重度椎体压缩骨折经椎弓根下缘后凸成形术

Percutaneous kyphoplasty for severe osteoporotic vertebral body compression fractures through bilateral pedicle inferior edge approaches

摘要:

[目的]评价经椎弓根下缘入路后凸成形术(percutaneous kyphoplasty, PKP)治疗重度骨质疏松性椎体压缩骨折(os- teoporotic vertebral compression fracture, OVCF)的临床疗效。[方法]回顾性分析 2020 年 1 月—12 月重度 OVCF(椎体压缩程度 ＞67%)48 例患者的临床资料。采用改良低位平行穿刺法，经双侧椎弓根下缘入路行 PKP 治疗。[结果]所有患者均在全麻下顺利完成手术，无严重术中并发症，单椎体手术时间平均为 (64.58±137.06) min，透视次数为 (21.68±6.12) 次，骨水泥注入量 (3.79±1.06)ml。7 例出现骨水泥渗漏(14.58%)，其中椎间隙渗漏 3 例(6.25%)，椎体旁渗漏 4 例(8.33%)，所有渗漏均无临床症状。随时间推移， VAS 和 ODI 评分均显著减少(P＜0.05)。影像方面，术后椎体前缘高度、椎体中部高度、局部后凸 Cobb 角均较术前显著改善(P＜0.05)。[结论] 经椎弓根下缘 PKP 可在常规透视和穿刺工具下，安全便捷地建立骨水泥灌注的工作通道，治疗重度 OVCF 疗效优良。

Abstract:

[Objective] To evaluate clinical outcomes of percutaneous kyphoplasty (PKP) through bilateral pedicle inferior approaches for severe osteoporotic vertebral compression fractures (OVCF) . [Methods] From January to December 2020, 48 patients received PKP through bilateral pedicle inferior approaches for severe OVCF with extent of vertebral compression more than 67%. [Results] All patients were successfully operated by general anesthesia without serious intraoperative complications, whereas with single-segment operation time of (64.58±137.06) minutes, the number of fluoroscopies of (21.68±6.12) times, and the amount of bone cement injected of (3.79±1.06) ml. Bone cement leakage was found in 7 patients (14.58%) , including 3 cases of intervertebral leakage (6.25%) and 4 cases of paraspinal leak- age (8.33%) , all of which had no clinical symptoms. Both VAS and ODI scores decreased significantly over time (P＜0.05) . Radiographical- ly, anterior vertebral height, middle vertebral height and local kyphosis Cobb angle significantly improved after PKP compared with those preoperatively (P＜0.05) . [Conclusion] The PKP through bilateral pedicle inferior edge approaches does establish safe working channels with conventional instruments, and has excellent efficacy for severe OVCF.