PVP治疗中上段胸椎骨质疏松性重度椎体压缩骨折的临床效果

Surgical outcome of PVP for severe middle and upper thoracic osteoporotic vertebral compression fracture

中文关键词:  经皮椎体成形术  椎体压缩骨折  中上胸椎  骨质疏松  椎弓根入路  椎弓根外侧入路

英文关键词:Percutaneous vertebroplasty  Vertebral compression fracture  Middle and upper thoracic  Osteoporosis  Transpediclar approach  Extrapedicular approach

中文摘要:

  【摘要】 目的：探讨经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗中上段胸椎（T6以上胸椎）骨质疏松性重度椎体压缩骨折（severe vertebral compression fractures，SVCF）的临床效果。方法：回顾性分析2011年1月~2012年12月我院采用PVP治疗的12例中上段胸椎骨质疏松性SVCF患者，男4例，女8例；年龄61~83岁，平均74.5岁。骨折节段：T2 1例，T3 3例，T5 3例，T6 5例。受累节段椎体前缘平均压缩为68%（65%~72%）。腰椎骨密度T值为-3.8~-5.2，平均-4.2。术前胸背痛VAS评分为6.75±1.14分，ODI为（68.58±5.70）%，受累节段椎体前缘高度为0.96±0.09cm，受累节段椎体后凸角为18.90°±1.03°。均行PVP，其中10例采用椎弓根入路，2例采用椎弓根外侧入路，所有患者均采取双侧穿刺置管。结果：所有患者均顺利完成手术，10例经椎弓根入路的手术时间为27～51min，平均41min；2例经椎弓根外侧入路的平均手术时间为62min。术中出血量为5～16ml，平均10ml。骨水泥注入量为1.7~2.8ml，平均为2.2ml。1例术前CT显示上终板裂口的患者术后发现椎间隙骨水泥渗漏，但无不适症状，未行特殊处理。术后2d，胸背痛VAS评分为3.17±1.03分，ODI为（33.00±17.54）%，均较术前明显改善（P＜0.05）；受累节段椎体前缘高度为0.98±0.11cm，受累节段椎体后凸角为19.10°±0.99°，与术前比较无明显改善（P＞0.05）。随访6个月～1年，手术椎体未再发生骨折及塌陷，未发现相邻节段骨折。末次随访时，胸背痛VAS评分为3.75±0.85分，ODI为（32.33±17.11）%，受累节段椎体前缘高度为0.97±0.12cm，受累节段椎体后凸角为19.08°±1.00°，与术后2d比较均无统计学差异（P＞0.05）。结论：PVP治疗中上段胸椎骨质疏松性SVCF可以有效缓解胸背痛，但受累节段椎体前缘高度及后凸角恢复不显著。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcome of percutaneous vertebroplasty（PVP） for middle and upper thoracic(above T6) osteoporotic severe vertebral compression fracture(SVCF). Methods: 12 patients with painful middle and upper thoracic osteoporotic SVCF treated by PVP between January 2011 and December 2012 were analyzed retrospectively. The patients included 4 males and 8 females, with a mean age of 74.5 years(61-83 years). A total of 12 vertebrae was involved in this group including T2 in 1, T3 in 3, T5 in 3 as well as T6 in 5. The mean rate of loss of vertebral height was 68%(65%-72%). The mean T value of lumbar BMD was -4.2[(-3.8)-(-5.2)]. Before operation, VAS score of back pain was 6.75±1.14, ODI was(68.58±5.70)%, anterior height(AH) of the compressive vertebral body was 0.96±0.09cm, kyphosis angle(KA) of the compressive vertebral body was 18.90°±1.03°. Bilateral transpedicular approach was used in 10 cases and bilateral extrapedicular approach in 2 cases. Results: Surgery was performed successfully on all the patients. The mean surgical time was 41min(27-51min) for 10 cases undergoing bilateral transpedicular approach and 62 minutes for 2 cases undergoing bilateral extrapedicular approach. The mean blood loss was 10ml(5-16ml). The average volume of instilling polymethylmethacrylate(PMMA) was 2.2(1.7-2.8)ml. Disc leakage of PMMA through the superior endplate incompetence was noted in one case, which was asymptomatic and free of intervention. Two days after operation, VAS of back pain was 3.17±1.03, ODI was (33.00±17.54)%, which all showed significant differences; AH was 0.98±0.11cm, KA was 19.10°±0.99°, which showed no improvement(P＞0.05). New fracture either in diseased level or adjacent level could not be found during the follow-up(range, 6 months to 1 year). At final follow-up, VAS of back pain was 3.75±0.87. ODI was (32.33±17.11)%, AH was 0.97±0.12cm, KA was 19.08°±1.00°, which remained unchanged compared with those of two days after operation(P＞0.05). Conclusions: For middle and upper thoracic SVCF, PVP can alleviate back pain effectively and safely, however, PVP is of no effect to correct the AH and KA.