经皮椎体后凸成形和椎体成形术治疗老年人无神经损伤Ⅲ期Kummell’s病的临床观察

The preliminary clinical effectiveness of percutaneous kyphoplasty/ percutaneous vertebroplasty in the treatment of stage Ⅲ of Kummell＇s disease without nerve injury

目的评估经皮椎体后凸成形术（PKP）／经皮椎体成形术（PVP）治疗无神经损伤的Ⅲ期Kummell＇s病的临床疗效。方法回顾性分析自2012年9月至2016年9月28例无神经损伤的Ⅲ期Kummell＇s病，采用PKP16例，PVP12例，年龄67～95岁；记录术前、术后7d、末次随访时的视觉模拟评分（VAS）、Oswesiry功能障碍指数（ODI）并测量x线侧位片病椎Cobb角、椎体前缘及后缘高度，根据术后病椎CT检查观察骨水泥填充及渗漏情况。结果所有28例患者平均随访18个月（12～36个月）。患者术中无血管神经损伤，13例出现骨水泥渗漏，无临床症状，术后12～24h可下地行走。3例术后6月及12月出现其他椎体压缩性骨折，再次经PKP治疗后症状缓解。VAS评分在术后7d及末次随访均改善，术后7d与术前比较差异有统计学意义（t=16．68，P〈0．01），末次随访改善率为71．4％（20／28）；ODI在术后7d及末次随访改善明显（67．9％，19／28），且术后7d与术前、末次随访与术后7d比较，差异有统计学意义（均P〈0．01）。术后7d椎体前缘高度、病椎Cobb角与术前比较差异有统计学意义（t值分别为2．29、2．52，均P〈0．05），末次随访与术后7d比较差异有统计学意义（t值分别为2．24、2．58，均P〈0．05）。结论PKP／PVP治疗无神经损伤的Ⅲ期Kummell＇s病可安全有效的改善临床症状，对脊柱后凸畸形、椎体高度可获得有限的矫正，但存在矫正度丢失、骨水泥渗漏率较高等不足，中远期疗效尚需进一步观察。

Objective To evaluate the effectiveness and radiographic outcomes of percutaneous kyphoplasty （PKP）/percutaneous vertebroplasty （PKP） in the treatment of stage Ⅲ Kummell＇s disease without nerve injury. Methods From September 2012 to September 2016, there were 28 patients with stage ⅢKummell＇s disease recruited to study, of which 16 patients were treated with PKP and the other 12 cases with PVP. with a mean age of 78, ranging from 67 to 95, consisted of 3 males and 29 females. All patients had single vertebral body lesions without symptom of spinal cord injury. Visual analogue scores （VAS） and oswestry dysfunction index （ODD were recorded before surgery, on the 7 d after surgery and at the last follow-up. Meanwhile, Cobb angles, anterior and posterior heights of the injured vertebral body were measured by X-ray lateral radiography at these three time points. Furthermore, the condition of bone cement in the injured vertebral body was observed with the postoperative CT examination. Results All patients completed the operation safely. Twenty-eight patients were followed up for an average of 18 months （ranging from 12 to 36 months）, and 4 patients who failed to be followed up were not included in the statistic analysis. There was no vessel or nerve injury in the operation. Thirteen out of 28 individuals who suffered from bone cement leakage showed no clinical symptom, and recovered walking ability between 12 and 24h after operation. Other types of vertebral body fractures due to compression occurred in 3 cases between 6 and 12 months after surgery, and the symptoms were relieved after another PKP. The rates of improvement at the last follow-up in VAS and ODI were 71,4G （20/28） and 67.9% （19/28）, respectively. There was statistical difference in VAS between before surgery and 7d after surgery （t=16.68, P〈0.01）. However, no statistical difference was found in the comparison of VAS between the last follow-up and 7d after surgery （t=0. 598, P 〉 0.05）. The difference of ODI between before surgery and 7d after surgery （t= 36. 830, P〈0.01） and that of ODI between the last follow-up and 7d after surgery （t=7. 375, P〈0.01） showed statistical significance. There were statistical differences in both Cobb angle and anterior heights of the diseased vertebral body between before surgery and 7d after surgery （t=2.52, 2.29, both P〈0.05）. Besides, significant differences were also observed in them between the last follow-up and 7d after surgery （t= 2.58, 2.24, both P〈0.05）. However, there was no statistical difference of the posterior height of the diseased vertebral body before surgery, 7d after surgery and at the last follow-up （t=0. 935, 0. 795, P〈0.05）. Conclusions PKP/PVP may relieve the clinical symptoms safely and effectively of stage Ⅲ Kummell＇s disease without nerve injury, and may correct heights of kyphosis and vertebral. Nevertheless, it may lead to loss of correction and high rate of bone cement leakage. Further observation is needed for the long-term effectiveness.