PKP治疗不同骨密度椎体压缩骨折的手术疗效分析

Surgical outcome of percutaneous kyphoplasty for vertebral compression fracture with different bone mineral density

中文关键词:  经皮椎体后凸成形术  骨密度  椎体压缩骨折  临床疗效

英文关键词:Percutaneous kyphoplasty  Bone mineral density  Vertebral compression fractures  Clinical therapeutic

中文摘要:

  【摘要】 目的：观察经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗不同骨密度椎体压缩骨折的临床疗效。方法：回顾性分析2008年3月～2009年11月在我院行PKP治疗的76例单节段中老年椎体压缩骨折患者的临床资料，其中男32例，女44例，年龄50～81岁。应用双能X线吸收法（DEXA）测定腰椎（L2～L4）骨密度值，根据骨密度T值大小将其分为骨质疏松组（A组，33例）、骨量减少组（B组，26例）和骨质正常组（C组，17例），每组均采用标准的PKP手术治疗，术后对患者进行VAS评分、Oswesty功能障碍指数（ODI）评定，并观察各组患者伤椎椎体高度恢复和并发症发生情况。结果：患者疼痛均得到迅速缓解，未发生脊髓神经损伤及球囊破裂。术后随访1.5～2.7年，平均2.1年。三组术后3d及末次随访时VAS、ODI评分均较术前明显降低（P＜0.05），组间比较差异无显著性（P＞0.05）。伤椎椎体平均高度A组术前为15.7±3.2mm，术后为23.1±5.7mm；B组术前为16.3±3.9mm，术后为22.5±4.8mm；C组术前为15.9±3.0mm，术后为21.8±5.2mm，差异均有统计学意义（P＜0.05）。局部后凸角A组术前为24.7°±7.1°，术后为17.8°±5.9°；B组术前为23.5°±6.2°，术后为18.2°±6.5°；C组术前为24.1°±5.6°，术后为18.0°±5.8°，与术前比较均有显著性差异（P＜0.05）。A组椎体高度恢复率为65.3%，B组为57.9%，C组为54.2%，组间比较差异具有显著性（P＜0.05）。A组1例患者发生骨水泥肺栓塞，经及时抗凝治疗后症状缓解。A组骨水泥渗漏率为6.06%，B组为11.54%，C组为17.65%，组间比较差异无统计学意义（P＞0.05）。随访中有2例患者发生邻近椎体骨折，均发生于骨密度最低的A组。结论：PKP对不同骨密度的椎体压缩骨折患者均有良好的疼痛缓解作用，骨密度较低者椎体高度及后凸角度恢复更理想，但合并有骨质疏松症者需注意邻近椎体骨折的发生。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical variation of percutaneous kyphoplasty(PKP) in treating vertebral compression fracture with different bone mineral density(BMD). Methods: Between March 2008 and November 2009, 76 patients (32 males and 44 females, average age: 63.1 years, range: 50-81 years) suffering from single level of vertebral compression fracture and undergoing PKP in our institute were retrospectively reviewed. The bone mineral density of lumbar was measured by dual-energy X-ray absorptiometry. According to the T-score, the patients were divided into 3 groups: group A(osteoporosis group, 33 cases), group B (bone loss group, 26 cases) and group C (normal bone group, 17 cases). The visual analogue scale(VAS), Oswesty disability index (ODI), vertebral height restoration and complications were used to evaluate the surgical outcome. Results: All patients reached quick back pain relief without neurological deficit and instrument failure. All patients had a follow-up of 1.5-2.7 years. Compared with pre-operation, the VAS score and ODI decreased significantly at 3 days after operation and final follow-up in 3 groups(P＜0.05), but no inter-group significant difference was noted(P＞0.05). When comparing the index of vertebral average height and local Cobb′s angle pre- and post-operation, each group had a significant recovery(P＜0.05). Group A had a higher striking vertebral height restoration rate(65.3%) than group B(57.9%) and C(54.2%) (P＜0.05). A total of 8 patients had bone cement leakage during operation, that 2 in group A(6.06%), 3 in group B(11.54%) and 3 in group C(17.65%), there was no statistical difference among the 3 groups at cement leakage rate. One patient was complicated with pulmonary embolism due to cement leakage in group A, which was resolved after correspondent intervention. During the follow-up, 2 adjacent vertebral fractures were found in group A, both of them recovered after an extra PKP treatment. Conclusions: PKP can provide an effective and safe therapeutic effect for vertebral compression fracture with different bone mineral density. Patients who have a lower BMD will get a better vertebral height restoration and Cobb′s angle rectification. However, patients who have the complication of osteoporosis should pay more attention to the adjacent vertebral fracture after the PKP procedure.