目的 探讨阶梯在 Kummell 病治疗中的临床效果和应用价值.方法 回顾分析 2018 年 6 月至 2022 年 6 月,我院采用阶梯序贯式椎体成形术治疗的 32 例 Kummell 病患者的临床资料.其中男 12 例,女20 例,年龄 63~92 岁,平均 74.5 岁.病程 3~60 个月,平均 12.3 个月.病椎分布为胸椎 16 例,腰椎16 例.其中 26 例采取双侧穿刺,6 例采取单侧穿刺.术后复查 X 线片观察骨水泥在椎体内的分布情况和渗漏情况,根据术前和术后 X 线片测量伤椎前缘高度变化和后凸角度变化,采用疼痛视觉模拟评分(visual analogue scale,VAS)和 Oswestry 功能障碍指数(oswestry disability index,ODI)评估手术治疗效果.结果 32 例患者均获得 12~36 个月随访,平均 15.3 个月.术后 7 例患者发生骨水泥渗漏,渗漏部位包括椎体前方1 例,椎管内 1 例,椎体侧方 2 例,椎间盘内 3 例,均未发生神经损伤、肺栓塞等相关并发症.术前、术后3 天和末次随访 3 个时间点上,伤椎前缘高度(前缘高度占后缘高度百分比)分别为(28.6±3.0)%、(42.3±6.4)%、(42.1±6.4)%,后凸角度分别为(18.8±4.7)°、(14.2±3.7)°、(14.0±3.8)°,VAS 评分分别为6.91±1.15、2.34±1.31、1.22±1.04,ODI 分别为(82.38±5.93)%、(25.75±8.65)%、(22.75±6.87)%.术后2 个时间点的以上指标与术前比较差异有统计学意义(P<0.05),术后 2 个时间点之间影像学指标比较差异均无统计学意义(P>0.05),VAS 评分和 ODI 比较差异有统计学意义(P<0.05).结论 对于 Kummell 病,采用阶梯序贯式椎体成形术进行手术治疗,可有效缓解症状,改善功能,减少骨水泥渗漏及相关并发症.
Objective To explore the efficacy and value of graded sequential percutaneous vertebroplasty(PVP)in the treatment of Kummell disease.Methods A series of 32 cases with Kummell disease were surgically treated by graded sequential PVP from June 2018 to June 2022.Of these cases,12 were male and 20 were female,aged from 63 to 92 years old(average:74.5 years)with a disease duration from 3 to 60 months(average:12.3 months).Affected segments included thoracic vertebra in 16 cases and lumbar vertebra in 16 cases.Bilateral puncture was used for 26 cases,while unilateral puncture for 6 cases.X-ray films were carried out after operation to evaluate bone cement filling and leakage.Anterior height and kyphosis angle changes were measured based on preoperative and post-operative radiology results.Visual analogue scale(VAS)and Oswestry disability index(ODI)were recorded to assess clinical effectiveness of surgical treatment.Results All the 32 cases were followed up 12 to 36 months(average:15.3 months).Cement leakage occurred in 7 patients,including 1 case of anterior paravertebral leakage,1 case of intracanal leakage,2 cases of lateral paravertebral leakage,3 cases of intervertebral disc leakage.There was no complication of neurodeficit or pulmonary embolism.The anterior height of the affected vertebrae was significantly improved from(28.6±3.0)%at preoperation to(42.3±6.4)%at 3 days after operation and(42.1±6.4)%at the last follow-up(P<0.05).The kyphosis angle was significantly improved from(18.8±4.7)° at preoperation to(14.2±3.7)° at 3 days after operation and(14.0±3.8)° at the last follow-up(P<0.05).The VAS scores were significantly decreased from(6.91±1.15)at preoperation to(2.34±1.31)at 3 days after operation and(1.22±1.04)at the last follow-up(P<0.05).The ODI was significantly decreased from(82.38±5.93)%to(25.75±8.65)%and(22.75±6.87)%(P<0.05).Significant differences were found in VAS and ODI between at 3 days and at the last follow-up(P<0.05),while no significant difference was found in anterior height of the affected vertebrae and kyphosis angle between the two postoperative time points(P>0.05).Conclusions Graded sequential PVP is a safe and effective procedure for Kummell disease and this technique could decrease the incidence of bone cement leakage and other complications.