过伸性体位复位与非复位经皮椎体后凸成形术治疗Kümmell病的疗效比较

Efficacy comparison of percutaneous kyphoplasty with hyperextension postural reduction or not in treatment of Kümmell disease

目的探讨过伸性体位复位与非复位经皮椎体后凸成形术(PKP)治疗Kümmell病的疗效。方法采用回顾性病例对照研究分析2014年1月至2017年7月重庆市人民医院收治的42例单节段Kümmell病患者的临床资料,其中男17例,女25例;年龄68~82岁[(75.7±5.7)岁]。两组患者均行PKP治疗。19例术前未采取过伸性体位复位(常规组),23例术前采取过伸性体位复位(复位组)。比较两组手术时间和并发症情况,以及术前、术后3 d及术后1年视觉模拟评分(VAS)、伤椎前缘高度压缩率及伤椎矢状面Cobb角。结果患者均获随访12~14个月[(13.2±1.3)个月]。复位组手术时间较常规组显著缩短[(31.7±2.2)min∶(43.5±2.4)min](P<0.01)。常规组出现骨水泥椎前渗漏2例(P<0.05);两组患者均未出现感染、神经根损伤、脑脊液漏、肺栓塞及过敏性休克等并发症。常规组术前、术后3 d和术后1年的VAS分别为(8.3±1.1)分、(2.7±0.8)分、(2.0±0.5)分;复位组术前、术后3 d和术后1年的VAS分别为(8.2±1.1)分、(2.6±0.8)分、(1.8±0.5)分。两组术后VAS均较术前明显降低(P<0.01),术后两组间比较,差异均无统计学意义(P>0.05)。常规组术前、术后3 d和术后1年的伤椎前缘高度压缩率分别为(69.9±3.4)%、(60.7±3.8)%、(62.9±3.6)%;复位组术前、术后3 d和术后1年的伤椎前缘高度压缩率分别为(71.8±3.1)%、(51.7±3.3)%、(53.6±3.3)%。两组术后伤椎前缘高度压缩率均较术前明显降低(P<0.01),术后两个时相点组间比较,复位组的伤椎前缘高度压缩率改善优于常规组(P<0.05)。常规组术前、术后3 d和术后1年的伤椎矢状面Cobb角分别为(19.2±1.9)°、(14.9±1.7)°、(15.4±1.7)°;复位组术前、术后3 d和术后1年的伤椎矢状面Cobb角分别为(24.4±1.9)°、(11.3±1.5)°、(12.4±1.6)°。两组术后伤椎矢状面Cobb角均较术前明显减小(P<0.01),术后两个时相点组间比较,复位组的伤椎矢状面Cobb角改善优于常规组(P<0.05)。结论对于单节段Kümmell病患者,过伸性体位复位较非复位PKP治疗可以缩短手术时间、减少骨水泥渗漏率、提高椎体的高度恢复率及Cobb角改善率。

Objective To investigate the effect of percutaneous kyphoplasty(PKP)with hyperextension postural reduction or not in the treatment of Kimmell disease.Methods A retrospective case-control study was conducted to analyze the clinical data of 42 patients with Kimmell disease admitted to Chongqing General Hospital from January 2014 to July 2017.There were 17 males and 25 females,with the age of 68-82 years[(75.7±5.7)years].PKP was performed in all patients.A total of 19 patients did not take hyperextension position reduction before operation(control group),and 23 patients took hyperextension position reduction group before operation(reduction group).The operation time,complications,and visual analogue scale(VAS),compression ratio of the anterior vertebral height,as well as injured vertebral Cobb angle on saggital plane before operation,3 days after operation and 1 year after operation were compared between the two groups.Results All patients were followed up for 12-14 months[(13.2±1.3)months].The operation time in reduction group was significantly shorter than that in control group[(31.7±2.2)minutes us.(43.5±2.4)minutes](P<0.01).Prevertebral leakage of bone cement occurred in 2 patients in control group.There were no complications such as infection,nerve root injury,cerebrospinal fluid leakage,pulmonary embolism and anaphylactic shock in the two groups.Before operation and 3 days and 1 year after operation,the VAS was respective(8.3±1.1)points,(2.7±0.8)points and(2.0±0.5)points in control group,and was respective(8.2±1.1)points,(2.6±0.8)points and(1.8±0.5)points in reduction group.The VAS in both groups was significantly lower than that before operation(P<0.01),but there was no significant difference between the two groups after operation(P>0.05).Before operation and 3 days and 1 year after operation,the compression ratio of the anterior vertebral height was respective(69.9±3.4)%,(60.7±3.8)%and(62.9±3.6)%in control group,and was respective(71.8±3.1)%,(51.7±3.3)%and(53.6±3.3)%in reduction group.The compression ratio of the anterior vertebral height in both gro oups showed a significant decrease after operation(P<0.01),and the improvement was better in reduction group than that in control group after operation(P<0.05).Before operation and 3 days and 1 year after operation,the injured vertebral Cobb angle on saggital plane was respective(19.2±1.9)°,(14.9±1.7)°and(15.4±I.7)°in control group,and was respective(24.4±1.9)°,(11.3±1.5)°and(12.4±1.6)°in reduction group.The injured vertebral Cobb angle on saggital plane in both groups was significantly decreased after operation(P<0.01),and the improvement was better in reduction group than that in control group after operation(P<0.05).Conclusion For single-segment Kimmell disease,PKP with hyperextension postural reduction can shorten operation time,reduce bone cement leakage,improve recovery rate of vertebral height and reduce Cobb angle compared with PKP without hyperextension postural reduction.