骨质疏松椎体骨折单侧椎弓根外经皮后凸成形术△

Unilateral extrapedicular percutaneous kyphoplasty for osteoporotic vertebral compression fracture

摘要:

[目的]介绍单侧经椎弓根外入路经皮后凸成形术治疗骨质疏松椎体骨折的手术操作技术和初步临床疗效。[方法] 对 26 例骨质疏松椎体骨折患者，行单侧经椎弓根外入路经皮后凸成形术。穿刺针沿穿刺点向椎弓根外缘逐步穿刺，调整穿刺针，透视正位像上穿刺针尖位于椎弓根外缘，侧位像穿刺针尖位于椎弓根中线，平行于上终板进针约 1 cm。置入环锯，旋入约 2 cm 后取出，沿穿刺工作套管置入球囊，缓慢扩张球囊至塌陷椎体高度恢复，撤出球囊，用骨水泥注入器在透视下低压将骨水泥推入椎体，进行椎体填充。[结果]26 例患者均顺利完成手术，其中骨水泥渗漏 1 例，切口红肿感染 1 例，皮缘坏死 2 例，切口血肿 3 例。随访时间 6 个月~3 年，所有患者疼痛均明显缓解，恢复日常生活活动能力；仅 2 例发现其他椎体新发骨折外，再次给予 PKP 治疗，恢复满意。所有患者均未发生死亡或其他严重并发症。[结论]单侧经椎弓根外入路经皮后凸成形术治疗骨质疏松椎体骨折，操作可行，可缩短手术时间，疗效可靠。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of unilateral extrapedicular percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). [Methods] A total of 26 patients received unilateral extrapedicular percutaneous kyphoplasty for OVCF. The puncture needle was gradually punctured along the puncture point to the outer edge of the pedicle, and the puncture needle was adjusted. As puncture needle tip was located at the outer edge of the pedicle on the anteroposterior (AP) image, and the needle tip was adjusted to locate at the median line of the pedicle on the lateral image, then the needle was inserted about 1 cm parallel to the upper endplate. Subsequently, a trephine was inserted and advanced about 2 cm before removed. A balloon was placed along the puncture working cannula, then was slowly expanded to recover at the height of the collapsed vertebral body. After the balloon was withdrawn, and the bone cement injector was used to push the bone cement into the vertebral body at low pressure with caution until the vertebral body was filled. [Results] All the 26 patients had the extrapedicular PKP performed successfully with 1 case of bone cement leakage, 1 case of knife edge infection, 2 cases of skin edge necrosis, 3 cases of knife edge hematoma. Follow-up period lasted from 6 months to 3 years, with an average of 1.6 years. All patients got significant pain relief and regain daily life activity capacity, except 2 cases who were found new onset of fractures in other vertebrae, were given PKP again and got satisfactory recovery. No death or other serious complications occurred in anyone of them. [Conclusion] Unilateral extrapedicular percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures is feasible with shortened operation time and reliable outcomes.