球囊二次扩张椎体后凸成形术治疗脊柱压缩性骨折  

The application of double balloon dilation in percutaneous kyphonplasty to vertebral compression fractures

作　　者：杨铁军[1] 周君琳[1] 田庆显[1] 刘清河[1] 陆铁[1] 赵会[1] 李一汉[1] 单磊[1] 刘洋[1] 

机构地区：[1]首都医科大学北京朝阳医院骨科,100020

出　　处：《中华骨科杂志》2016年第2期88-95,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨经皮穿刺球囊椎体内移动、二次撑开扩张椎体后凸成形术治疗脊柱压缩性骨折的可行性及临床疗效。方法收集2009年1月至2013年7月采取经皮穿刺、球囊撑开扩张椎体后凸成形术治疗脊柱压缩性骨折患者84例（94个椎体），均为受伤或出现明显腰痛〈1个月，伴有局部压痛、叩击痛，腰部活动受限。随机分为二次撑开扩张组及单次扩张组。44例（49个椎体）二次撑开扩张组在施行经皮单侧椎弓根穿刺、球囊扩张椎体后凸成形术，第一次撑开扩张后，使球囊在椎体内移动，行二次加压撑开扩张，灌注骨水泥椎体成形。单次扩张组40例（45个椎体）常规进行单侧经皮穿刺球囊扩张椎体后凸成形术。记录手术时间、出血量、骨水泥注入量，采用视觉模拟评分（visual arialogue scale，VAS）、椎体前缘高度、椎体后凸Cobb角评价疗效。结果84例患者均完成手术，随访时间18-24个月，平均22个月。二次撑开扩张组平均手术时间48min，出血量8-15ml，每椎骨水泥注入量平均5．1ml，无一例骨水泥外溢或尾影形成。单次撑开组平均手术时间44min，骨水泥平均注入量3．2ml，出血量10-15ml；出现骨水泥前方或侧方外溢2例，1例椎弓根内形成尾影。二次撑开组术前VAS评分8．5分，术后2．9分；椎体高度术前2．1cm，末次随访2．8cm；Cobb角度术前33°，末次随访20°。单次撑开组术后疼痛缓解满意，椎体高度术前2．0cm，末次随访2．4cm；Cobb角度术前32°，末次随访27°。两组末次随访的VAS评分、手术时间及出血量，差异无统计学意义，而两组平均骨水泥注入量、末次随访椎体前缘高度、Cobb角度改善差异有统计学意义。单次撑开组患者2例出现骨水泥外溢及渗漏，1例骨水泥尾影形成，并发症发生率5．6％。结论球囊在骨折椎体内移动进行二次撑开扩张，可使骨折复位有所改善，Objective To evaluate the clinical effectiveness of double balloon dilation in percutaneous kyphonplasty on curing vertebral-compression fractures. Methods From January 2009 to September 2013, 84 patients （94 vertebral bodies） with vertebral compression were treated by percutaneous kyphonplasty. All were fresh fractures and were injured or obvious low back pain 1 month, accompanied by local tenderness, kowtow attack painful, lumbar mobility, but no lower extremity injury numbness, activities and defecation disorders. After randomization, the double balloon dilation in percutaneous kyphonplasty method was used to treat 44 patients （49 vertebrae）. In the process of performing percutaneous unilateral pedicle puncture and balloon dilata- tion of the vertebral body, the balloon has been moved some distance in the vertebral body. Then completed the perfusion of bone cement, vertebral body forming. 40 cases （45 vertebrae） were used conventional unilateral percutaneous kyphonplasty to vertebral compression fractures. Recorded the operation time, amount of bleeding, bone-cement injection volume. Used visual analogue scale （VAS）, the height of the vertebral body and Cobb angle to evaluated the curative effect. Results All 84 patients completed the operation, follow-up time was 22 months （18-24 months）. In two mobile open expansion group, the operation time was about 48 min. The amount of bleeding was 8-15 ml. The average bone-cement injection volume was 5.1 ml. No patients quit the study and no bone cement-leakage cases or other side effects were observed, and no clinical accidents occurred. In a single stretching group, 40 cases （45 vertebrae） completed conventional vertebroplasty, the time of 44 min, bone cement average injection rate 3.2 ml, bleeding 10-15 ml. In two mobile open expansion group, the VAS score was 8.5 points, the height of the vertebral body height was 2.1cm, and the Cobb angle was 34°. After operation, the VAS score 2.9 points, the height of the vertebral body 2.8 cm, and Cobb 2

关 键 词：脊柱骨折 椎体后凸成形术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]