经皮椎体后凸成形术在多节段腰椎骨质疏松性压缩骨折中的疗效及安全性评价
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摘要
目的评价经皮椎体后凸成形术(PKP)在多节段腰椎骨质疏松性压缩骨折中的疗效及安全性。方法回顾性纳入2012年1月至2017年1月于北京市通州区新华医院行PKP治疗的66例多节段腰椎骨质疏松性压缩骨折患者。通过观察疼痛视觉模拟评分(VAS),腰椎Oswetry功能障碍指数(ODI)(术前以及术后3 d、1个月、6个月、12个月),术前骨折椎体高度,术后3 d椎体恢复高度,计算椎体高度恢复率,评估椎体高度恢复情况。术后3 d复查CT观察骨水泥渗漏情况,并记录并发症发送情况,评估其安全性。术后随访12个月,观察椎体再骨折率。结果所有患者均顺利完成手术,术后疼痛和脊柱活动功能均较术前明显改善。VAS评分从术前(7. 58±0. 14)分降至术后3 d(2. 98±0. 16)分,术后1个月(1. 47±0. 17)分,术后6个月(1. 44±0. 16)分,术后12个月(1. 40±0. 14)分,与术前相比,差异均具有统计学意义(P <0. 05); ODI评分从术前(73. 58±1. 42)%降至术后3 d(22. 95±2. 05)%、术后1个月(22. 84±1. 68)%、术后6个月(24. 19±1. 79)%、术后12个月(22. 70±1. 59)%,与术前相比,差异均具有统计学意义(P <0. 05)。术后椎体高度恢复率为(20±9. 7)%。共208个椎体行PKP,无症状骨水泥渗漏发生在32个椎体(15. 4%)。所有患者均未发生椎间盘炎,术后无感染、神经损伤、骨水泥植入综合征等并发症发生。随访12个月,椎体再骨折发生率为12. 12%。结论 PKP是一种微创且相对安全的治疗方法,可作为治疗多节段腰椎骨质疏松性骨折的首选方法。
Objective To evaluate the efficacy and safety of percutaneous kyphoplasty( PKP) in multi-segment( ≥2) vertebral osteoporotic compression fractures. Methods Sixty-six patients were retrospectively included with multi-segment( ≥2) lumbar osteoporotic compression fractures treated with PKP in Beijing Tongzhou District Xinhua Hospital from January 2012 to January 2017. The clinical efficacy of the surgery was evaluated by VAS,ODI( preoperative,postoperative 3 days,1 month,6 months and 12 months). The height of the vertebral body before after operation was observed. Complications like bone cement leakage were recorded to and evaluate the safety. All patients were followed up for 12 months to observe the re-fracture rate of vertebral body. Results All patients underwent successful operation,and postoperative pain and spinal function were significantly improved compared with preoperative. VAS decreased from( 7. 58 ± 0. 14) scores to( 2. 98 ± 0. 16) scores after3 days of operation,to( 1. 47 ± 0. 17) scores after one month of operation,to( 1. 44 ± 0. 16) scores after 6 months of operation,to( 1. 40 ± 0.14) scores after 12 months of operation( P < 0. 05); ODI score decreased from( 73. 58 ± 1. 42) % to( 22. 95 ± 2. 05) % after 3 days of operation,to( 22. 84 ± 1. 68) % after one month of operation,to( 24. 19 ± 1. 79) % after 6 months of operation,to( 22. 70 ± 1. 59) % after 12 months of operation( P < 0. 05). The vertebral height recovery rate was( 20 ± 9. 7) %. A total of 208 vertebral bodies were treated with percutaneous kyphoplasty,and asymptomatic bone cement leakage occurred in 32 vertebral bodies( 15. 4%). One patient developed dyspnea after surgery and diagnosed pulmonary embolism,but there was no leakage of cement and he was satisfied with anticoagulant therapy. There were no complications such as infection,nerve injury and bone cement syndrome after operation. During the 12 months follow-up period,the incidence of vertebral fractures was 12. 12%. Conclusion PKP is a minimally invasive and relatively safe treatment that can be used as the first choice for the treatment of multiple lumbar osteoporotic fractures.
