低压力单球囊单侧PKP治疗多椎体OVCF的临床疗效分析
|
摘要
目的探讨低压力单球囊单侧经皮椎体后凸成形术治疗多椎体骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法回顾2013年1月至2016年6月昆明医科大学第二附属医院收治的15例(共33个椎体)采用低压力单球囊单侧经皮椎体后凸成形术治疗OVCF患者的临床资料,其中双椎体12例,3椎体3例。扩张球囊压力不超过220Psi,同一患者使用同一个球囊,只行单侧椎弓根注射。分析患者术前及术后疼痛程度、活动能力、止痛药使用、椎体前缘、中线高度和局部后凸Cobb角、并发症发生情况。结果 15例患者均顺利完成手术。球囊扩张压力120～220Psi,平均200Psi。3例4个椎体发生骨水泥椎间盘渗漏,均无明显临床症状。无球囊破裂、肺栓塞、临近椎体骨折等并发症发生。患者术后1d、术后1周、术后4周、术后6个月模拟视觉评分(VAS)、活动能力、止痛药使用评分与术前1d比较显著降低,差异具有统计学意义(P<0.01)。术后1周、术后6个月椎体前缘高度、椎体中线高度、Cobb角与术前比较,高度与Cobb角显著恢复,差异具有统计学意义(P<0.05)。结论应用低压力单球囊单侧经皮椎体后凸成形术治疗多椎体OVCF,具有有效缓解疼痛、恢复椎体高度、恢复活动能力、减少止痛药物使用等优点。
Objective To investigate the clinical effect of low pressure single balloon unilateral percutaneous kyphoplasty for treating multiple vertebral osteoporotic vertebral compression fractures(OVCF).Methods The clinical data of 15 patients with OVCF(33 vertebraes)treated by low pressure single balloon unilateral percutaneous kyphoplasty in the Second Affiliated Hospital of Kunming Medical University from January2013 to June 2016 were reviewed,including 15 cases of double vertebral bodies and 3 cases of 3 vertebral bodies.The pressure of the expanded balloon was not exceeding 220 Psi.The same balloon was used in the same patient,and only one side pedicle was injected.The preoperative and postoperative pain degree,activity ability,use of analgesic drugs,anterior edge of vertebral body,middle line height and local kyphosis Cobb angle,and complications occurrence were analyzed.Results Fifteen cases successfully completed the operation.The balloon dilatation pressure was 120-220 Psi,with an average of 200 Psi.The bone cement intervertebral disc leakage occurred in 4 vertebraes of 3 cases without obvious clinical symptoms.No complications such as balloon rupture,pulmonary embolism,and adjacent vertebral fractures occurred.VAS,activity ability,use score of analgesic drugs on postoperative 1 d,at postoperative 1,4 weeks and postoperative 6 months were significantly decreased compared with those on preoperative 1 d,the differences were statistically significant(P<0.05).The height of vertebral anterior margin,height of vertebral body middle line and Cobb angle were significantly restored compared before operation,and the difference was statistically significant(P<0.05).Conclusion The treatment of vertebral compression fractures with multi-vertebral osteoporotic vertebral compression fractures The application of low-pressure single balloon unilateral percutaneous kyphoplasty for treating multiple vertebral OVCF has the advantages of effectively relieving pain,restoring the vertebral height,recovering the activity ability and reducing the use of analgesic drugs and so on.
Objective To investigate the clinical effect of low pressure single balloon unilateral percutaneous kyphoplasty for treating multiple vertebral osteoporotic vertebral compression fractures(OVCF).Methods The clinical data of 15 patients with OVCF(33 vertebraes)treated by low pressure single balloon unilateral percutaneous kyphoplasty in the Second Affiliated Hospital of Kunming Medical University from January2013 to June 2016 were reviewed,including 15 cases of double vertebral bodies and 3 cases of 3 vertebral bodies.The pressure of the expanded balloon was not exceeding 220 Psi.The same balloon was used in the same patient,and only one side pedicle was injected.The preoperative and postoperative pain degree,activity ability,use of analgesic drugs,anterior edge of vertebral body,middle line height and local kyphosis Cobb angle,and complications occurrence were analyzed.Results Fifteen cases successfully completed the operation.The balloon dilatation pressure was 120-220 Psi,with an average of 200 Psi.The bone cement intervertebral disc leakage occurred in 4 vertebraes of 3 cases without obvious clinical symptoms.No complications such as balloon rupture,pulmonary embolism,and adjacent vertebral fractures occurred.VAS,activity ability,use score of analgesic drugs on postoperative 1 d,at postoperative 1,4 weeks and postoperative 6 months were significantly decreased compared with those on preoperative 1 d,the differences were statistically significant(P<0.05).The height of vertebral anterior margin,height of vertebral body middle line and Cobb angle were significantly restored compared before operation,and the difference was statistically significant(P<0.05).Conclusion The treatment of vertebral compression fractures with multi-vertebral osteoporotic vertebral compression fractures The application of low-pressure single balloon unilateral percutaneous kyphoplasty for treating multiple vertebral OVCF has the advantages of effectively relieving pain,restoring the vertebral height,recovering the activity ability and reducing the use of analgesic drugs and so on.
引文
[1]TOLBA R,BOLASH R B,SHROLL J,et al.Kyphoplasty increases vertebral height,decreases both pain score and opiate requirements while improving functional status[J].Pain Pract,2014,14(3):91-97.
