关于Kümmell病的研究进展

Developments on Kümmell's disease

Kümmell病(Kümmell's disease,KD)是人在轻微创伤以后,以延迟的方式发生椎体缺血性坏死。KD表现为迟发性椎体压缩性骨折,最常见的病变部位为胸腰椎交界处。KD患者常有轻微创伤史,虽然术后疼痛消失,但症状经常复发并且加重,多年后出现后凸畸形。KD的确诊不仅要依靠影像学技术,也需结合患者的病史、临床症状综合分析,由创伤引起的椎管内骨折被认为是KD诊断中最重要的特征。KD患者可根据是否有神经功能缺损而采取不同的治疗方案,对于无神经功能缺损的KD患者,可采取保守治疗、经皮椎体成形术、后凸成形术等方法治疗。对于有神经缺损的KD患者,可采用前路重建、后路截骨术等方法治疗。但以上方法常常伴有骨水泥的渗漏。随着现代医学与科技的发展,临床医师为了减少骨水泥的渗漏,在经皮椎体成形术、后凸成形术、前路重建、后路截骨术的基础上对手术做出了一系列改良,有效地减少了并发症的发生,提高了患者的生活质量。

Kümmell's disease(KD)is a delayed form of vertebral ischemic necrosis after minor trauma.KD shows delayed vertebral compression fracture,and the most common lesion is at the junction of thoracolumbar spine.Patients with KD often have a history of minor trauma.Although the postoperative pain disappears,the symptoms often relapse and worsen,and kyphosis deformity occurs many years later.The diagnosis of KD depends not only on imaging technology,but also on the comprehensive analysis of patients'medical history and clinical symptoms.Intraspinal fracture caused by trauma is considered to be the most important feature in the diagnosis of KD.Patients with KD can adopt different treatment schemes according to whether there is nerve defect.Patients with KD without nerve defect can be treated with conservative treatment,percutaneous vertebroplasty(PVP),percutaneous kyphoplasty(PKP)and other methods.However,the above methods are often accompanied by leakage of bone cement.With the development of modern medicine and technology,in order to reduce the leakage of bone cement,clinicians have made a series of improvements to the operation on the basisof PVP,PKP,anterior reconstruction and posterior osteotomy,which effectively reduces the occurrence of complications and improves the quality of life of patients.