CAJ | 학술논문

目的：探讨经皮椎体后凸成形术( percutaneous kyphoplasty, PKP)在治疗伴椎体内裂隙样变的骨质疏松性椎体压缩骨折( osteoporotic vertebral compression fractures, OVCFs)中的临床效果。方法选择连云港市中医院及连云港市第一人民医院2011年1月—2013年12月接受PKP治疗的OVCFs 183例(225个椎体),根据影像学表现分为裂隙组(伴椎体内裂隙样变)44例(53个椎体)和无裂隙组(不伴椎体内裂隙样变)139例(172个椎体)。比较两组手术时间,骨折椎体分布,骨水泥注入量、渗透率、渗漏类型,骨折椎体高度恢复情况,术后疼痛视觉模拟( VAS)评分和Oswestry功能障碍指数( DOI),并发症发生情况。结果①裂隙组、无裂隙组平均手术时间分别为44、42 min,无明显差异。②裂隙组骨折椎体集中分布在T11~L2,无裂隙组骨折椎体主要分布在T7~9及T11~L5。③裂隙组、无裂隙组平均骨水泥注入量为4.3、4.5 ml,骨水泥渗漏率为45．3%、41．9%,差异均无统计学意义(P>0．05)；裂隙组骨水泥主要向椎体周围渗漏,无裂隙组骨水泥主要沿血管渗漏。④两组术后骨折椎体高度均较术前明显恢复(P<0．01),裂隙组较无裂隙组椎体前缘高度恢复明显( P<0．01)。⑤两组术后疼痛VAS评分和DOI均低于术前( P<0．01),两组间VAS评分和DOI比较差异无统计学意义(P>0．05)。⑥除骨水泥渗漏外,无裂隙组发生血压下降3例,裂隙组发生不典型肺栓塞1例,两组均发生术后邻椎骨折1例,均经对症处理后症状消失。结论采用PKP治疗伴椎体内裂隙样变的OVCFs可获得满意的临床效果。
목적：탐토경피추체후철성형술( percutaneous kyphoplasty, PKP)재치료반추체내렬극양변적골질소송성추체압축골절( osteoporotic vertebral compression fractures, OVCFs)중적림상효과。방법선택련운항시중의원급련운항시제일인민의원2011년1월—2013년12월접수PKP치료적OVCFs 183례(225개추체),근거영상학표현분위렬극조(반추체내렬극양변)44례(53개추체)화무렬극조(불반추체내렬극양변)139례(172개추체)。비교량조수술시간,골절추체분포,골수니주입량、삼투솔、삼루류형,골절추체고도회복정황,술후동통시각모의( VAS)평분화Oswestry공능장애지수( DOI),병발증발생정황。결과①렬극조、무렬극조평균수술시간분별위44、42 min,무명현차이。②렬극조골절추체집중분포재T11~L2,무렬극조골절추체주요분포재T7~9급T11~L5。③렬극조、무렬극조평균골수니주입량위4.3、4.5 ml,골수니삼루솔위45．3%、41．9%,차이균무통계학의의(P>0．05)；렬극조골수니주요향추체주위삼루,무렬극조골수니주요연혈관삼루。④량조술후골절추체고도균교술전명현회복(P<0．01),렬극조교무렬극조추체전연고도회복명현( P<0．01)。⑤량조술후동통VAS평분화DOI균저우술전( P<0．01),량조간VAS평분화DOI비교차이무통계학의의(P>0．05)。⑥제골수니삼루외,무렬극조발생혈압하강3례,렬극조발생불전형폐전새1례,량조균발생술후린추골절1례,균경대증처리후증상소실。결론채용PKP치료반추체내렬극양변적OVCFs가획득만의적림상효과。
Objective To explore the clinical effect of percutaneous kyphoplasty ( PKP) in treatment of osteopo-rotic vertebral compression fractures ( OVCFs) complicated by intravertebral cleft. Methods A total of 183 OVCFs pa-tients (225 vertebral bones) received percutaneous kyphoplasty ( PKP) in Traditional Chinese Medicine Hospital of Li-anyungang City and the First People's Hospital of Lianyungang City during January 2011 and December 2013, and were divided into IVC group (44 cases, 53 vertebral bones) and non-IVC group (139 cases, 172 vertebral bones) according to imaging results. The values of operative time, distributions of fractured vertebral body, injection volume of bone ce-ment, the leakage rate and type, height improvement of fracture vertebra, the visual analogue scales ( VAS) and Oswe-stry disability index ( ODI) after operation and postoperative complication rate in the two groups were compared. Results The mean operative time were 44 min in IVC group and 42 min in non-IVC group respectively, and there was no signif-icant difference. The fractured vertebral bodies were mainly distributed in T11-L2 in IVC group and in T7-9 and T11-L5 in non-IVC group respectively. The mean injection volume of bone cement were 4. 3 ml in IVC group and 4. 5 ml in non-IVC group respectively, and the leakage rate of bone cement were 45. 3% and 41. 9% correspondinly, and there was no sig-nificant difference (P>0. 05);bone cement mainly leaked into perivertebral tissues in IVC group, while in the non-IVC group it mainly leaked along blood vessels. In both groups, the heights of the fractured vertebral bodies were significantly improved after the operation compared with those before the operation, and the restoration of vertebral height in IVC group was more obvious than that in the non-IVC group (P<0. 01). The values of postoperative visual analogue scales (VAS) score and Oswestry disability index (ODI) in the two groups were lower than preoperative values (P<0. 01), but there were no significant differences between the two groups (P>0. 05). Except for leakage of bone cement, three patients had low blood pressure in non-IVC group, and one patient had atypical pulmonary embolism in IVC group. One patient had postoperative adjacent vertebral fractures in each group, and the symptoms disappeared after corresponding therapy. Con-clusion The PKP in the treatment of OVCF complicated by intravertebral cleft may achieve good clinical effect.