刘法敬,杜 伟,申 勇,丁文元,王林峰,杨大龙.PKP治疗不同骨密度椎体压缩骨折的手术疗效分析[J].中国脊柱脊髓杂志,2012,(4):324-329. |
PKP治疗不同骨密度椎体压缩骨折的手术疗效分析 |
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 |
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。 |
Surgical outcome of percutaneous kyphoplasty for vertebral compression fracture with different bone mineral density |
英文关键词:Percutaneous kyphoplasty Bone mineral density Vertebral compression fractures Clinical therapeutic |
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. |
投稿时间:2011-11-20 修订日期:2012-02-24 |
DOI:10.3969/j.issn.1004-406X.2012.4.324.5 |
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