经皮椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折的疗效
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摘要
背景:经皮椎体后凸成形术治疗胸腰段椎体骨质疏松性压缩骨折已成为常规手段,但用来治疗中上胸椎压缩骨折仍是一个挑战。目的:评估单侧椎弓根外入路行经皮椎体后凸成形术治疗中段胸椎骨质疏松性椎体压缩骨折的临床疗效。方法:选择2013年8月至2017年1月间经单侧椎弓根外入路行经皮椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折患者28例(38椎)。记录并比较患者术前、术后1周及末次随访时疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及椎体前缘高度。结果:28例患者均顺利完成手术,切口甲级愈合。所有患者均获得随访,随访时间7～24个月,平均随访(13.2±1.3)个月。4例患者椎体出现骨水泥渗漏,其中2例渗漏至椎体前缘,2例渗漏至椎间隙。无脊髓压迫症、肺栓塞及下肢深静脉血栓等严重并发症。患者术后1周及末次随访时疼痛VAS评分、ODI均较术前降低[(2.5±0.5)、(2.8±0.3)分vs(7.5±0.5)分,(34.2±1.5)%、(30.5±1.9)%vs(63.5±1.9)%],椎体前缘高度均较术前增加[(17.8±0.4)、(18.2±0.9)mm vs(12.7±1.3)mm],且差异均有统计学意义(P均<0.05);而患者术后1周与末次随访时疼痛VAS评分、ODI、椎体前缘高度差异均无统计学意义。结论:单侧椎弓根外入路经皮椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折,安全性高,并发症少,可明显改善伤椎椎体前缘高度,显著减轻患者背部疼痛,提高生活质量。
Background:Percutaneous kyphoplasty has become a classic procedure for osteoporotic vertebral compression fracture of low thoracic and thoracolumbar spine.However,kyphoplasty in middle and high thoracic levels is technically challenged.Objective:To evaluate clinical outcomes of percutaneous kyphoplasty via unilateral extrapedical approach in the treatment of mid-thoracic vertebral compression fractures.Methods:From August 2013 to January 2017,28 patients(38 vertebrae)with mid-thoracic osteoporotic fractures were treated by percutaneous kyphoplasty via unilateral extrapedicular approach.Vertebral anterior margin height,visual analogue scale(VAS)and Oswestry disability index(ODI)were recorded before operation,one week after operation and at the final follow-up.Results:Operation was successfully performed in all the 28 patients with primary wound healing.The average duration of follow-up was(13.2±1.3)months(range,7-24 months)in all the patients.Bone cement leakage occurred in 4 cases(the leakage reached the anterior edge of the vertebral body in 2 cases and to intervertebral space in the other two cases).No severe complications such as spinal cord compression,pulmonary embolism or deep venous thrombosis of lower extremities occurred.Compared with preoperative ones,VAS and ODI were significantly reduced at one week after operation and the final follow-up(7.5±0.5,2.5±0.5,2.8±0.3;63.5%±1.9%,34.2%±1.5%,30.5%±1.9%),while the vertebral anterior margin height was significantly increased([12.7±1.3]mm,[17.8±0.4]mm,[18.2±0.9]mm,P<0.05].However,there was no significant difference in the above-mentioned parameters at one week after operation versus those at the final follow-up(P>0.05).Conclusions:Unilateral extrapedicular kyphoplasty is safe and effective in treating mid-thoracic osteoporotic fractures.It can significantly release backache,restore vertebral anterior margin height.
Background:Percutaneous kyphoplasty has become a classic procedure for osteoporotic vertebral compression fracture of low thoracic and thoracolumbar spine.However,kyphoplasty in middle and high thoracic levels is technically challenged.Objective:To evaluate clinical outcomes of percutaneous kyphoplasty via unilateral extrapedical approach in the treatment of mid-thoracic vertebral compression fractures.Methods:From August 2013 to January 2017,28 patients(38 vertebrae)with mid-thoracic osteoporotic fractures were treated by percutaneous kyphoplasty via unilateral extrapedicular approach.Vertebral anterior margin height,visual analogue scale(VAS)and Oswestry disability index(ODI)were recorded before operation,one week after operation and at the final follow-up.Results:Operation was successfully performed in all the 28 patients with primary wound healing.The average duration of follow-up was(13.2±1.3)months(range,7-24 months)in all the patients.Bone cement leakage occurred in 4 cases(the leakage reached the anterior edge of the vertebral body in 2 cases and to intervertebral space in the other two cases).No severe complications such as spinal cord compression,pulmonary embolism or deep venous thrombosis of lower extremities occurred.Compared with preoperative ones,VAS and ODI were significantly reduced at one week after operation and the final follow-up(7.5±0.5,2.5±0.5,2.8±0.3;63.5%±1.9%,34.2%±1.5%,30.5%±1.9%),while the vertebral anterior margin height was significantly increased([12.7±1.3]mm,[17.8±0.4]mm,[18.2±0.9]mm,P<0.05].However,there was no significant difference in the above-mentioned parameters at one week after operation versus those at the final follow-up(P>0.05).Conclusions:Unilateral extrapedicular kyphoplasty is safe and effective in treating mid-thoracic osteoporotic fractures.It can significantly release backache,restore vertebral anterior margin height.
引文
[1]Bouza C,López-Cuadrado T,Almendro N,et al.Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe:a meta-analysis of randomized controlled trials.Eur Spine J,2015,24(4):715-723.
[2]Clark W,Bird P,Gonski P,et al.Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures(VAPOUR):a multicentre,randomised,double-blind,placebo-controlled trial.Lancet,2016,388(10052):1408-1416.
