應用Jack椎體擴張器系統椎體后凸成形術選擇性治療中老年骨質疏松性Denis B型胸腰椎爆裂性骨折近期療效觀察_《中國修復重建外科雜志》

作者：

馮玉旭 , 張崛 , 沈毅敏 , 任永信 , 殷國勇 , 張寧

南京醫科大學第一附屬醫院骨科（南京，210029）;

關鍵詞：

胸腰椎爆裂性骨折椎體后凸成形術 Jack椎體擴張器

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目的探討應用Jack椎體擴張器系統行椎體后凸成形術選擇性治療中老年骨質疏松性Denis B型胸腰椎爆裂性骨折的可行性及近期療效。方法2007年8月－2011年5月，應用自行設計的Jack椎體擴張器系統行椎體后凸成形術治療骨質疏松性Denis B型胸腰椎爆裂性骨折患者30例（32個椎體）。其中男7例，女23例；年齡57～85歲，平均76.9歲。骨折累及節段：T11 2個，T12 11個，L1 7個，L2 5個，L3 3個，L4 4個。分別于術前、術后1周及6個月對患者行疼痛視覺模擬評分（VAS）、Oswestry功能障礙指數（ODI）評定，在X線片上測量椎體前緣高度、椎體中部高度及矢狀面Cobb角。結果患者均順利完成手術，無骨水泥滲漏及癥狀性并發癥發生；術后腰背部疼痛均明顯減輕。30例患者于術后1周和6個月獲隨訪。術前、術后1周和術后6個月，VAS評分分別為（8.2 ± 1.3）、（1.5 ± 0.9）和（1.9 ± 0.5）分，ODI分別為82.4% ± 15.0%、17.8% ± 9.5%和23.0% ± 8.6%，骨折椎體前緣高度分別為（19.5 ± 3.2）、（24.8 ± 3.0）和（24.0 ± 2.6） mm，中部高度分別為（18.5 ± 3.4）、（23.7 ± 3.7）和（22.8 ± 3.5）mm，Cobb角分別為（14.9 ± 7.5）、（7.6 ± 6.0）和（8.3 ± 6.0）°。術后1周及6個月與術前比較差異均有統計學意義（P lt; 0.05），術后1周和術后6個月比較差異均無統計學意義（P gt; 0.05）。結論應用Jack椎體擴張器系統行椎體后凸成形術選擇性治療中老年骨質疏松性Denis B型胸腰椎爆裂性骨折，近期內可有效恢復骨折椎體前緣和中部高度，矯正畸形，緩解疼痛，改善功能，骨水泥滲漏發生率較低，具有良好的臨床效果和安全性。

引用本文： 馮玉旭,張崛,沈毅敏,任永信,殷國勇,張寧. 應用Jack椎體擴張器系統椎體后凸成形術選擇性治療中老年骨質疏松性Denis B型胸腰椎爆裂性骨折近期療效觀察. 中國修復重建外科雜志, 2012, 26(8): 972-976. doi: 復制

1.	Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
2.	Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
3.	Ross PD, Davis JW, Epstein RS, et al. Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol, 1994, 47(3): 231-239.
4.	Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166．.
5.	Panjabi MM, Goel V, Oxland T, et al. Human lumbar vertebrae: quantitative three-dimensional anatomy. Spine (Phila Pa 1976), 1992, 17(3): 299-306．.
6.	Ebraheim NA, Rollins JR Jr, Xu R, et al. Projection of the lumbar pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1996, 21(11): 1296-1300．.
7.	殷國勇, 張子韜, 張寧, 等. 應用Jack椎體擴張器行后凸成形術治療骨質疏松性胸腰椎壓縮骨折. 中國脊柱脊髓雜志, 2010, 20(9): 711-715.
8.	張寧, 殷國勇, 沈國蔚, 等. 椎體內復位擴張器在經皮后凸成形術治療中的研究現狀. 實用老年醫學, 2010, 24(5): 367-371.
9.	Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1511-1515.
10.	Marlin E, Nathoo N, Mendel E. Use of percuatneous kyphoplasty and vertebroplasty in spinal surgery. J Neurosurg Sci, 2012, 56(2): 105-112.
11.	Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(15): S45-53.
12.	Krappinger D, Kastenberger TJ, Schmid R. Augmented posterior instrumentation for the treatment of osteoporotic vertebral body fractures. Oper Orthop Traumatol, 2012, 24(1): 4-12.
13.	Poynton AR. Point of view. Spine (Phila Pa 1976), 2002, 27(5): 548.
14.	郭金庫, 丁文元, 申勇, 等. 球囊擴張后凸椎體成形術治療老年骨質疏松性胸腰椎爆裂骨折. 中國修復重建外科雜志, 2010, 24(11): 1341-1344.
15.	Gan M, Yang H, Zhou F, et al. Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics, 2010, 33(2): 88-92.
16.	Shen GW, Wu NQ, Zhang N, et al. A prospective comparative study of kyphoplasty using the Jack vertebral dilator and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Bone Joint Surg (Br), 2010, 92(9): 1282-1288.
17.	Renner SM, Tsitsopoulos PP, Dimitriadis AT, et al. Restoration of spinal alignment and disk mechanics following polyetheretherketone wafer kyphoplasty with StaXx FX. AJNR Am J Neuroradiol, 2011, 32(7): 1295-1300.
18.	Tzermiadianos MN, Renner SM, Phillips FM. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture. Eur Spine J, 2008, 17(11): 1522-1530.
19.	王靜成, 馮新民, 楊建東, 等. Jack椎體擴張器和球囊擴張后凸成形術的比較研究. 中華骨科雜志, 2010, 30(9): 842-847.

1. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
2. Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
3. Ross PD, Davis JW, Epstein RS, et al. Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol, 1994, 47(3): 231-239.
4. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166．.
5. Panjabi MM, Goel V, Oxland T, et al. Human lumbar vertebrae: quantitative three-dimensional anatomy. Spine (Phila Pa 1976), 1992, 17(3): 299-306．.
6. Ebraheim NA, Rollins JR Jr, Xu R, et al. Projection of the lumbar pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1996, 21(11): 1296-1300．.
7. 殷國勇, 張子韜, 張寧, 等. 應用Jack椎體擴張器行后凸成形術治療骨質疏松性胸腰椎壓縮骨折. 中國脊柱脊髓雜志, 2010, 20(9): 711-715.
8. 張寧, 殷國勇, 沈國蔚, 等. 椎體內復位擴張器在經皮后凸成形術治療中的研究現狀. 實用老年醫學, 2010, 24(5): 367-371.
9. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1511-1515.
10. Marlin E, Nathoo N, Mendel E. Use of percuatneous kyphoplasty and vertebroplasty in spinal surgery. J Neurosurg Sci, 2012, 56(2): 105-112.
11. Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(15): S45-53.
12. Krappinger D, Kastenberger TJ, Schmid R. Augmented posterior instrumentation for the treatment of osteoporotic vertebral body fractures. Oper Orthop Traumatol, 2012, 24(1): 4-12.
13. Poynton AR. Point of view. Spine (Phila Pa 1976), 2002, 27(5): 548.
14. 郭金庫, 丁文元, 申勇, 等. 球囊擴張后凸椎體成形術治療老年骨質疏松性胸腰椎爆裂骨折. 中國修復重建外科雜志, 2010, 24(11): 1341-1344.
15. Gan M, Yang H, Zhou F, et al. Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics, 2010, 33(2): 88-92.
16. Shen GW, Wu NQ, Zhang N, et al. A prospective comparative study of kyphoplasty using the Jack vertebral dilator and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Bone Joint Surg (Br), 2010, 92(9): 1282-1288.
17. Renner SM, Tsitsopoulos PP, Dimitriadis AT, et al. Restoration of spinal alignment and disk mechanics following polyetheretherketone wafer kyphoplasty with StaXx FX. AJNR Am J Neuroradiol, 2011, 32(7): 1295-1300.
18. Tzermiadianos MN, Renner SM, Phillips FM. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture. Eur Spine J, 2008, 17(11): 1522-1530.
19. 王靜成, 馮新民, 楊建東, 等. Jack椎體擴張器和球囊擴張后凸成形術的比較研究. 中華骨科雜志, 2010, 30(9): 842-847.

《中國修復重建外科雜志》

應用Jack椎體擴張器系統椎體后凸成形術選擇性治療中老年骨質疏松性Denis B型胸腰椎爆裂性骨折近期療效觀察

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《中國修復重建外科雜志》

應用Jack椎體擴張器系統椎體后凸成形術選擇性治療中老年骨質疏松性Denis B型胸腰椎爆裂性骨折近期療效觀察

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