单侧双靶点穿刺技术联合侧开口推进器行经皮椎体成形术治疗Kümmell病

Percutaneous vertebroplasty with unilateral double‑target puncture approach plus side opening propeller in treating Kümmell disease

目的比较单侧双靶点穿刺技术联合侧开口推进器行经皮椎体成形术(PVP)与传统PVP治疗Kümmell病的疗效。方法采用回顾性队列研究分析2020年1月至2022年6月郑州市骨科医院收治的40例Kümmell病患者的临床资料,其中男11例,女29例;年龄61~95岁[(74.3±9.5)岁]。20例采用单侧双靶点穿刺技术联合侧开口推进器行PVP(观察组),20例采用传统PVP(对照组)。比较两组手术时间、骨水泥注入量、骨水泥分布等级。术前、术后1 d及术后6个月视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Cobb角和椎体前缘高度。比较两组并发症发生率。结果患者均获随访6~12个月[(9.1±2.8)个月]。观察组手术时间为(40.3±4.5)min,对照组为(38.6±3.5)min(P>0.05)。观察组骨水泥注入量为(6.5±1.3)ml,大于对照组的(5.4±1.0)ml(P<0.01)。观察组骨水泥分布等级(1级0例,2级3例,3级17例)优于对照组(1级1例,2级15例,3级4例)(P<0.01)。术前两组VAS、ODI、Cobb角、椎体前缘高度比较,差异无统计学意义(P均>0.05)。术后1 d观察组与对照组VAS分别为(1.6±0.7)分、(2.5±0.8)分,ODI分别为16.1±3.3、21.3±4.1,Cobb角分别为(18.4±2.9)°、(21.4±2.0)°,椎体前缘高度分别为(23.7±1.8)mm、(20.1±1.7)mm;术后6个月观察组与对照组VAS分别为(1.3±0.5)分、(2.3±0.9)分,ODI分别为15.0±3.8、20.8±3.9,Cobb角分别为(19.3±2.9)°、(22.4±1.7)°,椎体前缘高度分别为(23.4±1.8)mm、(19.8±1.6)mm。术后1 d和术后6个月观察组VAS、ODI、Cobb角、椎体前缘高度优于对照组(P均<0.01)。术后1 d两组VAS、ODI、Cobb角、椎体前缘高度较术前有明显改善(P均<0.01);术后6个月两组VAS、ODI、Cobb角、椎体前缘高度较术前有明显改善(P均<0.01),但与术后1 d比较,差异无统计学意义(P均>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论与传统PVP比较,单侧双靶点穿刺技术联合侧开口推进器行PVP治疗Kümmell病,骨水泥注入量更充足、分布更均匀,可更有效减轻患者疼痛,改善生活质量,矫正后凸畸形及恢复椎体高度。

Objective To compare the efficacy between percutaneous vertebroplasty(PVP)with unilateral double‑target puncture approach plus side opening propeller and traditional PVP in the treatment of Kümmell disease.Methods A retrospective cohort study was conducted to analyze the clinical data of 40 patients with Kümmell disease admitted to Zhengzhou Orthopedic Hospital from January 2020 to June 2022,including 11 males and 29 females;aged 61‑95 years[(74.3±9.5)years].Twenty patients received the PVP with unilateral double‑target puncture approach plus side opening propeller(observation group),and 20 patients were treated with traditional PVP(control group).The operation time,volume of cement injection and distribution levels of bone cement were compared between the two groups,as well as the visual analogue score(VAS),Oswestry dysfunction index(ODI),Cobb angle,anterior height of the vertebral body before operation and at 1 day and 6 months after operation.The incidence of complications was also compared between the two groups.Results All patients were followed up for 6‑12 months[(9.1±2.8)months].The operation time was(40.3±4.5)minutes in the observation group and(38.6±3.5)minutes in the control group(P>0.05).The volume of cement injection was(6.5±1.3)ml in the observation group,significantly more than that in the control group[(5.4±1.0)ml](P<0.01).The distribution levels of bone cement in the observation group(0 patient in Grade 1,3 in Grade 2,and 17 in Grade 3)were better than those in the control group(1 patient in Grade 1,15 in Grade 2,and 4 in Grade 3)(P<0.01).There were no significant differences in the VAS,ODI,Cobb angle or anterior height of the vertebral body between the two groups before operation(all P>0.05).One day after operation,the VAS in the observation group and control group was(1.6±0.7)points and(2.5±0.8)points,with the ODI of 16.1±3.3 and 21.3±4.1,Cobb angle of(18.4±2.9)°and(21.4±2.0)°and anterior height of the vertebral body of(23.7±1.8)mm and(20.1±1.7)mm.Six months after operation,the VAS in the observation group and control group was(1.3±0.5)points and(2.3±0.9)points,with the ODI of 15.0±3.8 and 20.8±3.9,Cobb angle of(19.3±2.9)°and(22.4±1.7)°,and anterior height of the vertebral body of(23.4±1.8)mm and(19.8±1.6)mm.The VAS,ODI,Cobb angle and anterior height of the vertebral body in the observation group were better than those in the control group at 1 day and 6 months after operation(all P<0.01).The VAS,ODI,Cobb angle and anterior height of the vertebral body were significantly improved in the two groups at 1 day and 6 months after operation compared with those before operation(all P<0.01),but there were no significant differences between 1 day and 6 months after operation(all P>0.05).The incidence of complications was not significantly different between the two groups(P>0.05).Conclusion The PVP with unilateral double‑target puncture approach plus lateral opening propeller not only allows for adequate and evenly distributed injection of bone cement,but also effectively reduces the pain,improves the quality of life,corrects the kyphosis and restores the height of the vertebral body in treating Kümmell disease compared with the traditional PVP.