CAJ | 학술논문

目的探讨人工植骨结合二次球囊扩张治疗骨质疏松性脊柱压缩骨折术中骨水泥外渗的临床疗效.方法回顾性分析经单侧椎弓根穿刺球囊扩张椎体后凸成形术(PKP)治疗的60例骨质疏松性胸腰椎压缩骨折患者的临床资料.其中术中发现造影剂外渗15例(T113例,T123例,L15例,L2 2例,L4 1例,L51例),将人工骨压成粉末,调成稠糊状,使用骨水泥推注器将其注入椎体中,二次行球囊扩张后,在X线机透视下将牙膏状骨水泥缓慢注入椎体内.术后观察有无骨水泥外渗,以及后凸畸形Cobb角和疼痛视觉模拟(VAS)评分改善情况.根据疼痛缓解程度评定疗效.结果 15例患者均完成手术.术后第3天复查X线片显示各病椎体高度恢复良好,椎体内骨水泥充填良好,分布均匀,无椎间、椎旁及椎管内骨水泥外渗.后凸畸形Cobb角平均矫正10.1°±2.4°,VAS评分平均降低(6.2±0.2)分,与术前比较,差异均有统计学意义(tc.bb角=16.299,tVAS=120.062,P值均＜0.01).术后15例获随访4～24周,平均19周.术后4周复查X线片显示各病椎体高度无明显丢失,邻椎无新鲜骨折,患者疼痛症状消失或明显缓解,可正常行走,其中疗效优2例、良13例.结论人工植骨结合二次球囊扩张可有效预防球囊扩张PKP治疗骨质疏松性胸腰椎压缩骨折术中骨水泥外渗,其术后远期临床疗效还有待进一步观察.
목적 탐토인공식골결합이차구낭확장치료골질소송성척주압축골절술중골수니외삼적림상료효.방법 회고성분석경단측추궁근천자구낭확장추체후철성형술(PKP)치료적60례골질소송성흉요추압축골절환자적림상자료.기중술중발현조영제외삼15례(T113례,T123례,L15례,L2 2례,L4 1례,L51례),장인공골압성분말,조성주호상,사용골수니추주기장기주입추체중,이차행구낭확장후,재X선궤투시하장아고상골수니완만주입추체내.술후관찰유무골수니외삼,이급후철기형Cobb각화동통시각모의(VAS)평분개선정황.근거동통완해정도평정료효.결과 15례환자균완성수술.술후제3천복사X선편현시각병추체고도회복량호,추체내골수니충전량호,분포균균,무추간、추방급추관내골수니외삼.후철기형Cobb각평균교정10.1°±2.4°,VAS평분평균강저(6.2±0.2)분,여술전비교,차이균유통계학의의(tc.bb각=16.299,tVAS=120.062,P치균＜0.01).술후15례획수방4～24주,평균19주.술후4주복사X선편현시각병추체고도무명현주실,린추무신선골절,환자동통증상소실혹명현완해,가정상행주,기중료효우2례、량13례.결론 인공식골결합이차구낭확장가유효예방구낭확장PKP치료골질소송성흉요추압축골절술중골수니외삼,기술후원기림상료효환유대진일보관찰.
Objective To explore the clinical efficacy of cement extravasation prevention by artificial bone graft combined with the two balloon dilation for the treatment of osteoporotic vertebral compression fractures.Methods Clinical data of 60 cases with osteoporotic thoracolumbar vertebral compression fracture treated by the unilateral pedicle puncture percutaneous kyphoplasty (PKP) were retrospectively analyzed,including 15 cases(T11 3 cases,T12 3 cases,L1 5 cases,L2 2 cases,L4 1 case,L5 1 case) of contrast agent extravasation found in operation.The artificial bone was pressed into powder and tuned into a thick paste ; the thick paste was injected into the vertebral body by the injector.After the second balloon dilatation,bone cement like toothpaste was injected into the vertebral body slowly in X-ray fluoroscopy.Postoperative bone cement extravasation and kyphosis Cobb angle as well as visual analogue scale (VAS) score improvement were observed.According to the degree of pain reliesing evaluate the clinical curative effect.Results All 15 patients were completed the operation.The third day after the operation,the review X-ray showed a good recovery of vertebral height of each disease,the vertebral bone cement filling was good,evenly distributed,without intervertebral,paraspinal or spinal bone cement extravasation.The average Cobb angle of kyphosis was corrected 10.1 ° ± 2.4°,and the average VAS score was reduced by 6.2 ± 0.2.Compared with preoperation,the differences were statistically significant (tCobb =16.299,tvAs =120.062,all P values ＜ 0.01).Fifteen cases were followed up for 4 weeks to 24 weeks,with an average of 19 weeks.The fourth week of the postoperative,X-ray showed that no significant vertebral height of each disease was missing,no new adjacent vertebral fracture was found.The efficacy was evaluated the fourth week after surgery,the symptoms of pain was disappeared or obviously improved,and the patients could walk normally.Among them,2 cases were excellent,13 cases were good.Conclusions Artificial bone graft combined with the two balloon dilation is effective for cement extravasation prevention in the treatment of osteoporotic thoracolumbar compression fracture by PKP balloon dilation,but the postoperative clinical efficacy needs further observation.