一期经皮穿刺单个球囊多次扩张经皮椎体后凸成形术  

One-stage single balloon multiple expansions percutaneous kyphoplasty:report of 18 cases

作　　者：郑召民[1] 邝冠明[1] 董智勇[1] 李佛保[1] 吕游[1] 陈辉[1] 刘辉[1] 张奎渤[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510080

出　　处：《中华医学杂志》2007年第9期580-584,共5页National Medical Journal of China

摘　　要：目的探讨一期经皮穿刺单个球囊多次扩张经皮椎体后凸成形术(PKP)治疗骨质疏松性脊柱压缩骨折和椎体肿瘤的疗效和安全性。方法采用单个球囊一期多次扩张行 PKP 治疗多发性疼痛性椎体病变18例45椎,年龄平均68.77岁。其中骨质疏松性脊柱压缩骨折11例29椎,椎体转移肿瘤2例4椎,多发性骨髓瘤5例12椎。监测术中患者生命体征,分析患者术后疼痛缓解、日常生活功能恢复情况以及对手术满意程度等。比较手术前后椎体高度和后凸角(Cobb 角)。结果患者均安全完成手术。手术时间55～127 min,平均29.3 min/椎。术中球囊扩张的压力为87～210Psi,平均为165 Psi;扩张体积为1.5～4 ml,平均3.25 ml;扩张次数为2～5次,平均2.94次,1例球囊在第5次扩张时破裂,1例球囊在第3次扩张时破裂。骨水泥注射量为2～8.5 ml,平均3.95 ml/椎。1例1椎出现椎管内少量渗漏,1例2椎出现椎旁渗漏,均无症状。患者 VAS 由术前(8.00±0.97)分降低到术后的(3.28±0.75)分;ODI 评分由术前平均的72.8%降低到29.5%。椎体前缘高度和中线高度明显恢复,Cobb 角改善。术后随访6～18个月,平均12.3个月,受防患者的疼痛缓解效果均得到稳定的维持,日常生活能力改善,未见手术椎体再塌陷或手术临近椎体骨折发生。结论一期经皮穿刺单个球囊多次扩张经皮椎体后凸成形术治疗多发性骨质疏松性脊柱压缩骨折和多发性椎体肿瘤的经济、安全、有效。Objective To observe the effect and safety of one-stage single balloon multiple expansions percutaneous kyphoplasty （PKP） in treatment of osteoporotic vertebral compressive fracture （OVCF） and spinal tumor. Methods One-stage single balloon multiple expansions PKP was performed on 18 patients, 5 males and 13 females, aged 68.77 （44 - 80） , with 45 vertebrae, including 11 case of OVCF （with 29 diseased vertebrae） , 11 cases of multiple vertebral fracture （with 19 diseased vertebrae） , 5 cases of multiple myeloma （with 12 diseased vertebrae）, and 2 case of spinal metastatic tumor （with 4 diseased vertebrae）, the vital signs were record during operation. Pain rehef and functional recovery were evaluated with visual analogue pain scale （VAS） and Oswestry disability index （ODI） scaling, and restoration of vertebral height and Cobb angle were evaluated by X-ray examination. Follow-up was conducted by telephone survey or clinic consults for 12.3 months （6 - 18 months）. Results Operation was successfully performed on all patients with an operative time of 29.3 min （55 - 127 min） per vertebra. The average pressure of the balloon expansion was 165 Psi （87 - 210 Psi） , and the average balloon expanded volume was 3.25 ml （1.5 -4 ml）. A balloon was expanded 2 -5 times in one operation with the average of 2.94 expanded times. The bone cement volume injected was 3.95 ml （2 - 8.5 ml） per vertebra. Epidural cement leakage was seen in 1 vertebra in 1 case and paraspinal leakage was seen in two vertebrae in 1 case. The VAS and ODI scoring of these patients were both decreased significantly after operation. Both the anterior height and midline height of vertebrae were significantly improved. The pain relief and functional recovery were substantial and maintained to the last follow-up without any re-collapse or adjacent level fracture. Conclusion one-stage single balloon multiple expansions PKP is effective, economic and safe in treatment of multi-level OVCF and spinal tumor.

关 键 词：脊柱骨折 骨质疏松 骨肿瘤 

分 类 号：R687.3[医药卫生—骨科学]