ 0. 87） . Cement leakage were found in 16 patents （ 34. 9% ） ,while 1 patient had a neurological compromise for falling again and new fracture in the same vertebra 5 weeks after PKP,and posterior decompression was then performed. At the last follow-up （ average 13. 4 mon） in group A,13 patients （ 30. 2% ） had new vertebral fracture,and another PKP was performed in 8 patients （ 18. 6% ） . No difference was found in pain relieve rate and cement leakage in 3 months after PKP. Conclusion PKP is effective in stable VBF,and equivalent efficacy and safety are found compared with compression fracture,while certain neruological risk exists. A more accurate standard in applying PKP is the key for developing this technique in VBF.
出处
《中华骨质疏松和骨矿盐疾病杂志》
2013年第2期126-131,共6页
Chinese Journal Of Osteoporosis And Bone Mineral Research
