CAJ | 학술논문

目的探讨经椎弓根单球囊跨巾线扩张椎体后凸成形术治疗多发性骨质疏松脊柱压缩骨折的临床价值.方法36例疼痛性骨质疏松脊柱压缩骨折患者,累及椎体61个.在X线临测下,经一侧椎弓根将单球囊置入椎体的中线区,使单球囊在椎体内跨中线扩张,骨水泥在椎体内跨中线分布.术后观察患者视觉模拟疼痛评分(VAS)和Oswestry功能障碍指数(ODI)变化以及椎体高度恢复和后凸畸形矫正情况,并采用配对t检验对上述指标进行比较.随访6.0～12.0个月(平均9.2个月).结果36例患者手术顺利,平均每个椎体于术时间为(37.4±9.6)min,术后96 h疼痛明显缓解,功能改善显著,无严重临床并发症发生.患者VAS由术前平均(7.3±1.0)分降至术后(2.7±0.8)分(t=19.53,P＜0.01);ODI由术前平均(71.1±10.9)%降至术后(26.6±6.4)%(t=18.54,P＜0.01).术前病椎椎体前缘和中部高度丢失平均分别为(14.3±2.8)mm和(10.2±2.7)mm,术后分别为(10.0±1.8)mm和(5.9±1.8)mm,两者差异均有统计学意义(t值分别为14.68和16.44,P值均＜ 0.01).Cobb角术前平均23.4°±5.0°,术后矫正至16.2°±2.8°(t=15.60,P＜0.01).2例分别在椎体前缘和椎间隙内发现少许骨水泥渗漏,但无临床症状,其余椎体X线检查未发现骨水泥渗漏的表现.术后随访期间,患者无疼痛加重或椎体再次塌陷以及邻近椎体发生骨折的情况.结论经椎弓根单球囊跨中线扩张椎体后凸成形术治疗骨质疏松性脊柱压缩骨折疗效满意,手术时间与放射暴露时间短.
목적 탐토경추궁근단구낭과건선확장추체후철성형술치료다발성골질소송척주압축골절적림상개치.방법36례동통성골질소송척주압축골절환자,루급추체61개.재X선림측하,경일측추궁근장단구낭치입추체적중선구,사단구낭재추체내과중선확장,골수니재추체내과중선분포.술후관찰환자시각모의동통평분(VAS)화Oswestry공능장애지수(ODI)변화이급추체고도회복화후철기형교정정황,병채용배대t검험대상술지표진행비교.수방6.0～12.0개월(평균9.2개월).결과36례환자수술순리,평균매개추체우술시간위(37.4±9.6)min,술후96 h동통명현완해,공능개선현저,무엄중림상병발증발생.환자VAS유술전평균(7.3±1.0)분강지술후(2.7±0.8)분(t=19.53,P＜0.01);ODI유술전평균(71.1±10.9)%강지술후(26.6±6.4)%(t=18.54,P＜0.01).술전병추추체전연화중부고도주실평균분별위(14.3±2.8)mm화(10.2±2.7)mm,술후분별위(10.0±1.8)mm화(5.9±1.8)mm,량자차이균유통계학의의(t치분별위14.68화16.44,P치균＜ 0.01).Cobb각술전평균23.4°±5.0°,술후교정지16.2°±2.8°(t=15.60,P＜0.01).2례분별재추체전연화추간극내발현소허골수니삼루,단무림상증상,기여추체X선검사미발현골수니삼루적표현.술후수방기간,환자무동통가중혹추체재차탑함이급린근추체발생골절적정황.결론 경추궁근단구낭과중선확장추체후철성형술치료골질소송성척주압축골절료효만의,수술시간여방사폭로시간단.
Objective To evaluate the clinical efficacy and safety of kyphoplasty with single balloon cross-midline expansion using unipedicular approach for osteoporotic vertebral body compressive fracture (OVCF).Methods Thirty six cases of painful OVCF were included in the study,with 61 vertebrae involved.Under X-ray fluoroscopy monitoring,kyphoplasty was performed using a unilateral,single,balloon via a unilateral transpedicular approach.A final balloon position was in the midline of the vertebral body with the balloon cross-midline expansions and bone cement filled. Clinical outcomes were determined by comparison of preoperative and postoperative VAS and ODI scores.Radiographic assessment included vertebral height restoration and correction of kyphosis.Follow-up was conducted for 6.0-12.0 months(mean 9.2 months).Results Thirty-six consecutive patients with 61 vertebrae were successfully operated with an operative time of(37.4±9.6)rain per vertebra.All patients had significant pain relief and functional recovery within 96 h after the procedure with no surgery-and device-related complications.VAS score improved from(7.3±1.0)preoperatively to(2.7±0.8)postoperatively(t=19.53,P＜0.01).ODI score was decreased from(71.1±10.9)%preoperatively to(26.6±6.4)%postoperatively(t=18.54,P＜0.01).The average anterior body height loss was(14.3±2.8)mm before procedure and(10.0±1.8)mm after procedure(t=14.68,P＜0.01).The average middle body height loss was(10.2±2.7)mm before procedure and(5.9±1.8)mm after procedure(t=16.44,P＜0.01).The Cobb's angle was corrected from 23.4°±5.0° to 16.2°±2.8°(t=15.60,P＜0.01).Some leakages of cement around the anterior margin of vertebra and inter-vertebral space were found in 2 patients,but there were no clinical symptoms.X-ray examination indicated there were no cement leakages in other vertebra.The pain relief and functional recovery were substantial and maintained to the last follow up without any re-collapse or adjacent level fracture.Conclusions A single-balloon cross-midline expansion using unipedicular approach in kyphoplasty for OVCF is effective and safety,less operation time,less radiation exposure compared to the conventional kyphoplasty technique.