分步筑墙PKP治疗胸腰椎骨质疏松性骨折骨不连  

PKP with step by step wall operation for nonunion of thoracolumbar osteoporotic fracture

作　　者：徐松[1] 纳强[1] 张雄文[1] 王国著[1] 

机构地区：[1]云南省玉溪市人民医院骨外一科,云南653100

出　　处：《中国骨与关节损伤杂志》2016年第3期231-234,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨经皮椎体后凸成形（PKP）术中使用分步筑墙法注入骨水泥治疗胸腰椎骨质疏松性压缩骨折骨不连的临床疗效及并发症。方法回顾性分析自2012-01—2014-03采用分步筑墙法PKP手术治疗胸腰椎骨质疏松性椎体压缩骨折骨不连26例（28椎），术中使用分步调制骨水泥及分次推注骨水泥的方法。比较术前、术后3d、术后1年的伤椎前、中柱高度、Cobb角、VAS评分、ODI指数。结果术中每个椎体推注骨水泥（513±1．6）ml。术后X线片显示骨水泥填充良好，2例发生骨水泥侧方渗漏，1例椎间隙渗漏，早期1例前方渗漏，未出现骨水泥渗漏进入椎管。病检结果：增生的纤维结缔组织及骨、死骨组织、骨组织伴钙化。本组26例术后均获随访8～28个月，平均17．9个月。术后3d及术后1年时伤椎前、中柱高度、Cobb角、VAS评分、ODI指数均较术前明显改善，差异有统计学意义（P〈0．05）；但术后3d与术后1年随访时．观察指标差异无统计学意义（P〉0．05）。结论PKP术中采用分步筑墙法注入骨水泥治疗胸腰椎骨质疏松性压缩骨折骨不连能明显缓解疼痛和恢复伤椎高度，减少骨水泥渗漏。Objective To investigate the clinical efficacy and complications of PKP with step by step wall for treatment of nonunion of thoracolumbar osteoporotic fracture. Methods From January 2012 to March 2014, 26 patients（28 vertebras） with nonunion of thoracolumbar osteoporotic fracture were treated in our hospital. The step by step modulation of bone cement and multiple injection of ＂step by step wall＂ method in PKP were used. The injured vertebral height of anterior and middle column, Cobb angle, VAS score, ODI index changes were evaluated before and 3 days and 1 year after operation. Results Intraoperative bone cement injection amount in each vertebral body was （5.3±1.6）ml. Postoperative X-ray film showed that bone cement filling was good. Two patients had leakage of bone cement to the side, 1 leakage of bone cement into the intervertebral disc, 1 earlier leakage of bone cement to the front, but there were no leakage of bone cement into the spinal canal. Pathological examination result was： hyperplasia of fibrous connective tissue and bone, dead bone tissue and bone tissue with calcification. This group of 26 patients were foUowed up for 8 to 28 months postoperatively, an average of 17.9 months. Three days and 1 year after operation, the injured vertebral height of anterior and middle column, Cobb angle, VAS score, ODI index were obviously improved compared with those before operation, and the difference was statistically significant （P 〈0.05）. But compared between those 3 days and 1 year after operation, there were no statistically significant differences （P 〉0.05）. Conclusion PKP with step by step wall for nonunion of thoracolumbar osteoporotic fracture can effectively relieve pain and restore vertebral height, with less complications of the bone cement leakage.

关 键 词：胸腰椎 骨质疏松椎体压缩骨折 骨不连 经皮椎体后凸成形术 分步筑墙法 

分 类 号：R687.3[医药卫生—骨科学]