CAJ | 학술논문

目的探讨球囊扩张椎体后凸成形术结合活检在骨质疏松性胸腰椎骨折不愈合诊治中的可行性和有效性.方法回顾性分析2005年7月至2010年5月收治的8例(8椎)骨质疏松性胸腰椎骨折不愈合患者的临床资料并复习相关文献,总结骨质疏松性椎体骨折不愈合的特点.本组男性3例,女性5例;年龄65～86岁,平均73.5岁;T123例,L14例,L21例.患者均行X线片、CT和MRI检查.所有患者均采用球囊扩张椎体后凸成形术治疗并行术中活检.测量手术前后椎体前缘高度变化,采用疼痛视觉模拟评分(VAS)评估手术疗效.结果全部病例均顺利完成手术,无严重并发症发生.3例术后病理提示为死骨样组织,2例病理提示为稀疏样松质骨,3例术中活检失败.所有患者均获随访,随访时间3～37个月,平均22.6个月;术后疼痛明显减轻或消失,疼痛VAS术前均值9.5分,术后第3天均值为2.1分,两者比较差异有统计学意义(P＜0.05).末次随访VAS均值为2.3分,与术后比较差异无统计学意义(P＞0.05).术后病变椎体高度明显增加.术后椎体前缘高度平均恢复率67.2%,末次随访椎体前缘高度平均恢复率64.1%(P＞0.05).结论运用球囊扩张椎体后凸成形术治疗老年骨质疏松性胸腰椎骨折不愈合安全有效,术中活检有助于鉴别诊断.
목적 탐토구낭확장추체후철성형술결합활검재골질소송성흉요추골절불유합진치중적가행성화유효성.방법 회고성분석2005년7월지2010년5월수치적8례(8추)골질소송성흉요추골절불유합환자적림상자료병복습상관문헌,총결골질소송성추체골절불유합적특점.본조남성3례,녀성5례;년령65～86세,평균73.5세;T123례,L14례,L21례.환자균행X선편、CT화MRI검사.소유환자균채용구낭확장추체후철성형술치료병행술중활검.측량수술전후추체전연고도변화,채용동통시각모의평분(VAS)평고수술료효.결과 전부병례균순리완성수술,무엄중병발증발생.3례술후병리제시위사골양조직,2례병리제시위희소양송질골,3례술중활검실패.소유환자균획수방,수방시간3～37개월,평균22.6개월;술후동통명현감경혹소실,동통VAS술전균치9.5분,술후제3천균치위2.1분,량자비교차이유통계학의의(P＜0.05).말차수방VAS균치위2.3분,여술후비교차이무통계학의의(P＞0.05).술후병변추체고도명현증가.술후추체전연고도평균회복솔67.2%,말차수방추체전연고도평균회복솔64.1%(P＞0.05).결론 운용구낭확장추체후철성형술치료노년골질소송성흉요추골절불유합안전유효,술중활검유조우감별진단.
Objectives To investingate the clinical efficacy and safety of biopsy and Kyphoplasty in the diagnosis and treatment of osteoporotic thoracolumbar vertebral fracture nonunion, and to explore the clinical characteristics of the disease. Methods From July 2005 to May 2010, the clinical data of 8 patients with nonunion of osteoporotic thoracolumbar vertebral fractures were studied. There were 3 males and 5 females, with the mean age of 73.5 years(range, 65-86 years). The fracture vertebrae were 3 cases in T12,4 in L1, and 1 in L2. All cases received radiography, CT and MRI examination. All patients were treated by using Kyphoplasty. Five patients were performed bone biopsy successfully, 3 patients were failed.The curative effect was evaluated by visual analogue scale(VAS), anterior vertebral height restoration at preoperative, postoperative and followed-up time. Results All patients tolerated the procedure well with immediate relief of back pain after Kyphoplasty. No severe complications were found in all patients. Three cases had the pathologic appearance of sequestrum, 2 cases were sparse cancellous bone, 3 cases were abortive to biopsy. All the patients were followed up of 22.6 months(range, 3-37 months), the VAS was 9. 5 before operation, 2.1 at the third day postoperatively, there were significant difference between the two phase(P＜0.05), and 2.3 at last follow-up, there were no difference between postoperation and follow-up phase(P＞0.05). And the height of compressed body recovered markedly. The vertebral height had a recovery rate of 67.2% postoperatively, 64. 1% and at last follow-up, there were no difference between the two phase(P＞0.05). Conclusions Kyphoplasty is an effective and safe method in the treatment of osteoporotic throacolumbar vertebral fracture nonunion. Bone biopsy can play a further role of differential diagnosis.