经皮椎弓根旁与经皮椎弓根穿刺椎体后凸成形术治疗无神经症状Kümmell病的临床研究

Clinical study on the treatment of Kummell’s disease without neurological symptoms by percutaneous transpedicular and percutaneous pedicle puncture kyphoplasty

目的探讨经皮椎弓根旁与经皮椎弓根穿刺椎体后凸成形术(percutaneous kyphopoplasty,PKP)治疗无神经症状Kümmell病的临床研究,为临床诊治提供参考。方法回顾性分析2015年6月-2018年6月我院收治的66例无神经症状Kümmell病患者,均行PKP治疗。根据患者穿刺路径的不同分为经皮椎弓根旁穿刺组(n=30例,A组)和经皮椎弓根穿刺(n=36例,B组)。收集术前一般资料,比较治疗前后视觉模拟评分(Visual Anglogue Scale,VAS)、功能障碍评分(Oswsetry Disability Indexes,ODI)、手术时间、透视次数、骨水泥量、骨水泥渗漏及随访期间并发症的情况。结果两组术前资料(年龄、性别、责任椎体分布、骨密度、术前VAS评分及术前ODI评分)均无统计学意义(P> 0.05);与B组比较,A组的手术时间明显缩短,使用骨水泥量较多,X线透视次数显著减少、骨水泥分布弥散明显更好,骨水泥漏发生率情况亦有减少,差异均有统计学意义(P <0.05),但两组的术后VAS评分及术后ODI评分比较,均无明显统计学差异(P> 0.05);A、B两组内部术前与术后VAS评分及ODI评分比较均有统计学意义(P <0.05);随访期间,两组均未发生神经根损伤、手术部位感染和骨水泥移位不良事件。结论经皮椎弓根旁穿刺椎体后凸成形术治疗无神经症状Kümmell病是一种可靠、有效的治疗方案,值得临床推广应用。

Objective To investigate the Clinical study on the treatment of Kümmell disease without neurological symptoms by percutaneous transpedicular and percutaneous pedicle puncture kyphoplasty, and to provide reference for clinical diagnosis and treatment.Methods Retrospective analysis was performed on 66 cases of Kümmell disease with no neurological symptoms admitted to our hospital from June 2015 to June 2018. All of cases were received PKP treatment. According to the different puncture paths of the patients, they were divided into percutaneous pedicle side paracentesis group A(n=30 cases)and percutaneous pedicle paracentesis group B(n=36 cases).General preoperative data were collected, and the Visual Anglogue Scale(VAS), Oswsetry Disability Indexes(ODI), operation time,fluoroscopy frequency, bone cement volume, bone cement leakage, complications during follow-up were compared. Results There were no significant differences in preoperative data(including age, gender, vertebral distribution, bone mineral density, preoperative VAS score and preoperative ODI score)between the two groups(P > 0.05). Compared with that of group B, the operation time in group A was significantly shortened. The use of bone cement in group A was more. The use of X-ray fluoroscopy in group A was significantly reduced.The dispersion of the bone cement distribution in group A was improved, and the incidence of bone cement leakage in group A was reduced. The differences were statistically significant(P < 0.05), but postoperative VAS scores and postoperative ODI score between the two groups had no significant statistical difference(P > 0.05);The preoperative and postoperative VSA score and ODI score between group A and group B were statistically different(P < 0.01). During the follow-up period, no adverse events such as nerve root injury, surgical site infection and bone cement displacement occurred in either of group. Conclusion Percutaneous pedicle side paracentesis is a reliable and effective treatment for Kümmell disease, which is worthy of clinical application.