[2]SAXENA B P,SHAH B V,JOSHI S P.Outcome of percutaneous balloon kyphoplasty in vertebral compression fractures[J].Ind J Orthop,2015,49(4):458-464.
[3]WANG E,YI H W,WANG M,et al.Treatment of osteoporotic vertebral compression fractures with percutaneous kyphoplasty:a report of 196cases[J].Eur J Orthop Surg Traumatol,2013(1):71-75.
[4]LI L H,SUN T S,LIU Z,et al.Comparison of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures:a meta-analysis[J].Chin Med J(Engl),2013,126(20):3956-3961.
[5]隋福革,李恒,赵丛然,等.经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的并发症分析[J].中国脊柱脊髓杂志,2012,22(11):984-988.
[6]李勇,段大鹏,刘宗智.不同剂量骨水泥PKP治疗老年骨质疏松椎体压缩骨折疗效观察[J].陕西医学杂志,2015,44(3):303-305.
[7]WARDLAW D,VAN MEIRHAEGHE J,RANSTAM J,et al.Balloon kyphoplasty in patients with osteoporotic vertebral compression fractures[J].Expert Rev Med Devices,2012,9(4):423-436.
[8]RYU K S,HUH H Y,JUN S C,et al.Single-Balloon kyphoplasty in osteoporotic vertebral compression fractures:Far-lateral extrapedicular approach[J].J Korean Neurosurg Soc,2009,45(2):122-126.
[9]王成日,杨文彬,廖海浪,等.单侧入路单球囊治疗老年多椎体骨质疏松性骨折临床疗效分析[J].中国矫形外科杂志,2012,20(7):654-655.
[10]SONG B K,EUN J P,OH Y M.Clinical and radiological comparison of unipedicular versus bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures[J].Osteoporos Int,2009,20(10):1717-1723.
[11]WARDLAW D,CUMMINGS S R,VAN MEIRHAE-GHE J,et al.Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture(FREE):a randomised controlled trial[J].Lancet,2009,373(9668):1016-1024.
[12]罗文东,杨建义,林丰,等.骨质疏松性椎体压缩骨折经皮椎体后凸成形术围术期并发症防治进展[J].医学综述,2016,22(3):428-431.
[13]ZARGHOONI K,SIEWE J,KAULHAUSEN T,et al.Complications of vertebroplasty and kyphoplasty in the treatment of vertebral fractures:results of a questionnaire study[J].Acta Orthop Belg,2012,78(4):512-518.
[14]罗文东,赵刚,林丰,等.高黏度骨水泥治疗骨质疏松性椎体压缩骨折的临床研究[J].实用医学杂志,2015,31(24):4107-4109.
[2]SAXENA B P,SHAH B V,JOSHI S P.Outcome of percutaneous balloon kyphoplasty in vertebral compression fractures[J].Ind J Orthop,2015,49(4):458-464.
[3]WANG E,YI H W,WANG M,et al.Treatment of osteoporotic vertebral compression fractures with percutaneous kyphoplasty:a report of 196cases[J].Eur J Orthop Surg Traumatol,2013(1):71-75.
[4]LI L H,SUN T S,LIU Z,et al.Comparison of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures:a meta-analysis[J].Chin Med J(Engl),2013,126(20):3956-3961.
[5]隋福革,李恒,赵丛然,等.经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的并发症分析[J].中国脊柱脊髓杂志,2012,22(11):984-988.
[6]李勇,段大鹏,刘宗智.不同剂量骨水泥PKP治疗老年骨质疏松椎体压缩骨折疗效观察[J].陕西医学杂志,2015,44(3):303-305.
[7]WARDLAW D,VAN MEIRHAEGHE J,RANSTAM J,et al.Balloon kyphoplasty in patients with osteoporotic vertebral compression fractures[J].Expert Rev Med Devices,2012,9(4):423-436.
[8]RYU K S,HUH H Y,JUN S C,et al.Single-Balloon kyphoplasty in osteoporotic vertebral compression fractures:Far-lateral extrapedicular approach[J].J Korean Neurosurg Soc,2009,45(2):122-126.
[9]王成日,杨文彬,廖海浪,等.单侧入路单球囊治疗老年多椎体骨质疏松性骨折临床疗效分析[J].中国矫形外科杂志,2012,20(7):654-655.
[10]SONG B K,EUN J P,OH Y M.Clinical and radiological comparison of unipedicular versus bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures[J].Osteoporos Int,2009,20(10):1717-1723.
[11]WARDLAW D,CUMMINGS S R,VAN MEIRHAE-GHE J,et al.Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture(FREE):a randomised controlled trial[J].Lancet,2009,373(9668):1016-1024.
[12]罗文东,杨建义,林丰,等.骨质疏松性椎体压缩骨折经皮椎体后凸成形术围术期并发症防治进展[J].医学综述,2016,22(3):428-431.
[13]ZARGHOONI K,SIEWE J,KAULHAUSEN T,et al.Complications of vertebroplasty and kyphoplasty in the treatment of vertebral fractures:results of a questionnaire study[J].Acta Orthop Belg,2012,78(4):512-518.
[14]罗文东,赵刚,林丰,等.高黏度骨水泥治疗骨质疏松性椎体压缩骨折的临床研究[J].实用医学杂志,2015,31(24):4107-4109.