Objective To evaluate the efficacy and safety of percutaneous kyphoplasty( PKP) in multi-segment( ≥2) vertebral osteoporotic compression fractures. Methods Sixty-six patients were retrospectively included with multi-segment( ≥2) lumbar osteoporotic compression fractures treated with PKP in Beijing Tongzhou District Xinhua Hospital from January 2012 to January 2017. The clinical efficacy of the surgery was evaluated by VAS,ODI( preoperative,postoperative 3 days,1 month,6 months and 12 months). The height of the vertebral body before after operation was observed. Complications like bone cement leakage were recorded to and evaluate the safety. All patients were followed up for 12 months to observe the re-fracture rate of vertebral body. Results All patients underwent successful operation,and postoperative pain and spinal function were significantly improved compared with preoperative. VAS decreased from( 7. 58 ± 0. 14) scores to( 2. 98 ± 0. 16) scores after3 days of operation,to( 1. 47 ± 0. 17) scores after one month of operation,to( 1. 44 ± 0. 16) scores after 6 months of operation,to( 1. 40 ± 0.14) scores after 12 months of operation( P < 0. 05); ODI score decreased from( 73. 58 ± 1. 42) % to( 22. 95 ± 2. 05) % after 3 days of operation,to( 22. 84 ± 1. 68) % after one month of operation,to( 24. 19 ± 1. 79) % after 6 months of operation,to( 22. 70 ± 1. 59) % after 12 months of operation( P < 0. 05). The vertebral height recovery rate was( 20 ± 9. 7) %. A total of 208 vertebral bodies were treated with percutaneous kyphoplasty,and asymptomatic bone cement leakage occurred in 32 vertebral bodies( 15. 4%). One patient developed dyspnea after surgery and diagnosed pulmonary embolism,but there was no leakage of cement and he was satisfied with anticoagulant therapy. There were no complications such as infection,nerve injury and bone cement syndrome after operation. During the 12 months follow-up period,the incidence of vertebral fractures was 12. 12%. Conclusion PKP is a minimally invasive and relatively safe treatment that can be used as the first choice for the treatment of multiple lumbar osteoporotic fractures.
引文
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[6]王凯,李春亮,朱海勇,等.不同治疗方法减轻老年退行性骨质疏松性胸腰椎体压缩性骨折腰背部疼痛的差异:2年随访的非随机,对照临床试验方案及预试验结果[J].中国组织工程研究,2018,22(19):3000-3004.
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[8]马俊.经皮椎体后凸成形术与经皮椎体成形术治疗骨质疏松椎体压缩骨折的疗效比较[J].中国矫形外科杂志,2017,25(6):571-573.
[9]王炜,李富航.单侧或双侧经椎弓根行pkp对骨质疏松性椎体压缩骨折短期与中期预后的影响分析[J].临床和实验医学杂志,2016,15(21):2143-2146.
[10]崔志刚,张德光,刘福全.经皮穿刺椎体成形术结合体位复位在老年胸腰椎压缩性骨折中的应用效果[J].中国现代手术学杂志,2017,21(5):382-386.
[11]Baroud G,Samara M,Steffen T.Influence of mixing method on the cement temperature-mixing time history and doughing time of three acrylic cements for vertebroplasty[J].J Biomed Mater Res B Appl Biomater,2004,68(1):112-116.
[12]闫江涛,闫长红,赵松海,等.经皮椎体成形术治疗骨质疏松性椎体压缩性骨折手术时机与术后疼痛缓解关系的回顾性研究[J].临床和实验医学杂志,2017,16(18):1832-1834.
[13]王兵站,谭洪宇,刘屹林,等.经皮椎体成形术与经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效比较[J].中国老年学杂志,2015,35(24):7121-7123.
[14]张湛金,王煜巍,陈浩,等.经皮椎体成形术与经皮椎体后凸成形术术后手术椎体再发骨折比较[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(1):20-26.
[15]Barr JD,Barr MS,Lemley TJ,et al.Percutaneous vertebroplasty for pain relief and spinal stabilization[J].Spine(Phila Pa 1976),2000,25(8):923-928.
[16]Lavanga A,Guarnieri G,Muto M.Medical therapy and multilevel vertebroplasty in osteoporosis:when and why[J].Neuroradiol J,2010,23(2):244-248.
[17]Zoarski GH,Snow P,Olan WJ,et al.Percutaneous vertebroplasty for osteoporotic compression fractures:quantitative prospective evaluation of long-term outcomes[J].J Vasc Interv Radiol,2002,13(2 Pt 1):139-148.
[18]Mailli L,Filippiadis DK,Brountzos EN,et al.Clinical outcome and safety of multilevel vertebroplasty:clinical experience and results[J].Cardiovasc Intervent Radiol,2013,36(1):183-191.
[19]Singh AK,Pilgram TK,Gilula LA.Osteoporotic compression fractures:outcomes after single-versus multiple-level percutaneous vertebroplasty[J].Radiology,2006,238(1):211-220.
[20]Anselmetti GC,Corrao G,Monica PD,et al.Pain relief following percutaneous vertebroplasty:results of a series of 283 consecutive patients treated in a single institution[J].Cardiovasc Intervent Radiol,2007,30(3):441-447.
[21]Layton KF,Thielen KR,Koch CA,et al.Vertebroplasty,first 1000levels of a single center:evaluation of the outcomes and complications[J].AJNR Am J Neuroradiol,2007,28(4):683-689.
[22]Kim SH,Kang HS,Choi JA,et al.Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J].Acta Radiol,2004,45(4):440-445.
[23]Syed MI,Patel NA,Jan S,et al.New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women[J].AJNR Am J Neuroradiol,2005,26(6):1601-1604.
[24]Tanigawa N,Komemushi A,Kariya S,et al.Radiological follow-up of new compression fractures following percutaneous vertebroplasty[J].Cardiovasc Intervent Radiol,2006,29(1):92-96.
[25]Uppin AA,Hirsch JA,Centenera LV,et al.Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis[J].Radiology,2003,226(1):119-124.
