椎体后凸成形术治疗Kummell病的临床疗效分析

Analysis of Clinical Outcomes of Kummell Disease Treated with Percutaneous Kyphoplasty

目的分析椎体后凸成形术治疗Kummell病的临床疗效。方法 2005年4月至2012年6月收治疗老年陈旧性椎体压缩骨折326例,其中诊断符合为Kummell病者72例,70例采用后路经皮椎体后凸成形术治疗,2例因球囊未能复位而行后路切开截骨矫形、骨水泥钉道强化内固定术。术后给予腰背支局固定、抗骨质疏松等常规处理,通过对比手术前后椎体的高度、局部矢状位Cobb角度及疼痛视觉模拟评分（visual analogue scale,VAS）、Oswesay功能障碍指数（oswestrydisabilityindex,ODI）进行疗效评定。结果 70例患者术后X线片复查时椎体高度由术前（19.77±4.42）mm恢复至（21.47±3.71）mm,Cobb角由术前的15°~25°（21.2±0.5）°改善至3°~14°（9.1±0.6）°,较术前明显改善（P〈0.05）,改善率79.5%;术前VAS评分4~8分,平均（6.1±0.5）分,术后VAS评分1~4分,平均（3.2±0.4）分,较术前明显改善（P〈0.05）;ODI从术前的平均（63.7±2.3）改善至末次随访的平均（43.2±1.7）,明显提高了患者的生活质量。术中出现骨水泥渗漏者2例,其中1例随访中出现相邻椎体骨折者,给予对症治疗后,症状明显缓解;术后下腰部持续疼痛者1例,对症治疗1个月后症状消失。结论早期发现与治疗,消除椎体骨折处的微动,提供足够的生物力学支撑,恢复脊柱的稳定性是治疗本病的关键,椎体后凸成形术创伤小,是早期治疗Kummell病较好的手术方式,且并发症少。

Objective To analyze the clinical outcomes of Kummell disease treated with percutaneous Kyphoplasty（ PKP）. Methods 72 cases diagnosed as Kummell disease were involved from 326 cases with chronic vertebral compression fractures treated in our hospital from April 2005 to June 2012. 70 cases were treated with percutaneous Kyphoplasty and 2 cases were treated with posterior pedicle screw fixation with bone cement as balloon failed to restore height. Anti-osteoporosis and other conventional treatment were used after the surgery. Curative effect evaluation assessment including comparing pro-and postoperation of vertebral body height,local sagittal Cobb Angle and visual analogue scale（ VAS） pain,Oswesay disability index（ ODI）. Results There were statistically significant difference of vertebral body height,local sagittal Cobb Angle and pain scoresand Oswesay disability index compared with pro-surgery. The vertebral body height restore from（ 1 9. 7 7 ± 4. 4 2） to（ 21. 47 ± 3. 71）. The Cobb Angle improved from 15° ~ 25°[average（ 21. 2 ± 0. 5） °]to 3° ~ 14°[average（ 9. 1 ± 0. 6） °].Postoperative VAS score was 1 ~ 4 points,with an average of 3. 2 ± 0. 4 points,have improved significantly compared with preoperative（ P〈0. 05）. ODI improved from an average of（ 63. 7 ± 2. 3） preoperatively to the average of（ 43. 2 ± 1. 7） at the last follow-up. Intraoperative appeared bone cement leakage happened in 2 cases,including 1 case appeared adjacent vertebral fractures at follow-up. Conclusion It is critical to eliminate motion of vertebral fracture,provide sufficient biomechanical support and restore the stability of the spine in early stage for kummell disease. Minimally invasive surgical approach on patients of Kummell disease of PKP,which can provide a better vertebra reduction,and less complications.