中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (22): 3481-3487.doi: 10.3969/j.issn.2095-4344.1274

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

单侧穿刺经皮椎体后凸成形与椎体成形骨水泥注射治疗Kummell病的对比

蒋  杰,张  勇
  

  1. 湖南省永州市中心医院北院脊柱外科,湖南省永州市  425000
  • 收稿日期:2019-03-04
  • 作者简介:蒋杰,男,1987年生,湖南省永州市人,汉族,硕士,主治医师,主要从事脊柱外科研究。

Unipedicular percutaneous vertebroplasty versus percutaneous kyphoplasty bone cement for treating Kummell disease

Jiang Jie, Zhang Yong
  

  1. Department of Spine Surgery, the Central Hospital of Yongzhou, Yongzhou 425000, Hunan Province, China
  • Received:2019-03-04
  • About author:Jiang Jie, Master, Attending physician, Department of Spine Surgery, the Central Hospital of Yongzhou, Yongzhou 425000, Hunan Province, China

摘要:

文章快速阅读:

 

文题释义:
Kummell病:又称椎体内缺血性骨坏死,临床特征为创伤后数周或数月无症状期、迟发性椎体塌陷和受伤椎体出现真空征或裂隙征等,目前多数学者认为该病的病理机制复杂,可能是多种因素如椎体内缺血性坏死、脊柱生物力学改变及骨性结构微骨折损伤修复受阻等相互作用的结果,主流观点认为该病是在骨质疏松性椎体骨折的基础上伤椎椎体局部缺血坏死导致假关节形成,并最终演变为椎体塌陷。
椎体成形术:是指通过椎弓根向椎体内注入骨水泥,以达到增加椎体强度和稳定性、防止塌陷、缓解疼痛为目的的一种微创脊椎外科技术。
 
 
背景:经皮椎体成形和经皮椎体后凸成形骨水泥注射治疗均是治疗Ⅰ或Ⅱ型Kummell病的有效微创治疗方式,但究竟哪种治疗效果更具优势目前仍不清楚。
目的:对比单侧穿刺皮椎体成形与经皮椎体后凸成形骨水泥注射治疗Ⅰ或Ⅱ型Kummell病的临床疗效。
方法:选择2014年1月至2017年9月永州市中心医院骨科收治的51例单椎体Kummell病患者,其中男14例,女37例,年龄60-89岁,责任椎体T10-L3,其中27例进行单侧穿刺椎体成形骨水泥注射治疗(椎体成形组),24例进行单侧穿刺椎体后凸成形骨水泥注射治疗(椎体后凸成形组),记录术后及术后骨水泥渗漏、一过性发热及再骨折情况。治疗前、治疗后1 d及末次随访时,影像学评估伤椎椎体前缘高度与椎体后凸Cobb’s角;治疗前及治疗后1 d、1个月、6个月及12个月,进行疼痛目测类比评分与Oswestry功能障碍指数评估。试验方案已获得湖南省永州市中心医院伦理审批。
结果与结论:①两组骨水泥渗漏、一过性发热及再骨折发生情况比较差异均无显著性意义(P > 0.05);②两组治疗后的伤椎椎体前缘高度与椎体后凸Cobb’s角均较治疗前明显改善(P < 0.05),且椎体后凸成形组改善程度优于椎体成形组(P < 0.05);③两组治疗后的目测类比评分与Oswestry功能障碍指数评分均低于治疗前(P < 0.05),两组治疗后的目测类比评分与Oswestry功能障碍指数评分总体比较差异无显著性意义(P > 0.05);④结果表明,经皮椎体成形与经皮椎体后凸成形骨水泥注射治疗均可显著缓解Kummell病患者的疼痛,获得较好的治疗效果和安全性,但经皮椎体后凸成形骨水泥注射治疗可获得更好的椎体高度和后凸角度复位。

关键词: Kummell病, 骨水泥, 椎体成形, 椎体后凸成形, 骨科植入物, Oswestry功能障碍指数, 目测类比评分, 椎体后凸Cobb’s角

Abstract:

BACKGROUND: Percutaneous vertebroplasty and percutaneous kyphoplasty are effective minimally invasive treatments for type I or II Kummell disease, but it is still unclear which treatment is better.
OBJECTIVE: To compare the clinical efficacy of unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of type I or II Kummell disease.
METHODS: Fifty-one patients with Kummell disease were admitted at the Department of Orthopedics, the Central Hospital of Yongzhou from January 2014 to September 2017, including 14 males and 37 females, aged 60-89 years old, responsible for T10-L3. Of which, 27 patients underwent unilateral puncture vertebroplasty with cement injection, and 24 patients underwent unilateral puncture kyphoplasty with cement injection. Intraoperative and postoperative cement leakage, transient fever and re-fracture were recorded. Before treatment, 1 day after treatment and at the last follow-up, the height of the vertebral body of the injured vertebrae and the Cobb angle were evaluated by imaging. Visual Analogue Scale and Oswestry dysfunction index were assessed before treatment and 1 day, 1, 6 and 12 months after treatment. The study was approved by the Ethics Committee of the Central Hospital of Yongzhou, Hunan Province.
RESULTS AND CONCLUSION: (1) There was no significant difference in the occurrence of cement leakage, transient fever and re-fracture between two groups (P > 0.05). (2) The height of the anterior edge of the injured vertebral body and the Cobb angle in the two groups were significantly improved after treatment (P < 0.05), and the improvement in the puncture kyphoplasty group was better than that in the puncture vertebroplasty group (P < 0.05). (3) The Visual Analogue Scale and Oswestry dysfunction index scores after treatment in the two groups were lower than those before treatment (P < 0.05). There was no significant difference in the scores between two groups (P > 0.05). (4) These results show that percutaneous kyphoplasty or percutaneous vertebroplasty can significantly alleviate the pain of patients with Kummell disease and obtain good effectiveness and safety. In contrast, percutaneous kyphoplasty can achieve better imaging height and Cobb angle reduction.

Key words: Kummell disease, bone cement, vertebroplasty, percutaneous kyphoplasty, orthopedic implant, Oswestry dysfunction index, Visual Analogue Scale, Cobb angle

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