CAJ | 학술논문

目的:评价单侧椎弓根外入路经皮椎体后凸成形治疗胸椎骨质疏松性椎体压缩骨折的临床效果.方法:回顾性分析2004-07/2008-05宁夏医科大学附属医院脊柱外科收治的行单侧椎弓根外穿刺入路经皮椎体后凸成形治疗患者38例(52椎),男12例,女26例;年龄55～72岁,平均60.3岁;34例为原发性骨质疏松,4例因其他疾病有半年以上激素服用历史.结合体检、MRI及X射线平片确定责任椎体,骨折部位为T_4~T_(12).采用目测类比评分对患者手术前后的疼痛程度进行评估.观察病椎高度的恢复以及后凸畸形的矫正情况,骨水泥渗漏通过术中透视和术后平片观察,记录骨水泥渗漏位置和椎体外渗漏的并发症.结果:38例患者均安全完成手术,时间25~55 min,单椎体骨水泥注入量2.25~4.60 mL,平均(3.20±1.40)mL/椎.全部患者均获得随访,随访6～24个月,平均9.5个月.36例(95%)背痛明显缓解,术后3 d及末次随访目测类比评分较术前明显降低(P<0.05);复查X射线平片显示术后椎体前缘及中线高度较术前恢复明显(P<0.05),椎体中线高度矫正率为(50.90±34.60)%,而椎体后缘高度手术前后差异无显著性意义(P>o.05),冠状位X射线未发现椎体侧方楔形变增加.38例患者中有3例共5个椎体出现骨水泥渗漏,1例为经穿刺通道渗漏至椎体侧后缘,2例经椎体静脉系统渗漏至椎体侧方,但均未出现临床症状.患者术后第2天下地活动,第三四天出院,术后1个月恢复伤前的生活.无节段血管、脊髓等穿刺副损伤以及术中、术后肺栓塞、血管栓塞等并发症的发生.结论:经椎弓根外入路单侧椎体后凸成形是治疗胸椎骨质疏松性椎体压缩骨折安全有效的方法,可有效恢复椎体高度、迅速缓解疼痛,提高患者生活质量.
목적:평개단측추궁근외입로경피추체후철성형치료흉추골질소송성추체압축골절적림상효과.방법:회고성분석2004-07/2008-05저하의과대학부속의원척주외과수치적행단측추궁근외천자입로경피추체후철성형치료환자38례(52추),남12례,녀26례;년령55～72세,평균60.3세;34례위원발성골질소송,4례인기타질병유반년이상격소복용역사.결합체검、MRI급X사선평편학정책임추체,골절부위위T_4~T_(12).채용목측류비평분대환자수술전후적동통정도진행평고.관찰병추고도적회복이급후철기형적교정정황,골수니삼루통과술중투시화술후평편관찰,기록골수니삼루위치화추체외삼루적병발증.결과:38례환자균안전완성수술,시간25~55 min,단추체골수니주입량2.25~4.60 mL,평균(3.20±1.40)mL/추.전부환자균획득수방,수방6～24개월,평균9.5개월.36례(95%)배통명현완해,술후3 d급말차수방목측류비평분교술전명현강저(P<0.05);복사X사선평편현시술후추체전연급중선고도교술전회복명현(P<0.05),추체중선고도교정솔위(50.90±34.60)%,이추체후연고도수술전후차이무현저성의의(P>o.05),관상위X사선미발현추체측방설형변증가.38례환자중유3례공5개추체출현골수니삼루,1례위경천자통도삼루지추체측후연,2례경추체정맥계통삼루지추체측방,단균미출현림상증상.환자술후제2천하지활동,제삼사천출원,술후1개월회복상전적생활.무절단혈관、척수등천자부손상이급술중、술후폐전새、혈관전새등병발증적발생.결론:경추궁근외입로단측추체후철성형시치료흉추골질소송성추체압축골절안전유효적방법,가유효회복추체고도、신속완해동통,제고환자생활질량.
OBJECTIVE: To evaluate the clinical outcomes of single-balloon kyphoplasty in the treatment of thoracic osteoporotic compression fractures via extrapedicular approach METHODS: From July 2004 to May 2008, 38 cases (52 vertebra) of thoracic osteoporotic fractures were treated by balloon kyphoplasty via unilateral extrapedicular approach, including 12 males and 26 females with an average age of 60.3 years (range 55-72 years). There were 34 cases of primary osteoporosis, and 4 had administrated hormone due to other diseases for over 6 months. Symptomatic levels ranged from T_4 to T_(12) confirmed by physical examination, MRI and X-ray. The pain relief, restoration of vertebral height and kyphosis correction were compared before and after operation by using visual analogue scale (VAS) and radiograph, respectively. In addition, bone cement leakage location and complications were recorded. RESULTS: Operation were successfully performed in 38 cases with an average injection of bone cement volume of (3.2+ 1.4) mL (2.25-4.60 mL in unilateral infusion). The mean time of surgery was 25-55 minutes, and that of follow-up was 9.5 months (6-24 months). Back pain of 36 cases was improved, and the VAS 3 days postoperatively and the final follow-up was significantly reduced (P < 0.05). The vertebral anterior margin and median height following surgery were significantly improved detected by X-ray (P < 0.05), and average median height restoration was (50.90+34.60)%, but no significant change was found in posterior height (P > 0.05). No lateral wedging or changes in the coronal alignment was found. Three cases (5 vertebra) had cement leakage: the bone cement of 1 case leaked to posterior margin through the puncture channel, and 2 cases leaked to lateral vertebra through vertebral venous system without any adverse event. The patients could move the second day after surgery, discharged from the hospital at days 3-4, and restored to normal life at 1 month postoperatively. No blood vessel or spinal cord puncture injury or pulmonary embolism, or blood vessel embolism was found. CONCLUSION: Unilateral extrapedicular kyphoplasty is safe and effective in treating thoracic osteoporotic fractures. It rapidly releases backache, restores the body height of fractured thoracic vertebrae and improves quality of life of the patients.