椎体后凸成形术治疗Kummel病临床疗效观察

Percutaneous vertebroplasty for treatment of Kiimmers disease with vacuum signs

目的评价椎体后凸成形术治疗Ktimmel病的临床疗效。方法自2004年3月至2009年1月应用椎体后凸成形术治疗21例Ktimmel病（椎体骨折后不愈合，均经保守治疗无效，仍有剧烈腰背疼痛）患者。术前行CT扫描发现骨折未愈合，并且有“真空征”表现，部分动力位X线片提示椎体骨折处假关节形成。评价手术前后腰背疼痛及影像学相关指标。结果本组患者3例失访，随访率85．7％。18例随访3～12个月，平均（6．9±2．4）个月。疼痛采用视觉模拟评分（VAS）：术前7．0±1．2，随访时3．1±1．5，差异有统计学意义（P〈0．05）；骨折椎前缘高度：术前（2．1±0．3）cm，随访时（2．3±0．2）cm，差异有统计学意义（P〈0．05）；骨折椎前缘高度／后缘高度：术前0．67±0．10，随访时0．84±0．08，差异有统计学意义（P〈0．05）；局部后凸角度：术前27．3°±6．40°，随访时20．7°±5．0°，差异有统计学意义（P〈0．05）。无肺栓塞、神经功能障碍等并发症发生。结论椎体后凸成形术治疗Kummel病患者，可有效缓解腰背疼痛，部分恢复骨折椎高度，重建脊柱稳定性，减少局部后凸，是安全、有效的治疗方法之一。

Objective To study the clinical outcome of percutaneous vertebroplasty （PVP） for the treatment of Kummel＇s disease. Methods From March 2004 to January 2009, 21 patients with Kummel＇ s disease who had been suffering severe back pain even after conservative therapy for months were treated with PVP. Their preoperative CT images indicated nonunion of factures and ＂vacuum signs＂. Dynamic X-ray films demonstrated formation of pseudoarthrosis in the involved vertebral bodies in some cases. Their back pain was evaluated with visual analogue scale （VAS）. Their preoperative and postoperative VAS scores and radiological indexes were compared. Results The mean VAS scores were 7.0 ± 1.2 preoperatively, but 3.1 ± 1.5 at the follow-up （ P 〈 0.05） . The height of anterior margin of involved vertebral body was （2. 1 ±0. 3） cm preoperatively, but （2.3±0. 2） cm at the follow-up （ P 〈0. 05）. The ratio of anterior margin height to posterior margin height of the involved vertebral body was 0. 67± 0. 10, but 0. 84 ±0. 08 at the follow-up （ P 〈 0. 05）. The focal kyphosis angle was 27.3°± 6.4° preoperatively but 20. 7°± 5.0° at the follow-up （ P 〈 0. 05 ）. No pulmonary embolisms or neurological injuries happened. Conclusion PVP is an effective method for treating patients with Kummel＇s disease, because it can alleviate back pain effectively, restore the height of anterior margin of the involved vertebral body partially, and decrease the focal kyphosis.