椎体成形术治疗伴椎体裂隙征骨质疏松性椎体压缩骨折和Kümmell病的疗效分析

Vertebroplasty in the treatment of osteoporotic vertebral compression fracture with intravertebral vacuum cleft and Kummell’s disease-outcome evaluation research

目的对比分析经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗伴椎体内裂隙征(intravertebral vacuum cleft,IVC)的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)和Kümmell病(Kümmell’s disease,KD)的临床疗效及影像学变化。方法回顾性分析2013年1月至2017年1月,于我院接受PVP治疗的单个椎体受累的OVCF或KD患者,根据患者的病历资料和影像学资料,筛选出KD患者30例(A组)和其中伤椎合并IVC的椎体压缩骨折的患者37例(B组),记录所有患者术前、术后次日、1个月、6个月和1年随访的疼痛视觉模拟评分(visual analogue scale,VAS),同时回顾患者术前、术后次日、6个月和1年随访的影像学资料。通过独立样本t检验对比分析PVP治疗两种疾病的疗效及影像学变化,同时通过配对样本t检验对比分析手术前、后及随访的疗效及影像学变化情况。结果KD患者受伤至发病时间和骨密度明显高于伴伤椎裂隙征患者。两组患者术后VAS明显低于术前,但至术后1个月随访开始,KD组患者术后VAS明显高于伴伤椎裂隙征患者。KD组患者术后椎体前缘高度及中间高度改善率(29.6%和23.3%)明显高于伴伤椎裂隙征患者(14.3%和10.3%),但两组患者术后6个月随访和术后1年随访椎体高度改善率较前次明显下降,至术后1年随访时,两组高度改善率差异无统计学意义。两组患者术后局部后凸角(13.9°和14.3°)明显小于术前(18.0°和16.7°),但术后6个月和1年随访局部后凸角均较前次明显增加。结论椎体成形术是治疗KD和伴IVC的OVCF的有效方法,但术后随访KD患者疼痛较普通IVC患者为重,两种疾病术后均易发生椎体高度丢失及局部后凸畸形加重,虽然KD患者术后椎体高度能够获得较好改善,但随访椎体高度丢失亦更加明显。临床上应鉴别这两类疾病,KD患者行PVP更应慎重,对于其术后椎体高度明显丢失需引起临床足够的重视。

Objective To evaluate clinical outcomes and radiographic changes of Ku?mmell’s Disease(KD)and osteoporotic vertebral compression fracture(OVCF)plus intravertebral vacuum cleft(IVC)after percutaneous vertebroplasty(PVP).Methods All patients with KD or OVCF plus IVC that underwent single vertebral PVP in our department between January 2013 and January 2017 were analyzed retrospectively.According to the medical records and radiographic data,30 KD cases and 37 OVCF plus IVC cases were divided into two groups respectively.All patients’Visual Analogue Scales(VAS)for back pain and radiographic parameters were collected preoperatively,postoperatively and during the follow-up.Clinical and radiological differences between the two groups were compared by the independent t-test,whereas differences preoperation and follow-up were compared by the paired t-test.Results Clinical onset time and bone mineral density of KD group were significantly higher than the OVCF plus IVC group.Postoperative VAS for back pain of two groups(2.90&2.84)was significantly lower than that preoperatively.However,KD patients had higher VAS than IVC patients from postoperatively 1-month follow-up.Improvement rates of anterior vertebral height and medium height in KD group(29.6%&23.3%)were significantly higher than IVC group(14.3%&10.3%),however,improvement rates of vertebral height lost significantly from 6-month follow-up.And there were no significant differences between the two groups in 1-year follow-up.Postoperative regional kyphosis angles of two groups(13.9°&14.3°)were significantly lower than that preoperatively(18.0°&16.7°),and the angles continued to increase compared to the prior follow-up.Conclusions PVP is effective in the treatment of KD or OVCF plus IVC.However,KD patients may endure more serious back pain during the follow-up.Both two diseases may associate with postoperative vertebral height loss and kyphosis aggravation,even in KD patients.For patients with IVC in injured vertebrae,KD or OVCF plus IVC should be given priority.Close follow-up of KD patients is necessary.