單側入路經皮椎體成形術治療伴裂隙樣變的骨質疏松性椎體壓縮骨折_《中國修復重建外科雜志》

作者：

高萬旭 , 宓士軍 , 高景春

唐山市豐潤區人民醫院骨科（河北唐山，064000）;

關鍵詞：

經皮椎體成形術骨質疏松性椎體壓縮骨折椎體內裂隙樣變單側入路

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目的比較研究單側入路經皮椎體成形術（percutaneous vertebroplasty，PVP）治療伴或不伴椎體內裂隙樣變的骨質疏松性椎體壓縮骨折的療效，分析椎體內裂隙樣變對療效的影響。方法回顧性分析2008年1月－2011年3月符合選擇標準的65例骨質疏松性椎體壓縮骨折患者，根據是否伴椎體內裂隙樣變，分為裂隙樣變組（A組，25例）和非裂隙樣變組（B組，40例）。兩組性別、年齡、致傷原因、損傷節段、骨折程度、傷后至手術時間等一般資料比較差異均無統計學意義（P gt; 0.05），具有可比性。均采用單側入路PVP治療。記錄兩組手術時間、注入骨水泥量、起床活動時間、并發癥、相鄰椎體再骨折等。術前、術后1周及48周通過站立側位X線片測量傷椎前中柱椎體高度和傷椎后凸Cobb角的變化；術前，術后1、4、48周分別采用疼痛視覺模擬評分（VAS）和Oswestry功能障礙指數（ODI）評價疼痛緩解及功能改善情況。結果兩組手術時間、起床活動時間比較差異均無統計學意義（P gt; 0.05），注入骨水泥量B組少于A組（t=1.833，P=0.034）。術中發生骨水泥滲漏6例（A組4例、B組2例），其中A組滲漏至靜脈叢1例，椎體周圍2例，椎間盤內1例；B組滲漏至靜脈叢2例。無癥狀性肺動脈栓塞發生，術中、術后生命體征均平穩。兩組均獲隨訪，隨訪時間12～30個月，平均18.5個月。隨訪期間無相鄰及遠位椎體骨折，無受傷椎體再骨折。兩組術后各時間點VAS評分、ODI、椎體前中柱高度及傷椎后凸Cobb角均較術前顯著改善，差異有統計學意義（P lt; 0.05）；術前及術后各時間點兩組間比較差異均無統計學意義（P gt; 0.05）。結論單側入路PVP是治療伴椎體內裂隙樣變的骨質疏松性椎體壓縮骨折的有效方法，椎體內裂隙樣變對PVP的止痛療效、功能改善無明顯影響。

引用本文： 高萬旭,宓士軍,高景春. 單側入路經皮椎體成形術治療伴裂隙樣變的骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2012, 26(11): 1330-1335. doi: 復制

1.	Genant HK, Jergas M. Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int, 2003, 14(3 Suppl): 43-45.
2.	Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology, 1978, 129(1): 23-29.
3.	Mirovsky Y, Anekstein Y, Shalmon E, et al. Vacuum clefts of the vertebral bodies. AJNR Am J Neuroradiol, 2005, 26(7): 1634-1640.
4.	Kumpan W, Salomonowitz E, Seidl G, et al. The intravertebral vacuum phenomenon. Skeletal Radiol, 1986, 15(6): 444-447.
5.	Yang H, Gan M, Zou J, et al. Kyphoplasty for the treatment of Kümmell’s disease. Orthopedics, 2010, 33(7): 479.
6.	Koike Y, Takizawa K, Ogawa Y, et al. Percutaneous vertebroplasty for vertebral compression fractures with intravertebral cleft: cement injection under vacuum aspiration. J Vasc Interv Radiol, 2011, 22(12): 1721-1726.
7.	張云慶, 楊惠光, 劉勇, 等. 球囊擴張椎體后凸成形術結合過伸體位復位治療中晚期 Kümmell 病的療效分析. 中國修復重建外科雜志, 2012, 26(4): 411-415.
8.	Lane JI, Maus TP, Wald JT, et al. Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. AJNR Am J Neuroradiol, 2002, 23(10): 1642-1246.
9.	McKiernan F, Faciszewski T. Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum, 2003, 48(5): 1414-1419.
10.	Theodorou DJ. The intravertebral cleft sign. Radiology, 2001, 221(3): 787-788.
11.	Oka M, Masaki M, Nobuo K, et al. Intravertebral cleft sign on fat-suppressed contrast enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty. Acad Radiol, 2005, 12(8): 992-999.
12.	Gagnerie F, Taillan B, Euller-Ziegler L, et al. Intravertebral vacuum phenomenon in multiple myeloma. Clin Rheumatol, 1987, 6(4): 597-599.
13.	Heini PF, Wälchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J, 2000, 9(5): 445-450.
14.	Mathis JM, Barr JD, Belkoff SM, et al. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol, 2001, 22(2): 373-381.
15.	Li KC, LI AF, Hsieh CH, et al. Another option to treat kummell’s disease with cord compression. Eur-Spin J, 2007, 16(19): 1479-1487.
16.	Mochida J, Toh E, Chiba M, et al. Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord, 14(5): 393-398.
17.	Kaneda K, Asano S, Hashimoto T, et al. The treatment of osteoporotic post-traumatic vertebral collapse using the Kaneda device and abioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976), 17(8 Suppl): S295-303.
18.	Krauss M, Hirschfelder H, Tomandl B, et al. Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol, 2006, 16(5): 1015-1021.
19.	Hadjipavlou AG, Tzermiadianos MN, Katonis PG, et al. Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg (Br), 2005, 87(12): 1595-1604.
20.	Mathis JM. Percutaneous vertebroplasty: complication avoidance and techque optimization. AJNR Am J Neuroadiol, 2003, 24(8): 1697-1706.
21.	Chen LH, Lai PL, Chen WJ. Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft. Clin Orthop Relat Res, 2005, (435): 148-153.
22.	Hasegawa K, Homma T, Uchiyama S, et al. Vertbral pseudorthrosis in the osteoporotic spine. Spine (Phila Pa 1976), 1998, 23(20): 2201-2206.
23.	Peh WCG , Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
24.	Ha KY, Lee JS, Kim KW, et al. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts. J Bone Joint Surg (Br), 2006, 88(5): 629-633.
25.	Wiggins MC, Sehizadeh M, Pilgram TK, et al. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol, 2007, 188(3): 634-640.
26.	Kim YJ, Lee JW, Kim KJ, et al. Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors. Skeletal Radiol, 2010, 39(8): 757-766.

