摘要
目的探讨改进型的椎体后凸成形术在合并真空裂隙征的骨质疏松椎体骨折治疗中的可行性和应用价值。方法回顾性分析2008年2月～2011年11月行改进型椎体后凸成形术治疗的31例伴真空裂隙征骨质疏松椎体骨折患者的临床资料。术前、术后3d、6及12个月通过站立侧位X线片测量伤椎椎体前缘、中线高度和伤椎后凸Cobb角的变化；术前、术后3d、6及12个月以视觉模拟疼痛评分（VAS）评估腰背部疼痛的程度，Oswestry功能障碍指数（ODI）评估日常活动及功能障碍程度。结果所有患者均成功接受改进型椎体后凸成形术治疗，术中1例发生椎间盘骨水泥渗漏，但无临床症状。患者均获得12个月以上的随访。随访期间无伤椎再次骨折及相邻椎体骨折的发生。术前与术后VAS评分比较差异具有显著性意义（P〈0．05），而术后3d、6及12个月VAS评分比较差异无显著性意义（P〉0．05）。ODI评分由术前的72．25±9．84改善至术后3d的27．31±6．95，比较差异具有显著性意义（P〈0．05），而且在术后6及12个月随访时ODI评分仍然不断改善。术后3d伤椎椎体前缘、中线高度和伤椎后凸Cobb角较术前显著改善，差异有统计学意义（P〈0．05）；术后12个月随访时以上影像学指数均能较好的维持，与术后3d及6个月比较差异无显著性意义（P〉0．05）。结论椎体后凸成形术是治疗伴椎体内裂隙征的骨质疏松性椎体压缩骨折的一种相对安全、有效的方法，而且通过改进技术的应用可明显降低骨水泥渗漏，减少相邻椎体骨折的发生。
Objective To evaluate the feasibility and effectiveness of modified percutaneous kyphoplasty （PKP） in the treatment of osteoporotic vertebral compression fractures combined with intravertebral clefts （IVC）. Methods Between Feb. 2008 and Nov. 2011,31 patients with ＂intravertebral clefts＂ in osteoporotic vertebral frac- tures undergoing percutaneous kyphoplasty were retrospectively reviewed. The height of anterior and middle column and the posterior convex Cobb angle of the injured spine were measured on the lateral X-ray film in standing position preoperatively and at 3 days,6 months and 12 months postoperatively. The visual analogue scale （VAS） score was used to evaluate the pain relief and the Oswestry disability index （ODI） system was used to evaluate the improve- ment of daily activity function and disability preoperatively and at 3 days ,6 months and 12 months postoperatively. Results All patients tolerated kyphoplasty successfully. One patient occurred iutradiscal cement leakage after re- ceiving kyphoplasty, but without clinical symptoms. No re-fracture of the injured vertebrae or adjacent vertebral frac- ture occurred during the follow-up. There was significant difference in the VAS score between preoperatively and postoperatively （P 〈 0. 05） , despite of no significant difference in the VAS scores at 3-day,6-month and 12-month follow-up（P 〉 0. 05）. The ODI scores varied from 72. 25 ± 9.84 preoperatively to 24. 55±5.01 postoperatively （ P 〈 0. 05 ）. This improvement in ODI scores was still present at 6-month and 12-month follow-up. Between preop- eratively and at 3 days postoperatively, there was significant difference in the height of anterior/middle column and the posterior convex Cobb angle （ P 〈 0. 05 ） , but no significant difference among 3 days postoperatively, 6 monthspostoperatively and the final follow-up（ P 〈 0. 05 ）. Conclusion The modified PKP is an effective and safe way to treat osteoporotie vertebral compression fractures combined with intravertebral clefts （IVC）. It is a good choice to prevent cement leakage and adjacent vertebral fracture.
出处
《创伤外科杂志》
2013年第6期535-538,共4页
Journal of Traumatic Surgery
