PKP治疗不同骨密度椎体压缩骨折的手术疗效分析  

Surgical outcome of percutaneous kyphoplasty for vertebral compression fracture with different bone mineral density

作　　者：刘法敬[1] 杜伟[1] 申勇[1] 丁文元[1] 王林峰[1] 杨大龙[1] 

机构地区：[1]河北医科大学第三医院,河北省石家庄市050051

出　　处：《中国脊柱脊髓杂志》2012年第4期324-329,共6页Chinese Journal of Spine and Spinal Cord

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。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 reeovered after an extra PKP treatmen

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 

分 类 号：R681.5[医药卫生—骨科学]