CAJ | 학술논문

目的评估经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的疗效.方法本组OVCF共468例,采用单球囊双侧扩张PKP治疗,累及T6～L5共608个椎体.其中男性93例120椎, 女性375例488椎,年龄54～94岁,平均68.2岁.单椎体360例,双椎体76例,三椎体32例.采用疼痛视觉类比评分(VAS),止痛药使用评分,活动能力评分,伤椎高度测定及胸腰段脊柱后凸角度等指标评估PKP术的疗效,同时观察并发症.结果 412例(540椎)术后得到6个月～5年随访,平均3.6年.本组术后疼痛明显缓解,术前VAS评分(8.26±0.98)分,术后2天降低到(1.63±0.83)分,末次随访时(1.85±0.89)分(P<0.01).止痛药使用评分由术前的(1.62±0.94)分下降到术后2天的(0.18±0.45)分, 末次随访时(0.21±0.54)分(P<0.01).活动能力评分由术前的(3.15±0.83)分改善到术后2天的(1.41±0.56)分,末次随访时(1.47±0.62)分(P<0.01).术后X线检查,压缩骨折的椎体高度恢复满意,术前椎体前、中份高度分别为(19.39±2.22) mm、(19.19±2.06) mm,术后2天改善到(24.47±2.04) mm、(24.38±1.93) mm,末次随访时(23.88±2.25) mm、(23.57±2.12) mm(P<0.01).胸腰段脊柱后凸Cobb角术前20.28°±4.64°,术后2天12.2°±4.36°,末次随访时13.12°±3.38°(P<0.01).本组73椎(12%)发生骨水泥渗漏,除2例术后出现神经损害表现经对症治疗缓解外,其余均无不适主诉.末次随访时,18例(4.4%)出现疼痛复发或出现新的疼痛,16例(3.9%)出现邻近椎体骨折,再次行PKP治疗.结论 PKP治疗OVCF,是一种安全、复位可靠、止痛效果确切的脊柱微创外科技术.
목적 평고경피추체후철성형술(PKP)치료골질소송성추체압축성골절(OVCF)적료효.방법 본조OVCF공468례,채용단구낭쌍측확장PKP치료,루급T6～L5공608개추체.기중남성93례120추, 녀성375례488추,년령54～94세,평균68.2세.단추체360례,쌍추체76례,삼추체32례.채용동통시각류비평분(VAS),지통약사용평분,활동능력평분,상추고도측정급흉요단척주후철각도등지표평고PKP술적료효,동시관찰병발증.결과 412례(540추)술후득도6개월～5년수방,평균3.6년.본조술후동통명현완해,술전VAS평분(8.26±0.98)분,술후2천강저도(1.63±0.83)분,말차수방시(1.85±0.89)분(P<0.01).지통약사용평분유술전적(1.62±0.94)분하강도술후2천적(0.18±0.45)분, 말차수방시(0.21±0.54)분(P<0.01).활동능력평분유술전적(3.15±0.83)분개선도술후2천적(1.41±0.56)분,말차수방시(1.47±0.62)분(P<0.01).술후X선검사,압축골절적추체고도회복만의,술전추체전、중빈고도분별위(19.39±2.22) mm、(19.19±2.06) mm,술후2천개선도(24.47±2.04) mm、(24.38±1.93) mm,말차수방시(23.88±2.25) mm、(23.57±2.12) mm(P<0.01).흉요단척주후철Cobb각술전20.28°±4.64°,술후2천12.2°±4.36°,말차수방시13.12°±3.38°(P<0.01).본조73추(12%)발생골수니삼루,제2례술후출현신경손해표현경대증치료완해외,기여균무불괄주소.말차수방시,18례(4.4%)출현동통복발혹출현신적동통,16례(3.9%)출현린근추체골절,재차행PKP치료.결론 PKP치료OVCF,시일충안전、복위가고、지통효과학절적척주미창외과기술.
Objective To evaluate the efficacy of percutaneous kyphoplasty in relieving pain caused by osteoporotic vertebral compression fractures. Methods 468 patients whose average age was 68.2 years old (range 54 to 94), with osteoporotic vertebral compression fracture were treated with percutaneous kyphoplasty. 608 consecutive procedures (male 93 cases of 120 procedures, and female 375 cases of 488 procedures) were performed including single insertion of inflatable balloon through bilateral padicle of vertebal arch to make fracture reduction. The single vertebral body was 360 cases, the doubal of 76 cases, and the triple of 32 cases. The clinical effect was evaluated by observing the changes of visual analog scale (VAS), the use of pain-killer scale, locomotor activity scale, the Cobb's angle and the height of vertebral bodies. The complication wasrecorded simultaneously. Results 412 cases (540 procedures) were followed up for 3.6 years (range 6 months to 5 years). The back pain was marked relieved postoperatively. VAS pain score improved from 8.26±0.98 preoperatively to 1.63±0.83 postoperative ly and 1.85±0.89 at the last follow up(P<0.01). The use of pain-killer scale and locomotor activity scale were respectively improved from 1.62±0.94, 3.15±0.83 preoperatively to 0.18±0.45, 1.41±0.56 postoperatively and 0.21±0.54, 1.47±0.62 at the last follow up(P<0.01). The mean height of the anterior edge vertebral body was from 19.39±2.22 mm preoperatively to 24.47±2.04 mm postoperatively a nd 23.88±2.25 mm at final follow-up (P<0.01). The media vertebral bodies was increased from 19.19±2.06 mm to 24.38±1.93 mm, and at final follow-up 23.57±2.12 mm (P< 0.01). The mean kyphosis was improved from 20.28°±4.64° to 12.2°±4.36°, and 13.12°±3.38° at final follow-up (P<0.01). 73 vertebral bodies (12%) had cement leakage, in which 2 cases with nervous lesion were obviously relieved by symptomatic treatment, and the others without adverse events. At the final followup, 18 cases had old or novel back pain, and neighborhood vertebral compression fracture occurred in 16 cases which were treated with kyphoplasty. Conclusion Kyphoplasty for treatment of osteoporotic vertebral compression fracture can restore the height of fractured vertebra; relieve pain immediately, which is a safe and effective minimal invasion spinal intervention.