裂隙内外椎体成形治疗Kümmell病的临床观察

Clinical observation for internal and external intravertebral vacuum cleft bone cement injection in treatment of K mmell disease

目的 探讨双侧经皮椎体成形术（PVP）或经皮后凸成形术（PKP）中采用裂隙内外分别灌注骨水泥治疗Kümmell病的疗效.方法 2008年1月至2015年10月,对16例Kümmell病患者行双侧PVP或PKP裂隙内外分别灌注骨水泥治疗.其中男6例,女10例,年龄63 ～ 94岁.病程2～15个月.所有患者术前均行双能X线测定法（DEXA）骨密度测定,T值为-4.3-2.6.骨折位于T10～L4,其中2例为多发骨折.术后拍摄X线片观察骨水泥渗漏及病椎高度变化情况;采用Oswestry功能障碍指数（ODI）及疼痛视觉模拟量表（VAS）评估手术疗效.结果 16例均获随访,随访时间为12～ 96个月,术后4例发现骨水泥渗漏,但均未出现神经损伤等并发症.术前、术后2 d及末次随访时病椎前缘高度分别为正常的（50.3±8.3）％、（67.1±8.1）％、（65.2±6.4）％.术后2d及末次随访时病椎前缘高度较术前显著改善,差异有统计学意义（P＜0.05）;术后2d及末次随访时比较差异无统计学意义（P＞0.05）.术前、术后2d及末次随访时VAS评分分别为（8.63±1.23）、（2.56±3.48）、（1.38±0.92）分,ODI分别为（82.1±6.7）％、（28.5±7.3）％、（22.1-8.2）％.术后各时间点VAS评分与ODI均较术前显著改善,差异有统计学意义（P＜ 0.05）;术后2d及末次随访时比较差异均无统计学意义（P＞0.05）.术后无相邻和原位椎体发生再骨折.结论 采用裂隙内外分别灌注骨水泥治疗Kümmell病临床疗效良好,可有效缓解背痛症状,减少术中骨水泥渗漏和术后邻近椎体或原位再骨折发生.

Objective To discuss bilateral percutaneous vertebroplasty （PVP） or percutaneous kyphoplasty （PKP） using inside and outside intravertebral vacuum cleft （IVC） respectively with bone cement injection for the treatment of Kümmell disease.Methods From January 2008 to October 2015,16 cases of Kümmell disease patients were treated with bilateral PVP or PKP with inside and outside IVC perfusion of bone cement respectively.Of 16 cases,6 were male and 10 were female,aged from 63 to 94 years,with a disease duration from 2 to 15 months.The bone mineral density of every patient was measured by dual-energy X-rayabsorptiometry.The T value ranged from-4.3 to-2.6.Fractures located from T10 to L4,including 2 cases of multiple fractures.Postoperative X-ray was used to observe the vertebral bone cement leakage and anterior height changes of affected vertebrae.Visual analogue scale （VAS） and Oswestry disability index （ODI） were used to evaluate pain status and functional activity.Results All cases were followed up for 12-96 months.Cement leakage occurred in 4 patients without nerve complications.The anterior height of affected vertebrae before operation,2 d after operation and at the last follow-up was （50.3 ± 8.3）％,（67.1 ± 8.1）％ and （65.2 ± 6.4）％.The anterior height of affected vertebrae 2 d after operation and at the last follow-up were significantly improved compared with those before operation （P ＜ 0.05）,but there were no significant differences between 2 d after operation and at the last follow-up （P ＞ 0.05）.The scores of VAS before operation,2 d after operation and at the last followup was （8.63-± 1.23）,（2.56 ± 3.48） and （1.38 ± 0.92） scores,and the scores of ODI was （82.1 ± 6.7）％,（28.5 ± 7.3）％ and （22.1 ± 8.2）％.The scores of VAS and ODI 2 d after operation and at the last follow-up were significantly decreased compared with those before operation （P ＜ 0.05）,but there were no significant difference between 2 d after operation and at the last follow-up （P ＞ 0.05）.There was no postoperative in situ or adjacent vertebral fracture.Conclusions Using internal and external IVC bone cement injection for treatment of Kümmell disease has a good clinical curative effect.It can effectively relieve back pain symptoms,reduce intraoperative and postoperative bone cement leakage and recurrent adjacent or in situ vertebral fracture.