经皮椎体成形术治疗重度骨质疏松性压缩骨折△

Percutaneous vertebroplasty for severe osteoporotic vertebral compression fracture

摘要:

[目的]探讨经皮椎体成形术(percutaneous vertebroplasty, PVP)治疗重度骨质疏松性椎体压缩骨折(severe osteopo- rosis vertebral compression fractures, sOVCF)的临床效果。[方法]回顾性分析 2018 年 9 月—2020 年 12 月本院采用 PVP 治疗的 39 例 sOVCF 患者。评估临床和影像学资料。[结果]所有患者均顺利完成手术，平均手术时间(56.3±5.7)min，平均骨水泥注入量 (5.2±2.2) ml。术中有 9 例发生骨水泥渗漏 (23.1%)，其中椎旁渗漏 3 例，椎间隙渗漏 6 例，均无明显临床症状。所有患者均获随访，随访时间平均(12.7±3.8)个月，随时间推移(术前、术后第 2 d 和末次随访时)，VAS 评分 [(6.5±0.2) 分, (2.4± 0.8) 分, (2.5±0.8) 分, P＜0.05]、ODI 指数 [(77.9±4.4)%, (24.2±2.9)%, (24.7±3.4)%, P＜0.05] 显著降低，而 JOA 评分 [(14.3±2.7) 分, (21.3±1.9) 分, (20.7±1.7) 分, P＜0.05] 显著增加。影像方面，伤椎高度 [(6.7±1.7) mm, (16.5±4.0) mm, (14.4±3.3) mm, P＜0.05] 显著增加，而局部后凸 Cobb 角 [(24.1±13.0)°, (15.6±10.2)°, (19.0±11.5)°, P＜0.05] 显著降低。[结论]PVP 治疗 sOVCF 安全有效，术前体位复位和充分填充伤椎裂隙是治疗成功的关键。

Abstract:

[Objective] To investigate the clinical outcomes of percutaneous vertebroplasty (PVP) for severe osteoporotic vertebral com- pression fractures (sOVCF) . [Methods] A retrospective study was conducted on 39 patients who received PVP for sOVCF in our hospital from September 2018 to December 2020. The clinical and radiological data were evaluated. [Results] All patients were successfully operat- ed on with the mean operation time of (56.3±5.7) min and the mean bone cement injected of (5.2±2.2) ml. Bone cement leakage occurred in 9 cases (23.1%) , including paravertebral leakage in 3 cases and intervertebral leakage in 6 cases, all of which had no obvious clinical symptoms. All the patients were followed up for a mean of (12.7±3.8) months. With time elapsed preoperatively, 2 days postoperatively and the latest follow up, the VAS score [(6.5±0.2) , (2.4±0.8) , (2.5±0.8) , P＜0.05] and ODI score [(77.9±4.4) , (24.2±2.9) , (24.7±3.4) , P＜0.05] significantly reduced, while the JOA score [(14.3±2.7) , (21.3±1.9) , (20.7±1.7) , P＜0.05] significantly increased. Radiographically, the in- jured vertebral height [(6.7±1.7) mm, (16.5±4.0) mm, (14.4±3.3) mm, P＜0.05] increased significantly, while the local kyphotic Cobb angle [(24.1±13.0)°, (15.6±10.2)°, (19.0±1.5)°, P＜0.05] decreased significantly. [Conclusion] The PVP is safe and effective in the treatment of sOVCF. Preoperative position reduction and full filling of injured vertebral fissure are the key to successful treatment.