单侧入路经皮椎体后凸成形术治疗老年人脊柱脆性骨折

Unipedicular percutaneous kyphoplasty for treatment of vertebral fragility fractures in the elderly

摘要:

目的 探讨单侧入路经皮椎体后凸成形术（PKP）治疗老年人脊柱脆性骨折的有效性。方法 2009年1月至2011年1月，使用经皮椎体后凸成形PKP工具包治疗20例34个椎体脊椎脆性骨折。记录手术前后椎体前缘高度、Cobb￠s角、VAS评分，术后2d、随访末与术前进行比较。并记录并发症。结果 20例34个锥体顺利完成单侧PKP手术，手术过程顺利。20例均获随访，随访时间10～20个月，平均15.5个月。术前椎体前缘高度（17.68±3.33）mm，术后（30.94±3.22）mm，术前、术后比较，差异具有统计学意义（P＜0.05）；术前视觉疼痛模拟评分（VAS）（7.15±1.17）分，术后2d及末次随访时VAS分别为（2.20±0.53）分和（2.10±0.45）分，与术前比较,差异均有统计学意义（P＜0.05），术后2d与末次随访比较，差异无统计学意义（P＞0.05）。Cobb￠s角从术前平均（21.53°±5.22°）减小至术后（7.35°±2.16°），手术前后比较，差异具有统计学意义（P＜0.05）。1例1个椎体术中发生骨水泥外漏至椎管（2.9%），随访中无明显临床症状。继发骨折2例2个椎体（5.9%），均再次入院行PKP手术治疗。结论 单侧入路PKP是治疗老年脊柱脆性骨折安全有效的方法，与传统双侧PKP相比较，在缓解疼痛、椎体高度恢复、Cobb￠s角恢复等效果接近，但能够减少一半患者暴露在放射线中的机会，降低手术费用，减少手术时间，提高老年人生活质量。

Abstract:

Objective To evaluate the clinical outcomes and efficiency of the unipedicular percutaneous kyphoplasty(PKP) in vertebral fragility fractures. Methods A prospective observational study was performed. Twenty patients with a total of 34 vertebral compression fractures underwent kyphoplasty utilizing a unilateral pedicular/unipedicular approach. The vertebral bodies were measured at the anterior margins. And visual analog scale(VAS), Cobb￠s angle were compared preoperatively, at day 2 and the end of follow-up postoperatively. Complications were recorded. Height restoration, pain relief and Cobb￠s angle change were assessed pre- and post-operatively. Results Twenty patients underwent unipedicular PKP for a total of 34 levels. The mean duration of follow-up was 15.5 months (ranging 10 to 20 months). The mean pre-operative anterior vertebral height was (17.68±3.33)mm and postoperative one was (30.94±3.22)mm, which was significantly different (P＜0.05). The mean VAS was (7.15±1.17), (2.20±0.53) and (2.10±0.45) preoperatively, at day 2, and at the end of follow-up respectively, with significant difference between the 3 time points (P＜0.05). The VAS change had no statistica1 significance between day 2 and the end of follow-up time point (P＞0.05). The Cobb￠s angle decreased from (21.53°±5.22°) to (7.35°±2.16°), with statistical significance (P＜0.05). Cement extravagation was observed in one asymptomatic case (2.9%). Adjacent vertebral fractures were observed on 2 levels (5.9%) in 2 cases, who underwent kyphoplasty again. Conclusions Unipedicular PKP is both a safe and efficacious alternative to the traditional bipedicular kyphoplasty for the treatment of painful vertebral fragility fractures. And it is comparable with bipedicular kyphoplasty in height restoration, pain relief and Cobb￠s angle change. And also, it is faster, less expensive and involves less radiation exposure for the patient. It improves the life quality of the involved elderly cases.