改良经皮椎体后凸成形术与传统经皮椎体后凸成形术治疗Kümmell病的比较

Comparison between modified percutaneous vertebroplasty and conventional percutaneous vertebro-plasty for Kümmell disease

目的比较改良经皮椎体后凸成形术(PKP)与传统PKP治疗Kümmell病的疗效。方法回顾性研究2015年1月至2017年12月中山大学附属江门医院脊柱外科收治的57例单节段行PKP治疗的患者临床资料,根据手术方法不同分为改良PKP组(36例)和传统PKP组(21例)。改良PKP组:男24例,女12例;年龄(73.9±9.4)岁;病程(2.2±1.5)个月;损伤部位:胸椎20例,腰椎16例。传统PKP组:男15例,女6例;年龄(72.6±11.9)岁;病程(1.8±1.1)个月;损伤部位:胸椎10例,腰椎11例。比较两组患者的手术时间、骨水泥用量、骨水泥渗漏情况;比较两组患者术后3 d、1个月、3个月、末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎前缘、中线高度、伤椎后凸cobb角。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者均顺利完成手术,术中与术后均未出现脊髓神经损伤、伤口感染、肺栓塞、骨水泥中毒反应、死亡等严重并发症。两组患者手术时间、骨水泥用量比较差异均无统计学意义(P>0.05)。改良PKP组的骨水泥渗漏率[33.3%(9/27)]低于PKP组[52.4%(11/21)],差异有统计学意义(P<0.05)。术后3 d、术后1个月两组间VAS评分、ODI评分、伤椎前缘、中线高度、伤椎后凸cobb角比较差异均无统计学意义(P>0.05),同时较术前好转;但术后3个月、末次随访时改良PKP组各项指标优于传统PKP组,差异均有统计学意义(P<0.05)。结论相比传统PKP,改良PKP治疗Kümmell病更安全、有效。

Objective To compare the clinical outcomes between modified percutaneous kyphoplasty(PKP)and conventional PKP in the treatment of Kümmell disease.Methods A retrospective cohort study was conducted of the 57 patients with single level kummell disease who had undergone PKP between January 2015 and December 2017 at Department of Spinal Surgery,Jiangmen Hospital Affiliated to Sun Yat-sen Uni-versity.Of them,36 received modified PKP and 21 conventional PKP.In the modified PKP group,there were 24 males and 12 females with an age of 73.9 years±9.4 years and a course of disease of 2.2 months±1.5 months;the disease was located at a thorocic vertebra in 20 cases and at a lumbar vertebra in 16.In the conventional PKP group,there were 15 males and 6 females with an age of 72.6 years±11.9 years and a course of disease of 1.8 months±1.1 months;the disease was located at a thorocic vertebra in 10 cases and at a lumbar vertebra in 11.The 2 groups were compared in terms of operation time,bone cement volume,cement leakage,visual analogue scale(VAS),Oswestry disability index(ODI),anterior and middle heights and cobb angle of injured vertebra at postoperative 3 days,1 and 3 months,and final follow-up.Results There were no significant differences in the general clinical data between the 2 groups,showing compatibility between groups(P>0.05).All the operations were accomplished uneventfully with no such serious complications as spinal cord nerve injury,wound infection,pulmonary embolism,bone cement poisoning reaction or death.There was no significant difference between the 2 groups in operation time or bone cement volume(P>0.05).The rate of cement leakage in the modified PKP group[33.3%(9/27)]was significantly lower than that[52.4%(11/21)]in the conventional PKP group(P<0.05).There were no significant differences be-tween the 2 groups in VAS,ODI,anterior or middle height of injured vertebra or cobb angle at postoperative 3 days or one month(P>0.05),but the postoperative values were improved compared to the preoperative ones.At postoperative 3 months and final follow-up,the modified PKP group was significantly better in all the indexes than the conventional PKP group(P<0.05).Conclusion Compared with conventional PKP,the modified PKP may lead to better outcomes for Kümmell disease.