序贯椎体成形术治疗Kummell病的疗效观察  

GRADED INFUSION OF BONE CEMENT IN PERCUTANEOUS VERTEBROPLASTY FOR Kummell's DISEASE

作　　者：姚女兆[1] 夏曦[1] 唐绍锋[1] 

机构地区：[1]南华大学附属第一医院脊柱外科,湖南衡阳421001

出　　处：《中国修复重建外科杂志》2015年第10期1265-1268,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨单侧经皮椎体成形术（percutaneous vertebroplasty,PVP）中采用分次序贯灌注骨水泥治疗Kummell病的疗效。方法 2012年1月-2014年1月,对18例Kummell病患者行单侧PVP治疗,术中采用分次灌注骨水泥序贯椎体成形。其中男6例,女12例;年龄65-88岁,平均75岁。病程3-32个月,平均11.6个月。所有患者术前采用双能X线骨密度仪测定骨密度,T值为—4.0-—2.8,平均—3.4。病椎分别位于T11 3例,T12 10例,L1 3例,L2 2例。术后复查X线片观察骨水泥渗漏及病椎前缘高度变化情况;采用疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评估手术疗效。结果 18例均获随访,随访时间12-26个月,平均14个月。术后4例患者发生骨水泥渗漏,其中骨水泥渗入椎间盘内2例,椎体前侧1例,椎管内静脉丛1例;但均未出现神经功能损伤等相关并发症。术前、术后3 d及末次随访时,病椎前缘高度分别为29.1%±6.7%、68.1%±7.3%、67.8%±5.9%,VAS评分分别为（8.11±1.32）、（2.14±0.78）、（1.97±0.50）分,ODI分别为84.6%±8.5%、24.1%±9.7%、23.8%±10.2%;术后各时间点以上指标均较术前显著改善（P〈0.05）,术后3 d及末次随访间比较差异均无统计学意义（P〉0.05）。结论对于Kummell病,采用分次序贯灌注骨水泥方法行单侧PVP,可有效缓解腰背痛症状,减少骨水泥渗漏且并发症少。Objective To explore the safety and effectiveness of graded infusion of bone cement in the unipedicular percutaneous vertebroplasty （PVP） for Kummell’s disease. Methods Eighteen patients with Kummell’s disease were treated by unipedicular PVP with graded infusion of bone cement between January 2012 and January 2014. Of 18 cases, 6 were male and 12 were female, aged from 65 to 88 years （mean, 75 years）, with a disease duration from 3 to 32 months （mean, 11.6 months）. The bone mineral density was measured by dual-energy X-ray absorptiometry; the T value ranged from —4.0 to —2.8 （mean, —3.4）. Affected segments included T11 in 3 cases, T12 in 10 cases, L1 in 3 cases, and L2 in 2 cases. X-ray films were taken after operation to observe bone cement leakage and anterior height changes of affected vertebrae. Visual analogue scale （VAS） and Oswestry disability index （ODI） were used to assess pain status and functional activity. Results All cases underwent smoothly unipedicular PVP and were followed up 12-26 months （mean, 14 months）. Cement leakage occurred in 4 patients, including 1 case of anterior paravertebral soft tissue leakage, 2 cases of intervertebral disc leakage, and 1 case of canal venous leakage, but there was no other complications. The anterior height of affected vertebrae were significantly improved （P〈0.05） from 29.1%±6.7% at preoperation to 68.1%±7.3% at 3 days after operation and 67.8%±5.9% at last follow-up; the VAS scores were significantly decreased （P〈0.05） from 8.11±1.32 at preoperation to 2.14±0.78 at 3 days and 1.97± 0.50 at last follow-up; and ODI were significantly decreased （P〈0.05） from 84.6%±8.5% to 24.1%±9.7% and 23.8%±10.2%; but no significant difference was found between at 3 days and at last follow-up （P〉0.05）. Conclusion Graded infusion of bone cement in unipedicular PVP is a safe and effective procedure for Kummell’s disease and this technique could decrease the incidence of bone cement leakage.

关 键 词：Kummell病 骨质疏松 经皮椎体成形术 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]