经皮椎体后凸成形术治疗Kümmell's病的临床疗效

Clinical effectiveness of percutaneous kyphoplasty for treatment of Kümmell's disease

目的评价经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗Kümmell's病的临床疗效。方法回顾性分析2012年5月—2016年8月采用PKP治疗的21例Kümmell's病(Ⅰ期、Ⅱ期)患者的临床资料,其中,男性8例,女性13例;年龄59～78岁,平均67. 4岁。有可回忆的轻微创伤史者15例(平地摔伤8例,弯腰搬重物3例,腰扭伤1例,道路交通伤3例),自诉无创伤史者6例。记录患者手术时间、骨水泥注入量、术中术后并发症;比较术前、术后2d、术后1年的患椎高度比、椎体Cobb角,评价椎体复位情况及稳定性;通过疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评价症状缓解程度及日常生活改善情况。结果本组患者手术时间25～70min,平均37min;骨水泥注入量2. 5～7mL,平均4. 2mL。术中术后并发症主要是骨水泥渗漏(9. 5%)。术后各评价指标较术前均有显著改善(P <0. 05);术后1年VAS评分、ODI较术后2d进一步改善(P <0. 05),术后1年时患椎高度比以及椎体Cobb角较术后2d无明显丢失(P>0. 05)。结论经皮椎体后凸成形术治疗Ⅰ期、Ⅱ期Kümmell's病疗效确切,能明显缓解疼痛,恢复椎体高度,改善患者生活质量。

Objective To evaluate the effectiveness of percutaneous kyphoplasty for treatment of Kümmell s disease.Methods The clinical data of 21 patients with Kümmell s disease(stageⅠ,Ⅱ)between Apr.2012 and Feb.2015 was analyzed retrospectively.There were 8 males and 16 females aged from 59-78(average,67.4)years.Fifteen cases had obvious slight trauma history,of whom 8 were injured from falls,3 were injured when carring heavy objects,1 was from sprain and 3 were from traffic accidents,and the other 6 cases appeared no history.The operation time,amount of injected bone cement,and complications were recorded.The Cobb s angle,involved vertebral height rate at preoperation,2 days after operation,1 year after operation were compared to evaluate the reduction quality and stability.Oswestry Disability Index(ODI)and visual analogue scale(VAS scale)were used to evaluate pain relief and functional improvement.Results The operation time was 25-70min(mean 37min),and the amount of injected bone cement was 2.5-7mL(mean 4.2mL).The principal complication was bone cement leakage(9.5%).There was significant improvement of all evaluation index at postoperation compared to preoperation(P<0.05).There was further improvement in ODI and VAS at 1 year after operation compared with those of 2 days after operation(P<0.05).There was no significant difference in involved vertebral height rate and Cobb s angle between 2 days and 1 year after operation(P>0.05).Conclusion PKP has affirmative clinical efficacy in pain relief,functional improvement and the height reconstruction of Kümmell s disease(stageⅠ,Ⅱ).