刮匙器结合经皮椎体成形术治疗椎体内缺血性骨坏死的临床疗效观察  

Clinical Observation of Curette Combined with Percutaneous Vertebroplasty on the Treatment of Kummell’s Disease

作　　者：李会斌 贾育松 赵学千 谭建盛 黄健 马慧 王维 李晋玉 LI Huibin;JIA Yusong;ZHAO Xueqian;TAN Jiansheng;HUANG Jian;MA Hui;WANG Wei;LI Jinyu(Beijing University of Chinese Medicine,Beijing 100105,China;Beijing Fengtai Hospital of Integrated Traditional and Western Medicine,Beijing 100072,China;Tsinghua University Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100049,China;Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学,北京100105 [2]北京市丰台中西医结合医院 [3]清华大学中西医结合医院 [4]北京中医药大学东直门医院

出　　处：《中国中医骨伤科杂志》2022年第4期14-20,共7页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金面上项目(82074463)。

摘　　要：目的:对比单纯经皮椎体成形术(PVP)与应用刮匙器结合PVP治疗椎体内缺血性骨坏死(Kummell病)的临床疗效。方法:对本科2019年1月至2021年3月期间诊断为Ⅰ期或Ⅱ期Kummell病且行单纯PVP或刮匙器结合PVP治疗的35例患者进行回顾性研究,其中观察组15例采用刮匙器结合PVP治疗,对照组20例采用单纯PVP治疗。对比两组手术前、术后第3天、术后3个月随访时的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、椎体前缘高度、Cobb角。同时观察术中骨水泥填充情况、渗漏情况、分布情况及相关并发症。结果:术中骨水泥注入量观察组与对照组差异有统计学意义(P<0.05);观察组发生骨水泥渗漏2例,其中椎体前骨水泥渗漏1例,上终板渗漏1例,对照组见椎体前渗漏1例,观察组骨水泥渗漏率比较对照组,差异无统计学意义(P>0.05)。两组患者术后第3天的VAS评分、ODI、椎体前缘高度、Cobb角较术前均有好转,差异有统计学意义(P<0.05)。观察组术后3 d VAS评分、ODI、椎体前缘高度及Cobb角较对照组差异无统计学意义(P>0.05)。术后3个月随访时各指标与术后3 d比较差异无统计学意义(P>0.05)。术后X线显示观察组11例患者骨水泥分布呈弥散型,4例呈团块型,对照组中13例呈致密团块型,7例呈弥散型,差异有统计学意义(P<0.05)。结论:刮匙器结合PVP相较于单纯PVP,二者在缓解患者腰背部疼痛,改善功能,恢复后凸畸形及椎体高度方面没有明显差异。但刮匙器的使用可以使得骨水泥在椎体内更加充分地弥散,其是否有助于减少远期椎体再塌陷有待进一步研究。Objective:To compare the clinical efficacy of curettage combined with percutaneous vertebroplasty(PVP) and percutaneous vertebroplasty(PVP) alone on the treatment of Kummell’s disease.Methods:A retrospective study was conducted on 35 patients diagnosed with stage Ⅰ or Ⅱ Kummell’s disease and treated with percutaneous vertebroplasty or curettage combined with percutaneous vertebroplasty from January 2019 to March 2021.15 patients in the observation group were treated with curettage combined with percutaneous vertebroplasty.20 patients in the control group were treated with PVP.Visual analog scale(VAS) score,Oswestry disability index(ODI),vertebral anterior margin height and Cobb angle were compared between the two groups before surgery,on the third day after surgery and 3 months after surgery.The filling,leakage,distribution and related complica-tions of bone cement were observed during and after operation.Results:There was statistically significant difference in the amount of bone cement injection between the observation group and the control group(P<0.05).There were 2 cases of bone cement leakage in the observation group,including 1 case of prevertebral cement leakage and 1 case of upper endplate leakage,and 1 case of prevertebral leakage in the control group.There was no significant difference in bone cement leakage rate between the observation group and the control group(P>0.05).VAS score,ODI,anterior vertebral height and Cobb angle in two groups were improved on the third day after surgery compared with those before surgery(P<0.05).There were no significant differences was found in VAS score,ODI,anterior vertebral height and Cobb angle between the observation group and the control group 3 d after surgery(P>0.05).There was no significant difference in the indexes between 3 months after operation and 3 d after operation(P>0.05).It was showed in 11 patients by postoperative X-ray that the dispersion type of bone cement distribution,and the mass type was showed in 4 patients in the observation group,while

关 键 词：椎体内缺血性骨坏死 经皮椎体成形术 刮匙器 骨水泥分布 骨水泥渗漏 骨质疏松性椎体压缩性骨折 真空裂隙征 

分 类 号：R681.5[医药卫生—骨科学]