CAJ | 학술논문

目的：探讨经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗中上段胸椎（T6以上胸椎）骨质疏松性重度椎体压缩骨折（severe vertebral compression fractures，SVCF）的临床效果。方法：回顾性分析2011年1月~2012年12月我院采用PVP治疗的12例中上段胸椎骨质疏松性SVCF患者，男4例，女8例；年龄61~83岁，平均74.5岁。骨折节段：T21例，T33例，T53例，T65例。受累节段椎体前缘平均压缩为68%（65%~72%）。腰椎骨密度T值为-3.8~-5.2，平均-4.2。术前胸背痛VAS评分为6.75±1.14分，ODI为（68.58±5.70）%，受累节段椎体前缘高度为0.96±0.09cm，受累节段椎体后凸角为18.90°±1.03°。均行PVP，其中10例采用椎弓根入路，2例采用椎弓根外侧入路，所有患者均采取双侧穿刺置管。结果：所有患者均顺利完成手术，10例经椎弓根入路的手术时间为27～51min，平均41min；2例经椎弓根外侧入路的平均手术时间为62min。术中出血量为5～16ml，平均10ml。骨水泥注入量为1.7~2.8ml，平均为2.2ml。1例术前CT显示上终板裂口的患者术后发现椎间隙骨水泥渗漏，但无不适症状，未行特殊处理。术后2d，胸背痛VAS评分为3.17±1.03分，ODI为（33.00±17.54）%，均较术前明显改善（P＜0.05）；受累节段椎体前缘高度为0.98±0.11cm，受累节段椎体后凸角为19.10°±0.99°，与术前比较无明显改善（P＞0.05）。随访6个月～1年，手术椎体未再发生骨折及塌陷，未发现相邻节段骨折。末次随访时，胸背痛VAS评分为3.75±0.85分，ODI为（32.33±17.11）%，受累节段椎体前缘高度为0.97±0.12cm，受累节段椎体后凸角为19.08°±1.00°，与术后2d比较均无统计学差异（P＞0.05）。结论：PVP治疗中上段胸椎骨质疏松性SVCF可以有效缓解胸背痛，但受累节段椎体前缘高度及后凸角恢复不显著。
목적：탐토경피추체성형술（percutaneous vertebroplasty，PVP）치료중상단흉추（T6이상흉추）골질소송성중도추체압축골절（severe vertebral compression fractures，SVCF）적림상효과。방법：회고성분석2011년1월~2012년12월아원채용PVP치료적12례중상단흉추골질소송성SVCF환자，남4례，녀8례；년령61~83세，평균74.5세。골절절단：T21례，T33례，T53례，T65례。수루절단추체전연평균압축위68%（65%~72%）。요추골밀도T치위-3.8~-5.2，평균-4.2。술전흉배통VAS평분위6.75±1.14분，ODI위（68.58±5.70）%，수루절단추체전연고도위0.96±0.09cm，수루절단추체후철각위18.90°±1.03°。균행PVP，기중10례채용추궁근입로，2례채용추궁근외측입로，소유환자균채취쌍측천자치관。결과：소유환자균순리완성수술，10례경추궁근입로적수술시간위27～51min，평균41min；2례경추궁근외측입로적평균수술시간위62min。술중출혈량위5～16ml，평균10ml。골수니주입량위1.7~2.8ml，평균위2.2ml。1례술전CT현시상종판렬구적환자술후발현추간극골수니삼루，단무불괄증상，미행특수처리。술후2d，흉배통VAS평분위3.17±1.03분，ODI위（33.00±17.54）%，균교술전명현개선（P＜0.05）；수루절단추체전연고도위0.98±0.11cm，수루절단추체후철각위19.10°±0.99°，여술전비교무명현개선（P＞0.05）。수방6개월～1년，수술추체미재발생골절급탑함，미발현상린절단골절。말차수방시，흉배통VAS평분위3.75±0.85분，ODI위（32.33±17.11）%，수루절단추체전연고도위0.97±0.12cm，수루절단추체후철각위19.08°±1.00°，여술후2d비교균무통계학차이（P＞0.05）。결론：PVP치료중상단흉추골질소송성SVCF가이유효완해흉배통，단수루절단추체전연고도급후철각회복불현저。
Objectives: To investigate the clinical outcome of percutaneous vertebroplasty (PVP) for middle and upper thoracic(above T6) osteoporotic severe vertebral compression fracture(SVCF). Methods: 12 patients with painful middle and upper thoracic osteoporotic SVCF treated by PVP between January 2011 and Decem-ber 2012 were analyzed retrospectively. The patients included 4 males and 8 females, with a mean age of 74.5 years(61-83 years). A total of 12 vertebrae was involved in this group including T2 in 1, T3 in 3, T5 in 3 as well as T6 in 5. The mean rate of loss of vertebral height was 68%(65%-72%). The mean T value of lumbar BMD was -4.2[(-3.8)-(-5.2)]. Before operation, VAS score of back pain was 6.75 ±1.14, ODI was (68.58±5.70)%, anterior height(AH) of the compressive vertebral body was 0.96±0.09cm, kyphosis angle(KA) of the compressive vertebral body was 18.90°±1.03°. Bilateral transpedicular approach was used in 10 cases and bilateral extrapedicular approach in 2 cases. Results: Surgery was performed successfully on all the patients. The mean surgical time was 41min (27-51min) for 10 cases undergoing bilateral transpedicular approach and 62 minutes for 2 cases undergoing bilateral extrapedicular approach. The mean blood loss was 10ml(5-16ml). The average volume of instilling polymethylmethacrylate(PMMA) was 2.2(1.7-2.8)ml. Disc leakage of PMMA through the superior endplate incompetence was noted in one case, which was asymptomatic and free of in-tervention. Two days after operation, VAS of back pain was 3.17 ±1.03, ODI was (33.00 ±17.54)%, which all showed significant differences; AH was 0.98±0.11cm, KA was 19.10°±0.99°, which showed no improvement(P>0.05). New fracture either in diseased level or adjacent level could not be found during the follow-up(range, 6 months to 1 year). At final follow-up, VAS of back pain was 3.75 ±0.87. ODI was (32.33 ±17.11)%, AH was 0.97±0.12cm, KA was 19.08°±1.00°, which remained unchanged compared with those of two days after operation(P>0.05). Conclusions: For middle and upper thoracic SVCF, PVP can alleviate back pain effectively and safely, however, PVP is of no effect to correct the AH and KA.