[26]Lee DG,Park CK,Park CJ,et al.Analysis of Risk Factors Causing New Symptomatic Vertebral Compression Fractures After Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures:A 4-year Follow-up[J].J Spinal Disord Tech,2015,28(10):E578-583.
[2]中国健康促进基金会骨质疏松防治中国白皮书编委会.骨质疏松症中国白皮书[J].中华健康管理学杂志,2009,3(3):148-154.
[3]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5):413-443.
[4]Siris ES,Adler R,Bilezikian J,et al.The clinical diagnosis of osteoporosis:a position statement from the National Bone Health Alliance Working Group[J].Osteoporos Int,2014,25(5):1439-1443.
[5]王干生,陈峰,倪生华,等.经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩性骨折患者40例疗效观察[J].中国现代手术学杂志,2017,21(6):419-422.
[6]王凯,李春亮,朱海勇,等.不同治疗方法减轻老年退行性骨质疏松性胸腰椎体压缩性骨折腰背部疼痛的差异:2年随访的非随机,对照临床试验方案及预试验结果[J].中国组织工程研究,2018,22(19):3000-3004.
[7]Ling X,Cummings SR,Mingwei Q,et al.Vertebral fractures in Beijing,China:the Beijing Osteoporosis Project[J].J Bone Miner Res,2000,15(10):2019-2025.
[8]马俊.经皮椎体后凸成形术与经皮椎体成形术治疗骨质疏松椎体压缩骨折的疗效比较[J].中国矫形外科杂志,2017,25(6):571-573.
[9]王炜,李富航.单侧或双侧经椎弓根行pkp对骨质疏松性椎体压缩骨折短期与中期预后的影响分析[J].临床和实验医学杂志,2016,15(21):2143-2146.
[10]崔志刚,张德光,刘福全.经皮穿刺椎体成形术结合体位复位在老年胸腰椎压缩性骨折中的应用效果[J].中国现代手术学杂志,2017,21(5):382-386.
[11]Baroud G,Samara M,Steffen T.Influence of mixing method on the cement temperature-mixing time history and doughing time of three acrylic cements for vertebroplasty[J].J Biomed Mater Res B Appl Biomater,2004,68(1):112-116.
[12]闫江涛,闫长红,赵松海,等.经皮椎体成形术治疗骨质疏松性椎体压缩性骨折手术时机与术后疼痛缓解关系的回顾性研究[J].临床和实验医学杂志,2017,16(18):1832-1834.
[13]王兵站,谭洪宇,刘屹林,等.经皮椎体成形术与经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效比较[J].中国老年学杂志,2015,35(24):7121-7123.
[14]张湛金,王煜巍,陈浩,等.经皮椎体成形术与经皮椎体后凸成形术术后手术椎体再发骨折比较[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(1):20-26.
[15]Barr JD,Barr MS,Lemley TJ,et al.Percutaneous vertebroplasty for pain relief and spinal stabilization[J].Spine(Phila Pa 1976),2000,25(8):923-928.
[16]Lavanga A,Guarnieri G,Muto M.Medical therapy and multilevel vertebroplasty in osteoporosis:when and why[J].Neuroradiol J,2010,23(2):244-248.
[17]Zoarski GH,Snow P,Olan WJ,et al.Percutaneous vertebroplasty for osteoporotic compression fractures:quantitative prospective evaluation of long-term outcomes[J].J Vasc Interv Radiol,2002,13(2 Pt 1):139-148.
[18]Mailli L,Filippiadis DK,Brountzos EN,et al.Clinical outcome and safety of multilevel vertebroplasty:clinical experience and results[J].Cardiovasc Intervent Radiol,2013,36(1):183-191.
[19]Singh AK,Pilgram TK,Gilula LA.Osteoporotic compression fractures:outcomes after single-versus multiple-level percutaneous vertebroplasty[J].Radiology,2006,238(1):211-220.
[20]Anselmetti GC,Corrao G,Monica PD,et al.Pain relief following percutaneous vertebroplasty:results of a series of 283 consecutive patients treated in a single institution[J].Cardiovasc Intervent Radiol,2007,30(3):441-447.
[21]Layton KF,Thielen KR,Koch CA,et al.Vertebroplasty,first 1000levels of a single center:evaluation of the outcomes and complications[J].AJNR Am J Neuroradiol,2007,28(4):683-689.
[22]Kim SH,Kang HS,Choi JA,et al.Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J].Acta Radiol,2004,45(4):440-445.
[23]Syed MI,Patel NA,Jan S,et al.New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women[J].AJNR Am J Neuroradiol,2005,26(6):1601-1604.
[24]Tanigawa N,Komemushi A,Kariya S,et al.Radiological follow-up of new compression fractures following percutaneous vertebroplasty[J].Cardiovasc Intervent Radiol,2006,29(1):92-96.
[25]Uppin AA,Hirsch JA,Centenera LV,et al.Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis[J].Radiology,2003,226(1):119-124.
[26]Lee DG,Park CK,Park CJ,et al.Analysis of Risk Factors Causing New Symptomatic Vertebral Compression Fractures After Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures:A 4-year Follow-up[J].J Spinal Disord Tech,2015,28(10):E578-583.