| 陈国兆,王黎明,沙卫平.双侧穿刺序贯椎体成形治疗Kümmell病的临床疗效.骨科,2020,11(4): 293-298. |
| 双侧穿刺序贯椎体成形治疗Kümmell病的临床疗效 |
| Clinical effectiveness of bilateral graded infusion of bone cement in percutaneous vertebroplasty for Kümmell disease |
| 投稿时间：2020-03-06 |
| DOI：10.3969/j.issn.1674-8573.2020.04.005 |
| 中文关键词: 序贯椎体成形术 Kümmell病 双侧穿刺 椎体高度 Cobb角 并发症 |
| 英文关键词: Graded infusion in percutaneous vertebroplasty Kümmell disease Bilateral puncture Vertebral height Cobb angle Complications |
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| 中文摘要: |
| 目的 探讨双侧穿刺序贯经皮椎体成形术（percutaneous vertebroplasty, PVP）治疗Kümmell病的临床疗效。方法 回顾性研究2016年1月至2018年12月于我院行双侧穿刺序贯PVP治疗的Kümmell病病人30例，其中男12例，女18例；年龄为61~85岁（平均71岁），病程为2~10个月，病椎：T11 3例，T12 6例，L1 13例，L2 5例，L3 3例。收集比较病人术前、术后2 d、1个月、12个月的疼痛视觉模拟量表（visual analogue scale, VAS）评分和Oswestry功能障碍指数（Oswestry disability index, ODI）；基于病人X线片评估伤椎术后的椎体高度、矢状位Cobb角。结果 30例病人获得12~15个月的随访，平均13.3个月。未见穿刺部位感染、内植物感染、肺栓塞、脊髓神经损伤、椎前血管损伤、骨水泥松动或移位等严重并发症发生，随访期间未发生邻椎骨折或伤椎再骨折。骨水泥注入量为（5.85±0.57） ml，术中发生骨水泥渗漏5例，3例为椎体前方少量骨水泥渗漏，2例为上位椎间隙渗漏，病人术中术后未诉明显不适，未予处理。术后2 d、1个月、12个月的VAS、ODI、伤椎Cobb角均明显降低，伤椎椎体高度明显恢复，与术前比较，差异均有统计学意义（P均＜0.05）；但术后不同时间点的VAS、ODI、伤椎Cobb角及椎体高度比较，差异均无统计学意义（P均＞0.05）。结论 双侧穿刺序贯PVP的操作创伤小，骨水泥渗漏等并发症发生率低，病人术后恢复快，随访临床疗效满意，是Kümmell病的有效治疗手段。 |
| 英文摘要: |
| Objective To observe the clinical effect of bilateral graded infusion of bone cement in percutaneous vertebroplasty (PVP) for Kümmell disease. Methods With the retrospective analysis, 30 cases of Kümmell disease were treated by bilateral graded infusion of bone cement in PVP from January 2016 to December 2018, including 12 males and 18 females, aged from 61 to 85 years old (mean 71 years old), with a disease duration from 2-10 months. The affected segments included T11 in 3 cases, T12 in 6 cases, L1 in 13 cases, L2 in 5 cases and L3 in 3 cases. Visual analog scale (VAS), Oswestry disability index (ODI) at before operation,2nd day, 1st month and 12th month post-operation were collected and compared. The vertebral body height and sagittal Cobb angle were evaluated after operation based on the patient's X-ray film. Results All 30 patients treated by bilateral graded infusion of bone cement in PVP were followed up for 12-15 months, with an average of 13.3 months. No severe complications such as infection of puncture site, infection of internal plant, pulmonary embolism, spinal cord nerve injury, anterior vertebral artery injury, loosening and displacement of bone cement happened, and no fracture of adjacent segment or refracture of injured vertebral occurred during the follow-up period. The average injection volume of bone cement was (5.85±0.57) ml. Cement leakage occurred in 5 cases, including 3 cases of anterior paravertebral leakage, 2 cases of upper intervertebral disc leakage, the patients did not complain of obvious discomfort, and no measures were taken with the leakage. Compared with pre-operation, VAS score, ODI, and Cobb angle were significantly reduced and the height of the injured vertebrae was significantly restored at 2nd day, 1st month and 12th month post-operation (all P＜0.05), but no significant differences were found in VAS scores, ODI, Cobb angle and vertebral height among 2nd day, 1st month and 12th month post-operation (P＞0.05). Conclusion Bilateral graded infusion of bone cement in PVP has the advantages of less trauma, lowed incidence of complications especially the leakage of bone cement, faster recovery, and has a satisfactory clinical effectiveness. Bilateral graded infusion of bone cement in PVP is an effective way to treat Kümmell disease. |
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