[3]Yuan WH,Hsu HC,Lai KL,et al.Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures:A meta-analysis.Medicine,2016,95(31):e4491.
[4]Edidin AA,Ong KL,Lau E,et al.Mortality risk for operated and nonoperated vertebral fracture patients in the medicare population.J Bone Miner Res,2011,26(7):1617-1626.
[5]邱贵兴,裴福兴,胡贞明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨质诊断及治疗原则).中华关节外科杂志(电子版),2015,9(6):371-374.
[6]Seong JY,Kim JS,Jung B,et al.CT-guided percutaneous vertebroplasty in the treatment of an upper thoracic compression fracture.Korean J Radiol,2009,10(2):185-189.
[7]印飞,孙振中,宋升,等.单侧与双侧PKP治疗上中位胸椎骨质疏松行压缩骨折的前瞻性随机对照研究.中国骨与关节损伤杂志,2015,30(11):1137-1140.
[8]马红林,栗浩,王庆生.经皮穿刺椎体成形术对骨质疏松性椎体压缩性骨折患者骨钙素水平影响及短期疗效.中华骨与关节外科杂志,2018,11(11):821-825.
[9]Wang AC,Fahim DK.Safety and efficacy of balloon kyphoplasty at 4 or more levels in a single anesthetic session.JNeurosurg Spine,2018,28(4):372-378.
[10]刘昊,迮骁,邹俊,等.经皮椎体后凸成形术的骨水泥分布与临床疗效分析.中华骨与关节外科杂志,2017,10(1):8-12.
[11]Steinmann J,Tingey CT,Cruz G,et al.Biomechanical comparison of unipedicular versus bipedicular kyphoplasty.Spine,2005,30(2):201-205.
[12]Cheng X,Long HQ,Xu JH,et al.Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):a systematic review and meta-analysis.Eur Spine J,2016,25(11):1-11.
[13]陈柏龄,黎艺强,谢登辉,等.单侧与双侧椎体后凸成形术对椎体刚度和力学平衡影响的对比研究.中华创伤骨科杂志,2011,13(3):251-255.
[14]Polis B,Krawczyk J,Polis L,et al.Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patienttechnical note.Childs Nerv Syst,2016,32(11):2225-2231.
[15]Liang L,Chen X,Jiang W,et al.Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture?An updated systematic review and meta-analysis.Ann Saudi Med,2016,36(3):165-174.
[16]杨惠林,刘强,唐海.经皮椎体后凸成形术的规范化操作及相关问题的专家共识.中华医学杂志,2018,98(11):808-812.
[17]Lange A,Kasperk C,Alvares L,et al.Survival and cost comparison of kyphoplasty and percutaneous vertebroplasty using German claims data.Spine(Phila Pa 1976),2014,39(4):318-326.
[2]Clark W,Bird P,Gonski P,et al.Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures(VAPOUR):a multicentre,randomised,double-blind,placebo-controlled trial.Lancet,2016,388(10052):1408-1416.
[3]Yuan WH,Hsu HC,Lai KL,et al.Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures:A meta-analysis.Medicine,2016,95(31):e4491.
[4]Edidin AA,Ong KL,Lau E,et al.Mortality risk for operated and nonoperated vertebral fracture patients in the medicare population.J Bone Miner Res,2011,26(7):1617-1626.
[5]邱贵兴,裴福兴,胡贞明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨质诊断及治疗原则).中华关节外科杂志(电子版),2015,9(6):371-374.
[6]Seong JY,Kim JS,Jung B,et al.CT-guided percutaneous vertebroplasty in the treatment of an upper thoracic compression fracture.Korean J Radiol,2009,10(2):185-189.
[7]印飞,孙振中,宋升,等.单侧与双侧PKP治疗上中位胸椎骨质疏松行压缩骨折的前瞻性随机对照研究.中国骨与关节损伤杂志,2015,30(11):1137-1140.
[8]马红林,栗浩,王庆生.经皮穿刺椎体成形术对骨质疏松性椎体压缩性骨折患者骨钙素水平影响及短期疗效.中华骨与关节外科杂志,2018,11(11):821-825.
[9]Wang AC,Fahim DK.Safety and efficacy of balloon kyphoplasty at 4 or more levels in a single anesthetic session.JNeurosurg Spine,2018,28(4):372-378.
[10]刘昊,迮骁,邹俊,等.经皮椎体后凸成形术的骨水泥分布与临床疗效分析.中华骨与关节外科杂志,2017,10(1):8-12.
[11]Steinmann J,Tingey CT,Cruz G,et al.Biomechanical comparison of unipedicular versus bipedicular kyphoplasty.Spine,2005,30(2):201-205.
[12]Cheng X,Long HQ,Xu JH,et al.Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):a systematic review and meta-analysis.Eur Spine J,2016,25(11):1-11.
[13]陈柏龄,黎艺强,谢登辉,等.单侧与双侧椎体后凸成形术对椎体刚度和力学平衡影响的对比研究.中华创伤骨科杂志,2011,13(3):251-255.
[14]Polis B,Krawczyk J,Polis L,et al.Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patienttechnical note.Childs Nerv Syst,2016,32(11):2225-2231.
[15]Liang L,Chen X,Jiang W,et al.Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture?An updated systematic review and meta-analysis.Ann Saudi Med,2016,36(3):165-174.
[16]杨惠林,刘强,唐海.经皮椎体后凸成形术的规范化操作及相关问题的专家共识.中华医学杂志,2018,98(11):808-812.
[17]Lange A,Kasperk C,Alvares L,et al.Survival and cost comparison of kyphoplasty and percutaneous vertebroplasty using German claims data.Spine(Phila Pa 1976),2014,39(4):318-326.