无脊髓压迫症状的迟发性创伤后脊柱塌陷患者行经皮椎体后凸成形术的疗效优势  

The advantage of percutaneous kyphoplasty in patients with Kummell's disease without symptoms of spinal cord compression

作　　者：张顺利 顾运涛 陈荣 赵海[1] ZHANG Shun-li;GU Yun-tao;CHEN Rong;ZHAO Hai(Department of Orthopedics Area 1,the Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院骨科一区,海南海口570311

出　　处：《中华全科医学》2020年第10期1667-1670,1792,共5页Chinese Journal of General Practice

基　　金：海南省卫生厅科研基金(18A200111)。

摘　　要：目的探讨经皮椎体后凸成形术(PKP)治疗无脊髓压迫症状的迟发性创伤后脊柱塌陷(非3期Kummell病)的疗效优势,为无脊髓压迫症状的Kummell病的治疗选择提供理论支持。方法回顾性分析2016年1月-2018年1月海南医学院第二附属医院收治的128例无脊髓压迫症状的迟发性创伤后脊柱塌陷患者的资料,根据手术方式分为对照组[行经皮穿刺椎体成形术(PVP),61例]和实验组[行经皮椎体后凸成形术(PKP),67例],比较2组基本资料、椎体高度改善情况、手术前后ODI评分.Cobb角、并发症发生情况的统计学差异。结果实验组手术时间和骨水泥量均明显多于对照组(均P<0.05),实验组术后椎体前壁高度[(17.14±3.36)mm]和椎体中线高度[(16.25±4.37)mm]高于对照组的(11.74±4.34)mm和(12.53±4.21)mm(均P<0.05),且2组治疗后ODI评分及Cobb角较治疗前均降低,差异有统计学意义(均P<0.05)。2组患者在住院时间、椎体后壁高度改善、术后感染并发症对比差异无统计学意义(均P>0.05)。结论PKP在治疗无脊髓压迫症状的迟发性创伤后脊柱塌陷时,通过体位的复位和球囊扩张相结合的方式可以更有效的复位椎体的高度和改善后凸畸形,也更有利于骨水泥充分的填充在椎体裂隙当中,在增加骨水泥铆定作用的同时又降低了骨水泥渗漏的风险,进而显示出其在降低邻近椎体骨折和脊髓压迫并发症发生率方面的优势。Objective To investigate the advantages of curative efeet of percutaneous kyphoplasty in the treatment of pa-tients with Kummells disease without symptoms of spinal cord compression,and provide theoretical support for the treat-ment.Methods Retrospective analysis of 128 cases patients with Kummell 8s disease without symptoms of spinal cord compression who underwent surgery treatment from January 2016 to January 2018 in our hospital.According to the opera-tion,they were divided into control group(percutaneous vertebroplasty,PVP operation,61 cases)and experimental group(percutaneous kyphoplasty,PKP operation,67 cases).The statistical differences of clinical data,vertebral height improvement,Cobb Angle and complications between the two groups were compared.Results Compare of the operative time and the amount of bone cement injected,the experimental group were significantly increased than the control group(all P<0.05).After operation,the height of the anterior vertebral walls(17.14±3.36)mm and median vertebral walls(16.25±4.37)mm of the experimental group were significantly raised compared with those of the control group[(11.74±4.34)mm and(12.53±4.21)mm,P<0.05].The difference in ODI and Cobb Angle after surgery be-tween the two groups was statistically significant(P<0.05).There was no statistical significance in hospital stay,the height of the posterior vertebral walls,postoperative infective complications between the two groups(allP>0.05).Con-clusion PKP can effectively reduce the height of vertebral body and correet the kyphosis through the combination of body position reduction and balloon dilation when treating patients with Kummell's disease without symptoms of spinal cord com-pression,and it is also more conducive to the full illing of bone cement in the cleft of vertebral body.PKP can increase the riveting effect of bone cement and reduce the risk of leakage of bone cement,which shows its advantages in reducing the incidence of complications of adjacent vertebral fractures and spinal cord compression.

关 键 词：经皮椎体后凸成形术 经皮椎体成形术 骨质疏松 Kummell病 无脊髓压迫症状 

分 类 号：R683.2[医药卫生—骨科学]