CAJ | 학술논문

目的回顾总结椎体后凸成形术(PKP)治疗重度骨质疏松性椎体压缩骨折患者的临床经验,并提出分型治疗方案. 方法自2003年8月至2013年8月,采用椎体后凸术对1200例胸腰椎骨质疏松性压缩骨折患者进行了治疗.其中重度患者62例(5.2％,81椎),年龄69～95岁,平均76.5岁.伤椎压缩程度为66.7％～78.9％,平均71.3％.随访1～10年,平均78个月.术前根据影像学资料结合病史将骨折分为:单纯型、假关节型、空洞型和进展型.按照各型特点,实施个体化PKP术. 结果所有患者均顺利完成手术.疼痛视觉模拟评分(VAS)由术前的(7.2±2.1)分下降至术后第3天的(2.5±1.7)分(t=13.197,P＜0.01).SF-36评分由术前的(29.5±8.2)分至术后第3天的(46.5±9.9)分(t=22.884,P＜0.01).而椎体前缘高度由术前的(14.2±2.4)mm增至术后第3天的(19.3±4.4)mm(t=9.108,P＜0.01),伤椎节段Cobb角由术前的(16.5±5.4)°减至术后第3天的(9.4±4.1)°(t=9.355,P＜0.01).但随着随访时间的延长,椎体高度逐渐丢失,后凸畸形逐渐加重.末次随访时有21例(21/62,33.9％)出现其他椎体新发骨折. 结论术前对重度骨质疏松性椎体压缩骨折进行分型,实施个体化治疗,有助于提高PKP术的成功率,减少手术并发症.
목적 회고총결추체후철성형술(PKP)치료중도골질소송성추체압축골절환자적림상경험,병제출분형치료방안. 방법 자2003년8월지2013년8월,채용추체후철술대1200례흉요추골질소송성압축골절환자진행료치료.기중중도환자62례(5.2％,81추),년령69～95세,평균76.5세.상추압축정도위66.7％～78.9％,평균71.3％.수방1～10년,평균78개월.술전근거영상학자료결합병사장골절분위:단순형、가관절형、공동형화진전형.안조각형특점,실시개체화PKP술. 결과 소유환자균순리완성수술.동통시각모의평분(VAS)유술전적(7.2±2.1)분하강지술후제3천적(2.5±1.7)분(t=13.197,P＜0.01).SF-36평분유술전적(29.5±8.2)분지술후제3천적(46.5±9.9)분(t=22.884,P＜0.01).이추체전연고도유술전적(14.2±2.4)mm증지술후제3천적(19.3±4.4)mm(t=9.108,P＜0.01),상추절단Cobb각유술전적(16.5±5.4)°감지술후제3천적(9.4±4.1)°(t=9.355,P＜0.01).단수착수방시간적연장,추체고도축점주실,후철기형축점가중.말차수방시유21례(21/62,33.9％)출현기타추체신발골절. 결론 술전대중도골질소송성추체압축골절진행분형,실시개체화치료,유조우제고PKP술적성공솔,감소수술병발증.
Objective To retrospectively review the clinical experience of percutaneous kyphoplasty (PKP) in the treatment of severe osteoporotic vertebral compression fracture (OVCF) during 10 years,and to propose a new classified treatment for OVCF.Methods 1200 patients with osteoporotic thoracolumbar vertebral compression fracture underwent percutaneous kyphoplasty from Aug.2003 to Aug.2013.There were 62 severe patients (5.2％,81 vertebraes),aged from 69 to 95 years (average 76.5 years),with 66.7％ to 78.9％ (average 71.3％) of vertebral body compression.Patients were followed up for 12 to 120 months (average 78 months).According to the preoperative imaging data,the fractures were classified into four types:simple type,pseudarthrosis type,cavern type,progressive type.Individualized PKP was performed on each patient.Results All the patients tolerated procedure well.The visual analogue scale (VAS) was reduced from (7.2± 2.1)preoperatively to (2.5±1.7) 3 days after PKP(t=13.197,P＜0.01).The Medical Outcomes Study (MOS) 36-Item Short Form Health Survey (SF-36) scales was improved from (29.5±8.2) to (46.5±9.9) 3 days after surgery(t=22.884,P＜0.01).Most patients were satisfied with the efficacy.The anterior height of vertebral body was increased from (14.21±2.44) mm preoperatively to (19.28 ±4.37) mm 3 days after surgery(t=9.108,P＜0.01).The Cobb angle were decreased from (16.45 ± ±5.37)° to (9.41±4.13)° 3 days after surgery(t=9.355,P＜0.01).The height of vertebrae was lost and the kyphosis angle aggravated with the follow-up time.New vertebral fractures were found in 21 patients (21/62,33.9％) at the last follow-up.Conclusions The preoperative accurate classification of severe osteoporosis vertebral compression fracture and individualized PKP can raise the successful operation rate and reduce the incidences of complications.