骨水泥椎体成形修复类风湿关节炎合并Kümmell病:骨折椎体高度及脊柱稳定性随访

Bone cement kyphoplasty for repair of rheumatoid arthritis combined with Kümmell's disease:a follow-up addressing vertebral height and spinal stabilization

背景:对于类风湿关节炎合并Kümmell病患者,如何能够有效控制背部疼痛,尽快恢复患者的活动能力、避免失用性骨质疏松的恶性循环是一个重要的治疗目标。椎体后凸成形是近年来发展起来的脊柱微创外科新技术,椎体后凸成形治疗类风湿关节炎合并Kümmell病尚未见文献报道。目的:评价骨水泥椎体成形治疗类风湿关节炎合并Kümmell病的临床疗效。方法:自2012年6月至2013年7月应用骨水泥椎体成形治疗11例类风湿关节炎合并Kümmell病患者,全部为女性,年龄(65.4±5.1)岁,均有剧烈腰背疼痛。对比观察术前及随访时后腰背疼痛情况及影像学相关指标,影像学指标包括手术前、后骨折椎椎体前缘高度、椎体前后缘高度比值及局部后凸角度(Cobb法)。结果与结论:11例患者无失访,随访6-12个月。随访时与术前目测类比评分、骨折椎前缘高度、骨折椎前缘高度/后缘高度、局部后凸角度相比,差异均有显著性意义(P<0.05)。2例患者发生骨水泥渗漏,无肺栓塞、神经功能障碍等严重并发症发生。提示骨水泥椎体成形治疗类风湿关节炎合并Kümmell病患者,可有效缓解腰背疼痛,部分恢复骨折椎体高度,重建脊柱稳定性,减少局部后凸,是安全有效的修复方法之一。

BACKGROUND：For patients with rheumatoid arthritis and Kümmel ’s disease, how to effectively control back pain, to recover patient’s locomotor activity and to avoid a vicious cycle of disuse osteoporosis is a key therapeutic target. Kyphoplasty is a recently developed new technology of minimal y invasive spine surgery. Few reports concerned the kyphoplasty for rheumatoid arthritis and Kümmel ’s disease. OBJECTIVE：To assess the clinical outcome of bone cement kyphoplasty for the treatment of Kümmel ’s disease combined with rheumatoid arthritis. METHODS：From June 2012 to July 2013, 11 female patients at the age of 65.4±5.1 years with Kümmel ’s disease combined with rheumatoid arthritis, who suffered from severe back pain, were treated with bone cement vertebroplasty. Back pain and imaging indexes were compared and observed before surgery and during fol ow-up. Imaging indexes contained preoperative and postoperative anterior height of vertebral body after fractures, the ratio of anterior height to posterior height of the vertebral body, and local kyphosis angle （Cobb method）. RESULTS AND CONCLUSION：No patients were lost to fol ow up. 11 patients were fol owed up for 6 to 12 months. Significant differences in fol ow-up and preoperative Visual Analogue Scale scores, anterior height of vertebral body after fractures, the ratio of anterior height to posterior height of the vertebral body, and local kyphosis angle were detected （P〈0.05）. Two patients experienced bone cement leakage. No severe complications appeared such as pulmonary embolism or neurological dysfunction. These data confirmed that bone cement vertebroplasty for rheumatoid arthritis combined with Kümmel ’s disease can effectively lessen back pain, partial y restore the height of vertebral body after fracture, rebuild spinal stabilization, reduce local kyphosis, and is a safe effective repair method.