经皮椎体后凸成形术结合体外复位器治疗Kümmell病

Percutaneous kyphoplasty combined with external reduction device for Kummell’s disease

目的探讨经皮椎体后凸成形术(PKP)结合体外复位器治疗Kümmell病的临床应用价值。方法2013年10月—2017年12月,采用PKP结合体外复位器治疗Kümmell病患者40例(共40个椎体)。记录手术前后疼痛视觉模拟量表(VAS)评分、伤椎容积、矢状面Cobb角、术中骨水泥注射量、术后骨水泥渗漏率,并观察术后并发症发生情况。结果所有手术顺利完成,无术中死亡,无神经根及脊髓损伤,无肺栓塞及心脑血管系统急性反应。所有患者随访6~24个月,平均13个月。患者术后VAS评分、伤椎容积和Cobb角均较术前显著改善,差异有统计学意义(P<0.05)。术中骨水泥注射量5.5~7.5(6.5±0.8)mL,术后11个椎体发生骨水泥渗漏,渗漏率27.5%,均为椎间隙内渗漏,椎弓根、椎管结构完整。结论对于Kümmell病患者,PKP结合体外复位器能有效止痛,并具有优越的生物力学复位性能,可有效恢复脊柱生理曲度和力学强度,降低骨水泥渗漏率,克服了单纯球囊扩张椎体高度恢复不足的缺陷,提高了手术的疗效。

Objective To evaluate the clinical application value of percutaneous kyphoplasty(PKP)combined with external reduction device in Kümmell’s disease.Methods From October 2013 to December 2017,40 patients(40 vertebrae)with Kümmell’s disease were treated with PKP combined with external reduction device.The pain visual analogue scale(VAS)score,vertebral volume,sagittal Cobb’s angle,intraoperative cement injection volume,postoperative cement leakage rate and complications were recorded.Results All the operations were successfully completed without death,nerve root and spinal cord injury,pulmonary embolism and acute cardiovascular and cerebrovascular reactions.All the patients were followed up for 6-24 months,with an average of 13 months.The VAS score,vertebral volume and Cobb’s angle were significantly improved after operation,with statistical significance(P<0.05).Intraoperative bone cement injection was 5.5-7.5(6.5±0.8)mL.Postoperative bone cement leakage occurred in 11 vertebral bodies,with a leakage rate of 27.5%.All of them were intra-intervertebral leakage with complete pedicle and spinal canal structures.Conclusion For patients with Kümmell’s disease,PKP combined with external reduction device can effectively relieve pain,and has excellent biomechanical repositioning performance.It can effectively restore the physiological radian and mechanical strength of the spine,reduce the leakage rate of bone cement,overcome the defect of insufficient recovery of vertebral height by balloon dilatation alone,and improve the surgical outcome.