Kummell病的诊断及治疗进展

Progress of Diagnosis and Treatment of Kummell′s Disease

Kummell病是一种发生在轻微创伤后椎体骨折不愈合导致的椎体缺血性坏死。最初创伤后患者通常无症状,但大部分患者数月后会逐渐出现腰背部疼痛、进行性下胸腰椎后凸畸形以及神经症状。Kummell病的诊断主要依靠临床表现、影像学检查以及病理检查,其中椎体内裂隙是其典型的影像学表现。处于不同阶段的Kummell病患者可采用不同的治疗方案,对于持续性疼痛而无神经症状的患者,可采用经皮椎体成形术和经皮椎体后凸成形术,效果较好;对于持续疼痛伴神经症状的患者,需要行开放性减压手术。

Kummell′s disease is a kind of avascular necrosis of vertebral body caused by nonunion after minor trauma.After initial vertebral trauma,the patients are usually asymptomatic,but most will gradually develop back pain,progressive lower thoracolumbar kyphosis,and other neurological symptoms over a period of months.The diagnosis of Kummell′s disease mainly depends on the clinical manifestation,imaging and pathological examination,among which the intravertebral cleft is the characteristic imaging manifestation.Patients with Kummell′s disease in different stages can be treated differently.Percutaneous vertebroplasty and percutaneous kyphoplasty are better for patients with persistent pain but no neurological symptoms,while for patients with persistent pain and neurological symptoms,open decompression of the lamina is required.