CAJ | 학술논문

目的：探讨改进型的椎体后凸成形术在合并真空裂隙征的骨质疏松椎体骨折治疗中的可行性和应用价值。方法回顾性分析2008年2月～2011年11月行改进型椎体后凸成形术治疗的31例伴真空裂隙征骨质疏松椎体骨折患者的临床资料。术前、术后3d、6及12个月通过站立侧位X 线片测量伤椎椎体前缘、中线高度和伤椎后凸Cobb角的变化；术前、术后3d、6及12个月以视觉模拟疼痛评分（VAS）评估腰背部疼痛的程度，Oswestry功能障碍指数（ODI）评估日常活动及功能障碍程度。结果所有患者均成功接受改进型椎体后凸成形术治疗，术中1例发生椎间盘骨水泥渗漏，但无临床症状。患者均获得12个月以上的随访。随访期间无伤椎再次骨折及相邻椎体骨折的发生。术前与术后VAS评分比较差异具有显著性意义（P＜0.05），而术后3d、6及12个月VAS评分比较差异无显著性意义（P＞0.05）。 ODI评分由术前的72.25±9.84改善至术后3d的27.31±6.95，比较差异具有显著性意义（P＜0.05），而且在术后6及12个月随访时ODI评分仍然不断改善。术后3d伤椎椎体前缘、中线高度和伤椎后凸Cobb角较术前显著改善，差异有统计学意义（P＜0.05）；术后12个月随访时以上影像学指数均能较好的维持，与术后3d及6个月比较差异无显著性意义（P ＞0.05）。结论椎体后凸成形术是治疗伴椎体内裂隙征的骨质疏松性椎体压缩骨折的一种相对安全、有效的方法，而且通过改进技术的应用可明显降低骨水泥渗漏，减少相邻椎体骨折的发生。
목적：탐토개진형적추체후철성형술재합병진공렬극정적골질소송추체골절치료중적가행성화응용개치。방법회고성분석2008년2월～2011년11월행개진형추체후철성형술치료적31례반진공렬극정골질소송추체골절환자적림상자료。술전、술후3d、6급12개월통과참립측위X 선편측량상추추체전연、중선고도화상추후철Cobb각적변화；술전、술후3d、6급12개월이시각모의동통평분（VAS）평고요배부동통적정도，Oswestry공능장애지수（ODI）평고일상활동급공능장애정도。결과소유환자균성공접수개진형추체후철성형술치료，술중1례발생추간반골수니삼루，단무림상증상。환자균획득12개월이상적수방。수방기간무상추재차골절급상린추체골절적발생。술전여술후VAS평분비교차이구유현저성의의（P＜0.05），이술후3d、6급12개월VAS평분비교차이무현저성의의（P＞0.05）。 ODI평분유술전적72.25±9.84개선지술후3d적27.31±6.95，비교차이구유현저성의의（P＜0.05），이차재술후6급12개월수방시ODI평분잉연불단개선。술후3d상추추체전연、중선고도화상추후철Cobb각교술전현저개선，차이유통계학의의（P＜0.05）；술후12개월수방시이상영상학지수균능교호적유지，여술후3d급6개월비교차이무현저성의의（P ＞0.05）。결론추체후철성형술시치료반추체내렬극정적골질소송성추체압축골절적일충상대안전、유효적방법，이차통과개진기술적응용가명현강저골수니삼루，감소상린추체골절적발생。
Objective To evaluate the feasibility and effectiveness of modified percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures combined with intravertebral clefts (IVC). Methods Between Feb.2008 and Nov.2011,31 patients with “intravertebral clefts” in osteoporotic vertebral frac-tures undergoing percutaneous kyphoplasty were retrospectively reviewed .The height of anterior and middle column and the posterior convex Cobb angle of the injured spine were measured on the lateral X -ray film in standing position preoperatively and at 3 days,6 months and 12 months postoperatively.The visual analogue scale (VAS) score was used to evaluate the pain relief and the Oswestry disability index (ODI) system was used to evaluate the improve-ment of daily activity function and disability preoperatively and at 3 days,6 months and 12 months postoperatively. Results All patients tolerated kyphoplasty successfully .One patient occurred intradiscal cement leakage after re-ceiving kyphoplasty,but without clinical symptoms.No re-fracture of the injured vertebrae or adjacent vertebral frac-ture occurred during the follow-up.There was significant difference in the VAS score between preoperatively and postoperatively (P<0.05),despite of no significant difference in the VAS scores at 3-day,6-month and 12-month follow-up(P>0.05).The ODI scores varied from 72.25 ±9.84 preoperatively to 24.55 ±5.01 postoperatively (P<0.05).This improvement in ODI scores was still present at 6-month and 12-month follow-up.Between preop-eratively and at 3 days postoperatively,there was significant difference in the height of anterior/middle column and the posterior convex Cobb angle (P<0.05),but no significant difference among 3 days postoperatively,6 months postoperatively and the final follow-up(P<0.05).Conclusion The modified PKP is an effective and safe way to treat osteoporotic vertebral compression fractures combined with intravertebral clefts (IVC).It is a good choice to prevent cement leakage and adjacent vertebral fracture .