CAJ | 학술논문

目的评价经皮椎体后凸成形术(PKP)治疗伴裂隙征陈旧性椎体骨质疏松性骨折的疗效. 方法 2010年6月至2012年9月采用PKP治疗了25例(25个椎体)伴裂隙征的陈旧性椎体骨质疏松性骨折患者,男性8例,女性17例,年龄64～84岁,平均72.7岁,病程6周～24个月,平均7.8个月.手术前后采用疼痛视觉模拟评分(VAS)评估临床症状,摄站立位X线片测量病变椎体Cobb角及椎体前缘高度,并记录术中出血量、骨水泥量及并发症发生情况. 结果 25例患者均顺利完成手术,无严重手术并发症.术中透视见5个椎体(20％)出现骨水泥渗漏,其中渗漏至椎体前侧3例,椎体侧方2例.单个椎体手术时间35～60 min,平均42 min；注射骨水泥量2.0～5.5 ml,平均3.1 ml;25例患者均获随访,随访时间6～15个月,平均12个月.患者术前、术后3d及末次随访时VAS评分分别为(7.44±1.0)分、(2.36±0.8)分、(2.12±0.7)分(F=297.84,P=0.000＜)；Cobb角分别为(28.28±3.76)°、(23.28±3.76)°、(24.32±3.94)°(F=12.39,P=0.000)；椎体前缘高度分别为(22.48±4.38)mm、(25.80±4.89) mm、(25.24±4.84)mm (F=3.56,P=0.034);术后3d和末次随访时比较差异无统计学意义(均P＞0.05). 结论 PKP是治疗伴裂隙征的陈旧性骨质疏松性椎体压缩性骨折的有效方法,能快速缓解疼痛、矫正后凸畸形、预防椎体塌陷.
목적 평개경피추체후철성형술(PKP)치료반렬극정진구성추체골질소송성골절적료효. 방법 2010년6월지2012년9월채용PKP치료료25례(25개추체)반렬극정적진구성추체골질소송성골절환자,남성8례,녀성17례,년령64～84세,평균72.7세,병정6주～24개월,평균7.8개월.수술전후채용동통시각모의평분(VAS)평고림상증상,섭참립위X선편측량병변추체Cobb각급추체전연고도,병기록술중출혈량、골수니량급병발증발생정황. 결과 25례환자균순리완성수술,무엄중수술병발증.술중투시견5개추체(20％)출현골수니삼루,기중삼루지추체전측3례,추체측방2례.단개추체수술시간35～60 min,평균42 min；주사골수니량2.0～5.5 ml,평균3.1 ml;25례환자균획수방,수방시간6～15개월,평균12개월.환자술전、술후3d급말차수방시VAS평분분별위(7.44±1.0)분、(2.36±0.8)분、(2.12±0.7)분(F=297.84,P=0.000＜)；Cobb각분별위(28.28±3.76)°、(23.28±3.76)°、(24.32±3.94)°(F=12.39,P=0.000)；추체전연고도분별위(22.48±4.38)mm、(25.80±4.89) mm、(25.24±4.84)mm (F=3.56,P=0.034);술후3d화말차수방시비교차이무통계학의의(균P＞0.05). 결론 PKP시치료반렬극정적진구성골질소송성추체압축성골절적유효방법,능쾌속완해동통、교정후철기형、예방추체탑함.
Objective To evaluate the effect of percutaneous kyphoplasty (PKP) in the treatment of old osteoporotic vertebral compression fractures with intravertebral clefts.Methods 25 patients (25 vertebrae) suffering from old OVCF with vacuum phenomenon were treated with PKP.There were 8 males and 17 females with an average age of 72.7 years (range,64-84 years) and with an average duration of 7.8 months (range,6-24 months).The height of anterior column and the posterior convex Cobb angle of injured spine were measured on the lateral X-ray film in standing position at pre-operation and post-operation.Clinical symptoms were evaluated by visual analogue scale (VAS).The amount of bleeding and bone cement and complications were recorded.Results All of 25 operations were performed successfully without severe complications.Cement leakage occurred in 5 cases (20％),including 3 cases at the anterior vertebral edge and 2 cases at the lateral vertebra.The surgery time for each vertebra was 35～60 min (mean 42 min),and bone cement volume for each vertebra was 2.0～5.5 ml (mean 3.1 ml).25 patients were followed up for 12 months (range,6-15 months).The VAS score was decreased from (7.44 ± 1.0) preoperatively to (2.36 ± 0.8) day 3 postoperatively and to (2.12 ± 0.7) the last follow-up; the Cobb' s angle was improved from (28.28±3.76) to (23.28±3.76) and (24.32±3.94) respectively; and the anterior vertebral height was increased from (22.48±4.38) mm to (25.80±4.89) mm and (25.24±4.84) mm respectively.There were significant differences in VAS,Cobb's angle,and anterior vertebral height between prre-and post-operation (F=297.84,12.39 and 3.56,P＜0.001 or 0.05),but there were no significant differences in these indicators between day 3 postoperatively and the last follow-up (all P ＞ 0.05).Conclusions PKP is effective in the treatment of old osteoporotic vertebral compression fractures combined with intravertebral clefts.It can relieve pain rapidly and effectively,correct kyphosis,and prevent vertebra collapse.