骨质疏松性椎体骨坏死的诊断及椎体后凸成形术治疗

Determination and kyphoplasty for osteoporotic vertebral osteonecrosis

中文关键词:  骨坏死  椎体后凸成形术  骨质疏松症  椎体骨折

英文关键词:Osteonecrosis  Kyphoplasty  Osteoporosis  Vertebral fractures

中文摘要:

  【摘要】 目的：探讨骨质疏松性椎体骨坏死的初步诊断依据及其经皮球囊扩张椎体后凸成形术的疗效。方法：回顾分析2006年1月～2010年6月在我院行球囊扩张椎体后凸成形术治疗的39例骨质疏松性椎体骨坏死患者的临床资料。男17例，女22例；年龄61～80岁，平均69.4岁；腰背部疼痛病程3周～10年，平均3.2个月。术前腰椎骨密度T值为-2.69~-6.73，平均-3.17。术前均行脊柱X线片、MRI及CT检查，病变椎体为T7 1例，T9 2例，T11 5例，T12 13例，L1 9例，L2 5例，L3 3例，L4 1例。均术中抽取病变椎体内组织行病理检查证实为骨坏死。分析本组患者的临床及影像学特点，通过测量术前、术后2d与末次随访时站立位X线片上椎体前缘高度变化及VAS评分和Oswestry功能障碍指数（ODI）变化评估椎体后凸成形术的疗效。结果：术前均有腰背痛，坐起、翻身及行走等脊柱承受负荷时疼痛加重，且病程>3周。脊柱X线片上均有椎体压缩改变，25例（64%)骨坏死椎体在X线片可见椎体内裂隙征，31例(79%)骨坏死椎体在CT片上可见椎体内裂隙征，所有骨坏死椎体在MRI片上有界限清晰的信号改变区域。随访13～48个月，平均26.3个月，骨坏死椎体前缘高度由术前（31.7±11.1）%恢复至术后2d（69.4±12.7）%，差异有统计学意义（P<0.05），末次随访时为（67.2±15.5）%，与术后2d比较无统计学差异（P>0.05）。VAS评分及ODI术前分别为8.2±1.4分和（80.1±8.7）%，术后2d分别为1.8±0.6分和（25.7±8.1）%，差异均有统计学意义（P<0.05）；末次随访时分别为1.9±0.5分和（26.1±7.9）%，与术后2d比较差异均无统计学意义（P>0.05）。5例术中发生骨水泥渗漏，未出现临床症状。3例术后发生其他椎体骨折。结论：骨质疏松性椎体骨坏死根据影像学特点并结合临床特点可做出初步诊断，采用球囊扩张椎体后凸成形术治疗创伤小、安全有效。

英文摘要:

  【Abstract】 Objectives： To explore the preliminary diagnosis of osteoporotic vertebral osteonecrosis and its intervention by percutaneous balloon kyphoplasty. Methods： The clinical data of 39 patients with osteoporotic vertebral osteonecrosis treated by balloon kyphoplasty were analyzed retrospectively from January 2006 to June 2010. There were 17 males and 22 females in this study. The mean age of the patients at surgery was 69.4 years(range, 61-80 years). The back pain duration was 3.2 months(range, 3 weeks-10 years). The T value of preoperative lumbar spine bone mineral density was -2.69 to -6.73(average, -3.17). All cases received radiography, MRI and CT examination before operation. Diseased level sited in T7 in 1 case, T9 in 2 cases, T11 in 5 cases, T12 in 13 cases, L1 in 9 cases, L2 in 5 cases, L3 in 3 cases and L4 in 1 case. Biopsies were performed for final determination. The clinical and imaging characteristics of these patients were analyzed. The anterior vertebral height of diseased level was measured on a standing lateral radiograph at pre-operation, two days after operation, and at the final follow-up, respectively. Visual analog scale(VAS) and Oswestry disability index(ODI) were chosen to evaluate pain status and functional activity at the same time points. Results： All patients had back pain lasting more than three weeks before surgery. Increased spinal load would make the pain worse, such as sitting, standing or walking. Spinal vertebral compression was evidenced on X-ray films. 64%(25 cases) of vertebral osteonecrosis showed intervertebral cleft in X-ray, 79%(31cases) showed intervertebral cleft in CT. All vertebral osteonecrosis showed well-margional signal intensity in the cleft in MRI. The mean follow-up was 26.3 months(range, 13-48 months). The anterior vertebral body height restored from preoperative (31.7±11.1)% to postoperative (69.4±12.7)%, and (67.2±15.5)% at final follow-up. which showed significant improvement between preoperation and postoperation(P<0.05) while no difference between postoperation and final follow-up(P>0.05). The VAS was 8.2±1.4 at preoperation, 1.8±0.6 at two days after surgery, 1.9±0.5 at final follow-up; and the ODI was (80.1±8.7)% at preoperation, (25.7±8.1)% at two days after surgery, (26.1±7.9)% at final follow-up. There was statistically significant improvement in the VAS and ODI between post-operative assessments and the pre-operative ones(P<0.05), while no significant differences existed between postoperation and final follow-up(P>0.05). Asymptomatic bone cement leakage occurred in five cases. Onset of vertebral fracture occurred in three cases. Conclusions: Osteoporotic vertebral osteonecrosis can be initially diagnosed based on the imaging and clinical presentation. Balloon kyphoplasty is a minimally invasive, safe and effective intervention for this disease.