球囊扩张后凸椎体成形术治疗老年骨质疏松性胸腰椎爆裂骨折  

SELECTIVE TREATMENT OF AGED OSTEOPOROSIS THORACOLUMBAR VERTEBRAE BURST FRACTURE WITH BALLOON KYPHOPLASTY

作　　者：郭金库[1] 丁文元[1] 申勇[1] 李宝俊[1] 吴海龙[1] 曹来震[1] 李鹏飞[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中国修复重建外科杂志》2010年第11期1341-1344,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨选择性应用球囊扩张后凸椎体成形术治疗老年骨质疏松性胸腰椎爆裂骨折的疗效。方法回顾性分析2003年1月-2008年1月收治的符合纳入标准的36例采用球囊扩张后凸椎体成形术治疗的老年骨质疏松性胸腰椎爆裂骨折患者临床资料。其中男15例,女21例;年龄59～72岁,平均65.4岁。无明显外伤史14例,轻微外伤史19例,较剧烈外伤史3例。共40个椎体受损,其中T71个,T93个,T108个,T1210个,L19个,L27个,L42个。均表现为骨折椎体部位的局限性疼痛,无双下肢神经症状,骨密度测定均显示为骨质疏松症。术中经单侧椎弓根穿刺者31例,双侧椎弓根穿刺者5例;受损椎体注入聚甲基丙烯酸甲酯骨水泥,每个椎体注入量为(3.46±0.86)mL。术前及末次随访时行疼痛视觉模拟评分(VAS),摄X线片测定椎体前缘压缩程度、椎体后缘压缩程度、椎体矢状面移位程度。结果术中发生硬膜破裂脑脊液漏2例;术后1例腰背痛未彻底缓解,经对症治疗后治愈。36例均获随访,随访时间1.5～4.0年,平均2.3年。术后患者均未出现骨水泥渗漏,X线片示骨水泥弥散良好;无神经压迫症状,无其他并发症,椎体高度恢复满意。末次随访时VAS评分为(2.34±1.03)分,明显低于术前的(6.78±1.21)分,差异有统计学意义(P<0.05);椎体前缘压缩程度为19.80%±1.03%,明显低于术前的25.30%±2.50%,差异有统计学意义(P<0.05);术前及末次随访时椎体后缘压缩程度和椎体矢状面移位程度比较差异均无统计学意义(P>0.05)。结论以影像学评分结果为选择依据,选择性应用球囊扩张后凸椎体成形术治疗老年骨质疏松性胸腰椎爆裂骨折,影像学及临床效果均满意。Objective To evaluate the effectiveness and the value of balloon kyphoplasty in treating aged osteoporosis thoracolumbar vertebrae burst fracture.Methods Between January 2003 and January 2008,36 thoracolumbar vertebrae burst fracture patients were treated.There were 15 males and 21 females with an average age of 65.4 years（range,59-72 years）.Fourteen cases had no obvious history of trauma,19 had a history of slight trauma,and 3 had a history of severe trauma.Forty vertebral bodies were involved,including 1 T7,3 T9,8 T10,10 T12,9 L1,7 L2,and 2 L4.All patients displayed local pain and osteoporosis by bone density measurement with no neurological symptom of both lower limbs.Balloon kyphoplasty through unilateral（31 cases） or bilateral（5 cases） vertebral pedicles with polymethylmethacrylate was performed at the injection volume of（3.46 ± 0.86） mL per vertebral body.Before and after operation,the anterior height and posterior height of fractured vertebral body and the sagittal displacement were measured.Results Two cases had intraoperative cerebrospinal fluid leakage;1 case had no remission of waist-back pain and pain was released after symptomatic treatment.All 36 patients were followed up 2.3 years on average（range,1.5-4.0 years）.No cement leakage was found with good diffusion of cement on X-ray film.The restoration of the height of vertebral bodies was satisfactory without nerve compression symptoms and other complications.The Visual Analogue Score at last follow-up（2.34 ± 1.03） was significantly lower than that of preoperation（6.78 ± 1.21）,（P 0.05）.The compressive percentage of anterior height（19.80% ± 1.03%） of fractured vertebral body after operation was significantly lower than that before operation（25.30% ± 2.50%）,（P 0.05）.There was no significant difference in posterior compressive percentage and sagittal displacement between pre-and post-operation（P 0.05）.Conclusion Based on roentgenographic scores,balloon kyphoplasty is selectively used to treat aged oste

关 键 词：骨质疏松 胸腰椎 爆裂骨折 球囊扩张后凸椎体成形术 老年 

分 类 号：R687.3[医药卫生—骨科学]