经皮椎体后凸成形术治疗无神经症状性Ⅲ期Kümmell病  

Percutaneous kyphoplasty for stage Ⅲ Kümmell's disease with no neurological symptom

作　　者：刘义杰[1] 杨森 李雪峰[1] 姜为民[1] 李人杰 汪恒[1] 管华清[1] 陈洁[1] 王根林[1] 杨惠林[1] Liu Yijie;Yang Sen;Li Xuefeng;Jiang Weimin;Li Renjie;Wang Heng;Guan Huaqing;Chen Jie;Wang Genlin;Yang Huilin(Department of Orthopaedics, The First Hospital Affiliated to Soochow University, Suzhou 215006, China)

机构地区：[1]苏州大学附属第一医院骨科,215006

出　　处：《中华创伤骨科杂志》2019年第10期888-893,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨经皮椎体后凸成形术(PKP)治疗无神经症状性Ⅲ期Kümmell病的疗效。方法回顾性研究2009年1月至2018年6月苏州大学附属第一医院骨科行PKP手术治疗的45例无神经症状性Ⅲ期Kümmell病患者资料,其中男12例,女33例;年龄61~85岁,平均70.9岁。记录并比较术前、术后1 d、3个月、末次随访时疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(Oswestry)、责任椎体高度及后凸cobb角。结果45例患者均获随访,时间12~48个月(平均28.0个月)。所有患者术后1 d、3个月、末次随访时VAS评分[(2.4±0.7)、(2.2±0.7)、(2.3±0.6)分]、ODI评分[(34.7±6.8)、(34.2±6.5)、(34.1±6.6)分]和后凸cobb角[15.7°±2.2°、15.8°±2.2°、15.9°±2.4°]均较术前降低[(8.2±1.1)分、(75.3±9.0)分、25.2°±3.9°],术后1 d、术后3个月、末次随访时责任椎体前缘高度比(54.0%±4.3%、53.7%±4.2%、53.6%±4.0%)、椎体中线高度(56.8%±4.0%、56.5%±3.9%、56.6%±3.9%)均较术前(25.8%±3.9%、27.2%±3.1%)增加,差异有统计学意义(P<0.001)。骨水泥渗漏率为13.3%(6/45),所有患者术后均未出现神经症状。结论PKP治疗无神经症状性Ⅲ期Kümmell病能有效改善患者症状,恢复责任椎体高度,减小局部后凸cobb角,是一种微创、安全、有效的方法。Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of stage Ⅲ Kümmell's disease with no neurological symptom. Methods From January 2009 to June 2018, 45 patients underwent PKP for stage Ⅲ Kümmell's disease with no neurological symptom at Department of Orthopaedics, The First Hospital Affiliated to Soochow University. They were 12 males and 33 females, aged from 61 to 85 years (average, 70.9 years). Their visual analog scale (VAS) scores for back pain, Oswestry disability indexes (ODI), heights of fractured vertebrae and kyphosis cob angles were recorded and compared between preoperation, one day, 3 months and final follow-up after operation. Results All the 45 patients were followed up for 12 to 48 months (average, 28.0 months). Their VAS scores (2.4±0.7, 2.2±0.7 and 2.3±0.6), ODI sores (34.7±6.8, 34.2±6.5 and 34.1±6.6) and cobb angles (15.7°±2.2°, 15.8°±2.2° and 15.9°±2.4°) at one day, 3 months and final follow-up after operation were significantly lower than those (8.2±1.1, 75.3±9.0 and 25.2°±3.9°) before operation (P<0.001). Their anterior height ratios of the fractured vertebra (54.0%±4.3%, 53.7%±4.2% and 53.6%±4.0%) and median height ratios of the fractured vertebra (56.8%±4.0%, 56.5%±3.9% and 56.6%±3.9%) at one day, 3 months and final follow-up after operation were significantly higher than those (25.8%±3.9% and 27.2%±3.1%) before operation (P<0.001). The rate of cement leakage was 13.3%(6/45). No patients had neurological symptoms after operation. Conclusion PKP is a minimally invasive, safe and effective treatment for stage Ⅲ Kümmell's disease with no neurological symptom, because it can relieve the symptoms of the patients, restore the height of the fractured vertebral body and reduce the local kyphosis cobb angle.

关 键 词：椎体成形术 脊柱后凸 脊髓压迫症 Kümmell病 

分 类 号：R687[医药卫生—骨科学]