双侧矢状面交叉穿刺经皮穿刺椎体成形术治疗Kümmell病

Percutaneous vertebroplasty to treat Kümmell disease with bilateral sagittal cross paracentesis

目的探讨双侧矢状面交叉穿刺经皮穿刺椎体成形术(PVP)治疗Kümmell病的疗效。方法 2015年6月至2017年9月重庆大学附属中心医院骨科收治的78例Kümmell病病人实施该手术。观察指标包括骨水泥渗漏、椎体内骨水泥分布、伤椎前缘高度、矢状面Cobb角、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果 78例病人均获得24个月随访。1例病人出现骨水泥渗漏,无严重并发症发生。骨水泥在椎体内分布均匀,同时接触上、下终板。伤椎前缘高度、Cobb角、VAS、ODI评分术后2 d[(21.5±2.4)mm、(12.7±2.3)°、(2.3±0.6)分、(25.1±4.1)%]、1月[(20.7±2.5)mm、(13.1±2.0)°、(2.1±0.5)分、(22.1±3.5)%]、12月[(20.4±2.2)mm、(13.3±2.1)°、(1.9±0.4)分、(21.1±3.1)%]、24月[(20.1±1.6)mm、(14.1±1.5)°、(2.2±0.1)分、(24.1±2.5)%]较术前[(14.1±2.1)mm、(21.1±3.0)°、(7.7±0.9)分、(73.9±3.3)%]显著改善(P<0.05),术后1月、12月、24月与术后2 d相比较差异无统计学意义(P>0.05)。随访24个月,病人无骨水泥松动、移位及手术椎体再骨折发生。结论双侧矢状面交叉穿刺PVP治疗Kümmell病疗效确切,安全可靠。此技术能使骨水泥同时接触上、下终板,全椎体强化,降低手术椎体再骨折风险。

Objective To investigate the clinical efficacy of percutaneous vertebroplasty(PVP)in the treatment of Kümmell’s disease with bilateral sagittal cross paracentesis.Methods From June 2015 to September 2017,78 patients with Kümmell disease ad⁃mitted to the Department of Orthopedics of the Central Hospital of Chongqing University underwent the operation.Observed indica⁃tors included bone cement leakage,bone cement distribution in the vertebral body,the anterior border height of the injured vertebral body,the Cobb angle of the sagittal plane,visual analog scale(VAS),and oswestry dysfunction index(ODI).Results All 78 patients were followed up for 24 months.There were 1 cases of cement leakage without serious complications.The bone cement is evenly distributed in the vertebral body while contacting the upper and lower endplates at the same time.The height of the anterior border of the injured vertebrae,Cobb angle,VAS,ODI scores after 2 days,1 month,12 months,and 24 months of the operation re⁃spectively were:2 days[(21.5±2.4)mm,(12.7±2.3)°,(2.3±0.6)points,(25.1±4.1)%],1 month[(20.7±2.5)mm,(13.1±2.0)°,(2.1±0.5)minutes,(22.1±3.5)%],12 months[(20.4±2.2)mm,(13.3±2.1)°,(1.9±0.4)Minutes,(21.1±3.1)%],24 months[(20.1±1.6)mm,(14.1±1.5)°,(2.2±0.1)minutes,(24.1±2.5)%].Compared with preoperative data which were[(14.1±2.1)mm,(21.1±3.0)°,(7.7±0.9)points,(73.9±3.3)%],those indicators significantly improved(P<0.05).There was no statistically significant difference between 2 days and 1 month,12 months,24 months postoperative(P>0.05).After 2 years of follow⁃up,no bone cement loosening,displacement and refracture of cemented vertebra occurred.Conclusion Bilateral sagittal cross⁃puncture PVP is ef⁃fective and safe in the treatment of Kümmell disease.This technology enables bone cement simultaneously touched the upper and lower endplates to strenghthen the whole vertebra,reducing the risk of bone cement leakage and refracture of cemented vertebra.