单球囊双侧交替扩张后凸成形术结合体位复位治疗严重骨质疏松性椎体压缩骨折.pdfVIP

浙江临床医学2014年11月第16卷第11期 ·1711· 单球囊双侧交替扩张后凸成形术结合体位复位 治疗严重骨质疏松性椎体压缩骨折 何 磊  钱宇  金以军 【摘要】 目的 观察体位复位辅助下单球囊双侧交替扩张后凸成形术治疗严重骨质疏松性椎体压缩骨折的临床疗效。方 法 回顾分析2009年1月至2012年2月，采用单球囊双侧交替扩张后凸成形术结合体位复位治疗骨质疏松性椎体压缩骨折患者 32例（36椎），其中男5例，女27例；年龄61~91岁，平均71.2岁。患者椎体压缩程度75.1%~80.2% ，平均77%。取俯卧位调节 手术床使患者椎体骨折部位过伸，达到一定闭合复位后，在”C”型臂X线机引导下，经皮穿刺进针，经两侧椎弓根建立工作 通道后，一侧放入可扩张球囊，行两侧缓慢交替扩张。复位基本满意或球囊到达椎体皮质时停止扩张，取出球囊，在”C”型 臂X线机监视下将骨水泥注入椎体。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度。记录分析视觉模拟评分（visual analogue scale ，VAS ）及伤椎形态变化。结果 椎体前壁高度和中间高度明显恢复，后凸畸形得到矫正，术后伤椎处疼痛均显 著缓解，VAS评分从术前平均（7.28 ±1.11 ）分降至术后平均（1.92 ±0.73 ）分。结论 单球囊双侧交替扩张后凸成形术结合 体位复位是治疗严重骨质疏松性椎体压缩骨折的可行及有效方法。 【关键词】 严重椎体压缩骨折 椎体后凸成形术 胸椎 腰椎 疗效 【Abstract 】 Objective To evaluate the feasibility and therapeutic effect of combination of postural reduction and Kyphoplasty with one balloon bilateral dilatation in treating severe osteoporotic compressive fractures. Methods Thiety-two patients （36 vertebral bodies ） with very severe osteoporotic compressive fractures were included. There were 27 females and 5 males with the mean age of 71.2 years.Patients were treated with posture reduction by extending the operating table ，then the reduction of the vertebral body was performed by one balloon dilatation via bilateral transpedicular approach in rotation.And then the balloon was deflated and withdraw ， leaving cavity within the vertebral body ，which then fulfilled with bone cement.Preoperative and postoperative radiographic findings and visual analog scale （VAS ） were recorded. Results All patients reported significant alleviation of the pain after treatment. VAS score was reduced averagely from （7.28 ±1.11 ）to （1.92 ±0.73 ），the anterior and middle vertebral height was restored and kyphotic abnormality was corrected. Conclusion Combination of postural reduction and Kyphoplasty with one balloon bilateral dilatation is feasible and effective