骨填充网袋椎体成形术与经皮后凸椎体成形术治疗无神经症状Kümmell病Ⅲ期的疗效对比

Postoperative comparison of unilateral perforator bone-filling mesh container vertebroplasty versus unilateral percutaneous kyphoplasty for stage III Kümmell’s disease without neurological symptoms

目的 探讨骨填充网袋运用于无神经症状Ⅲ期Kümmell病的疗效及安全性。方法 选取2018年1月至2020年12月36例无神经症状性Ⅲ期Kümmell病患者,其中男14例,女22例,年龄63~84岁。采用随机数字表法分2组(n=18):单侧经皮后凸椎体成形术(PKP组)和骨填充网袋组(BFMCS组)。记录术前(T_(1))、术后1天(T_(2))、术后1周(T_(3))、术后1月(T_(4))、术后6月(T_(5))疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、cobb角、椎管内径变化、责任椎体高度变化、术中骨水泥渗漏发生情况。结果 与术前比较,PKP组与BFMCS组在VAS评分、ODI评分、cobb角均较术前降低,椎管内径较术前有扩大,责任椎体前缘高度较术前增加,但两组患者差异无统计学意义。BFMCS组骨水泥渗漏率较PKP组低,差异有统计学意义。术后两组患者均未出现神经损伤症状。结论 单侧穿刺骨填充网袋与PKP治疗无神经症状Ⅲ期Kümmell病能有效改善患者症状,但骨填充网袋骨水泥渗漏率较低,部份恢复椎体高度,是一种微创、安全、有效的方法。

Objective To investigate the efficacy and safety of using bone-filling mesh container vertebroplasty in stage Ⅲ Kümmell’s disease without neurological symptoms.Methods Thirty-six patients with non-neurological symptomatic stage Ⅲ Kümmell’s disease treated with vertebroplasty from January 2018 to December 2020 were selected,including 14 males and 22 females,aged 63~84 years.A random number table method was utilized to divide the patients into 2 groups(n=18):percutaneous posterior convex vertebroplasty(PKP group)and bone-filling mesh container vertebroplasty group(BFMCS group).The preoperative(T_(1)),1 day postoperative(T_(2)),1 week postoperative(T_(3)),1 month postoperative(T_(4)),and 6 month postoperative(T_(5))pain visual analog scale(VAS),Oswestry dysfunction index(ODI),cobb angle,change in the internal diameter of the spinal canal,change in the height of the responsible vertebral body,and the occurrence ofinterpretative bone cement leakage were recorded.Results Compared with the preoperative period,the PKP group and the BFMCS group showed lower VAS score,ODI score and cobb angle,enlarged internal diameter of the spinal canal and increased height of the anterior margin of the responsible vertebral body compared with the preoperative period,but the difference between the two groups was not statistically significant.The rate of bone cement leakage in the BFMCS group was lower than that in the PKP group,and the difference was statistically significant.None of the patients in both groups showed symptoms of nerve injury after surgery.Conclusion Unilateral puncture of the bone-filled mesh bag with PKP for non-neurological stage Ⅲ Kümmell’s disease is effective in improving the patient’s symptoms,but the bone-filled mesh bag has a lower cement leakage rate and partially restores vertebral height,making it a minimally invasive,safe,and effective method.