经皮椎体后凸成形术治疗创伤性胸腰椎椎体压缩性骨折的近期疗效观察

The short-term outcome of percutaneous kyphoplasty for traumatic thoracolumbar vertebral compression fractures

中文关键词:  椎体后凸成形术  椎体压缩性骨折  创伤性

英文关键词:Kyphoplasty  Vertebral compression fracture  Traumatic

中文摘要:

  【摘要】　目的：观察经皮椎体后凸成形术（PKP）治疗50岁以上创伤性胸腰椎椎体压缩性骨折患者的近期疗效。方法：2006年10月～2008年10月收治创伤性胸腰椎椎体压缩性骨折患者36例，男11例，女25例，年龄50～61岁，平均54.5岁，累及T11～L2共36个椎体。均在C型臂X线机引导下行经皮椎体后凸成形术，椎体填充物均应用MIIGX3人工骨。采用疼痛视觉类比评分（VAS）、止痛药使用评分、伤椎高度及胸腰椎后凸角度等指标评估PKP术的近期疗效。结果：所有患者均顺利完成手术，手术时间平均32.5min/椎，出血量平均38.5ml/椎，MIIGX3填充量平均5.0ml/椎，无肺栓塞、MIIGX3渗漏等并发症发生。随访6个月～2年6个月。术前VAS评分平均8.5±0.8分，术后2d时降低到2.2±0.8分，末次随访时为2.5±0.8分；止痛药使用评分由术前的1.8±0.6分下降到术后2d的0.2±0.6分，末次随访时为0.3±0.5分；伤椎椎体前、中柱高度分别由术前的21.5±3.1mm、20.3±2.9mm，改善到术后2d的24.6±2.8mm、24.3±2.1mm，末次随访时为24.4±2.6mm、24.1±2.5mm；脊柱后凸Cobb角术前18.5°±4.5°，术后2d改善为13.5°±3.5°，末次随访时为14.0°±4.5°。各指标术后及末次随访时与术前比较均有显著性差异（P<0.01）。影像学复查示术后MIIGX3充填均匀，术后3个月时已基本吸收，为自体松质骨替代。结论：PKP治疗创伤性胸腰椎椎体压缩性骨折是一种安全、复位可靠、止痛效果确切的微创脊柱外科技术。

英文摘要:

  【Abstract】　Objective：To evaluate the short-term outcome of percutaneous kyphoplasty for traumatic thoracolumbar vertebral compression fractures.Method：A total of 36 vertebras from 36 cases（11 males and 25 females） with the mean age of 54.5 years old（range，50 to 61 years old） suffering from traumatic thoracolumbar vertebral compression fractures experienced percutaneous kyphoplasty under fluorescence.Each fractured vertebra was filled with MIIGX3 artificial bone.The clinical outcome was evaluated by visual analog scale（VAS） and other parameters including use of pain-killer scale，the Cobb′s angle and the height of vertebral bodies.Result：All surgery were completed successfully，mean operative time was 32.5min/vertebrae，mean bleeding was 38.5min/vertebra，mean filling amount of MIIGX3 was 5.0ml/vertebrae，without pulmonary embolism，MIIGX3 leakage and other complication occurred.Each patient had back pain relieved postoperatively.The followed up was 6 months to 30 months.The VAS score improved from preoperative 8.5±0.8 to postoperative 2.2±0.8 and 2.5±0.8 for final follow up（P<0.01）.The use of pain-killer scale improved from preoperative 1.8±0.6 to postoperative 0.2±0.6 and 0.3±0.5 for final follow up（P<0.01）.The mean height of the anterior vertebral body increased from preoperative 21.5±3.1mm to postoperative 24.6±2.8mm and 24.4±2.6mm for final follow-up（P<0.01）.The median vertebral body increased from 20.3±2.9mm to 24.3±2.1mm，and 24.1±2.5mm for final follow-up（P<0.01）.The mean Cobb′s angle for kyphosis increased from 18.5°±4.5° to 13.5°±3.5°，and 14.0°±4.5° for final follow-up（P<0.01）.After 3 months follow-up，all 36 cases regained routine daily activity.Conclusion：Kyphoplasty as a reliable treatment for traumatic thoracolumbar vertebral compression fracture has the advantage of vertebra height restoration and definite pain relief.