Kümmell’s病椎体成形术后继发相邻椎体骨折伴脊髓受压的手术策略(1例报告及文献复习)

Adjacent vertebral fractures after percutaneous vertebroplasty for Kümmell's disease: A case report with literature review

目的探讨Kümmell’s病的诊断、影像学表现及手术治疗效果。方法分析我院收治的1例组合术式治疗Kümmell’s病椎体成形术(PVP)后继发上位椎体骨折伴脊髓压迫的临床资料,并结合文献复习。结果 1例胸12椎体Kümmell’s病患者第一次PVP术中出现骨水泥渗漏入上方椎间隙,继发引起胸11椎体压缩骨折和胸腰段后凸角进行性增大,并出现脊髓压迫症状。通过"PVP(胸11)+后路椎管减压+多节段椎弓根螺钉内固定+后外侧植骨融合"的组合术式治疗,患者术后2周疼痛消失,运动功能恢复,脊髓压迫症状解除;随访X线内固定位置良好,胸腰段后凸角明显纠正。结论 Kümmell’s病的诊断需结合病史、X线、CT和MRI检查。PVP治疗术中骨水泥渗漏率高,易增加相邻椎体新发骨折风险,术后X线随访有助于观察疾病的动态发展,对患者进行个体化评估和组合术式的使用可获得满意的临床疗效。

Objective To discuss the diagnosis, image characteristics and surgical treatment methods of Kümmell＇s disease. Methods A case of subsequent adjacent vertebral fractures after percutaneous vertebroplasty（PVP） for Kümmell＇s Disease admitted to Beijing Friendship hospital in 2015 was retrospectively analyzed. The patient＇s medical history data, diagnosis and treatment process, and follow-up image information were collected and related literatures were reviewed. Results The patient received the first surgery of PVP（T12） and intraoperative bone cement leakage to the T11-12 disc was founded. The patient was readmitted 9 months after the first surgery for the subsequent T11 compressed fracture, progressive thoracolumbar kyphosis and the spinal cord compression symptoms. The combined surgery including PVP（T11）, posterior spinal decompression, segmental pedicle screws immobilization and posterolateral bone fusion was used. The follow-up data showed that satisfied clinical and radiological results were achieved. Conclusion The bone cement leakage rate during PVP treatment for Kummell＇s disease is high and increases the risk of subsequent adjacent vertebral fracture. Individualized assessment and the use of combination surgery method can obtain satisfactory clinical results.