1. Genant HK, Jergas M. Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int, 2003, 14(3 Suppl): 43-45.
2. Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology, 1978, 129(1): 23-29.
3. Mirovsky Y, Anekstein Y, Shalmon E, et al. Vacuum clefts of the vertebral bodies. AJNR Am J Neuroradiol, 2005, 26(7): 1634-1640.
4. Kumpan W, Salomonowitz E, Seidl G, et al. The intravertebral vacuum phenomenon. Skeletal Radiol, 1986, 15(6): 444-447.
5. Yang H, Gan M, Zou J, et al. Kyphoplasty for the treatment of Kümmell’s disease. Orthopedics, 2010, 33(7): 479.
6. Koike Y, Takizawa K, Ogawa Y, et al. Percutaneous vertebroplasty for vertebral compression fractures with intravertebral cleft: cement injection under vacuum aspiration. J Vasc Interv Radiol, 2011, 22(12): 1721-1726.
7. 張云慶, 楊惠光, 劉勇, 等. 球囊擴張椎體后凸成形術結合過伸體位復位治療中晚期 Kümmell 病的療效分析. 中國修復重建外科雜志, 2012, 26(4): 411-415.
8. Lane JI, Maus TP, Wald JT, et al. Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. AJNR Am J Neuroradiol, 2002, 23(10): 1642-1246.
9. McKiernan F, Faciszewski T. Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum, 2003, 48(5): 1414-1419.
10. Theodorou DJ. The intravertebral cleft sign. Radiology, 2001, 221(3): 787-788.
11. Oka M, Masaki M, Nobuo K, et al. Intravertebral cleft sign on fat-suppressed contrast enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty. Acad Radiol, 2005, 12(8): 992-999.
12. Gagnerie F, Taillan B, Euller-Ziegler L, et al. Intravertebral vacuum phenomenon in multiple myeloma. Clin Rheumatol, 1987, 6(4): 597-599.
13. Heini PF, Wälchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J, 2000, 9(5): 445-450.
14. Mathis JM, Barr JD, Belkoff SM, et al. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol, 2001, 22(2): 373-381.
15. Li KC, LI AF, Hsieh CH, et al. Another option to treat kummell’s disease with cord compression. Eur-Spin J, 2007, 16(19): 1479-1487.
16. Mochida J, Toh E, Chiba M, et al. Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord, 14(5): 393-398.
17. Kaneda K, Asano S, Hashimoto T, et al. The treatment of osteoporotic post-traumatic vertebral collapse using the Kaneda device and abioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976), 17(8 Suppl): S295-303.
18. Krauss M, Hirschfelder H, Tomandl B, et al. Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol, 2006, 16(5): 1015-1021.
19. Hadjipavlou AG, Tzermiadianos MN, Katonis PG, et al. Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg (Br), 2005, 87(12): 1595-1604.
20. Mathis JM. Percutaneous vertebroplasty: complication avoidance and techque optimization. AJNR Am J Neuroadiol, 2003, 24(8): 1697-1706.
21. Chen LH, Lai PL, Chen WJ. Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft. Clin Orthop Relat Res, 2005, (435): 148-153.
22. Hasegawa K, Homma T, Uchiyama S, et al. Vertbral pseudorthrosis in the osteoporotic spine. Spine (Phila Pa 1976), 1998, 23(20): 2201-2206.
23. Peh WCG , Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
24. Ha KY, Lee JS, Kim KW, et al. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts. J Bone Joint Surg (Br), 2006, 88(5): 629-633.
25. Wiggins MC, Sehizadeh M, Pilgram TK, et al. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol, 2007, 188(3): 634-640.
26. Kim YJ, Lee JW, Kim KJ, et al. Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors. Skeletal Radiol, 2010, 39(8): 757-766.

《中國修復重建外科雜志》

單側入路經皮椎體成形術治療伴裂隙樣變的骨質疏松性椎體壓縮骨折

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《中國修復重建外科雜志》

單側入路經皮椎體成形術治療伴裂隙樣變的骨質疏松性椎體壓縮骨折

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