摘要目的 探讨椎体裂隙征( IVC)在骨质疏松性椎体骨折(OVCFs)中的发生率及影像学特征,并分析其对经皮后凸成形术(PKP)疗效的影响.方法 回顾性分析2005年8月至2010年8月行PKP、疼痛持续时间超过1个月的骨质疏松性胸腰椎骨折患者76例的临床资料,总结IVC发生率及影像学特点,统计分析手术前后伤椎后凸角、伤椎前缘相对高度情况,观察骨水泥灌注及渗漏等情况；统计分析手术前后视觉模拟量表( VAS)评分及Oswestry功能障碍指数(ODI)变化.结果 76例95个伤椎中,共发现32例39个椎体具有IVC征,15例同时存在IVC与非IVC椎体.X线片、CT、MRI诊断IVC阳性率分别为33.3％、85.7％及84.6％.IVC组(25例)与非IVC组(36例)患者术后3d及末次随访伤椎后凸角及前缘相对高度均明显好于术前(F =21.82 ～72. 18,P＜0.01),末次随访与术后3d比较差异无统计学意义(P＞0.05).两组术后3d与末次随访VAS评分及ODI指数均较术前明显改善(F=131.06 ～ 364.12,P＜0.01),末次随访与术后3d比较差异无统计学意义(P＞0.05).IVC组团块型骨水泥分布占72.0％,非IVC组团块型占19.4％.两组各有4例骨水泥渗漏,其中IVC组3例为椎间盘内渗漏,非IVC组3例为椎前渗漏.结论 IVC在OVCFs导致的慢性疼痛患者中具有较高的发生率,CT与MRI是敏感的检测方法.PKP手术对伴或不伴IVC的OVCFs患者疗效均较好,IVC对PKP手术骨水泥的灌注形态及渗漏部位有一定影响.

abstractsObjectives To study incidence and radiological features of intravertebral cleft (IVC) in patients with chronic pain due to osteoporotic vertebral compression fractures (OVCFs),and analyze influence of IVC for surgery of percutaneous kyphoplasty ( PKP ). Methods Seventy-six patients with osteoporotic vertebral compression fractures and pain duration more than one month were underwent procedures of PKP between August 2005 and August 2010.The incidence and radiological features of IVC were analyzed.Sixty-one patients with single-level OVCFs were divided into two groups with and without IVC.Preoperative and postoperative kyphotic angle and relative anterior vertebral height were recorded,as well as visual analogue scales (VAS) and Oswestry disability index (ODI).Cement patterns of opacification and leakage were also recorded.Results Thirty two patients with 39 vertebraes were found with IVC sign.The diagnostic sensitivity of X ray,CT and MRI for IVC was respectively 33.3％,85.7％ and 84.6％.Two groups with IVC and without IVC both had apparent correction of kyphotic angle and reduction of anterior height at 3 days after surgery and last follow-up ( F =21.82-72.18,P ＜ 0.01 ).There was no statistical significance between two groups ( P ＞ 0.05 ).In addition,both groups had significant improvement as regard to VAS and ODI ( F =131.06-364.12,P ＜ 0.01 ). Solid pattern accounted for 72.0％ of all cemented vertebraes in the group with IVC and 19.4％ in the group without IVC.Four cement leakage were found in the group with IVC and another four in the group without IVC.Conclusions There is a high incidence of IVC in patients with chronic pain due to osteoporotic vertebral compression fractures. CT and MRI are sensitive for detection of IVC.The procedure of PKP is effective for both groups with and without IVC.IVC produces an apparent influence on cement opacification and leakage location during the procedure of PKP.