过伸复位联合椎体成形术中采用温度梯度法注射骨水泥治疗Ⅱ期Kümmell病  

Hyperextension reduction combined with bone cement injection by temperature gradient method in percutaneous vertebroplasty for treatment of stageⅡKümmell disease

作　　者：王润生 黄承军 夏子茗 薛鸿 杨嘉 苏正义 张乐 Wang Runsheng;Huang Chengjun;Xia Ziming;Xue Hong;Yang Jia;Su Zhengyi;Zhang Le(Department of Orthopedics,Liuzhou Traditional Chinese Medicine Hospital,Liuzhou 545026,Guangxi,China)

机构地区：[1]柳州市中医医院骨科,柳州545026

出　　处：《脊柱外科杂志》2024年第6期405-410,共6页Journal of Spinal Surgery

摘　　要：目的探讨过伸复位联合椎体成形术(PVP)中采用温度梯度法注射骨水泥治疗Ⅱ期Kümmell病的临床疗效。方法2018年1月—2022年6月共收治Ⅱ期Kümmell病患者43例,其中21例采用术前过伸复位联合PVP术中温度梯度法注射骨水泥治疗(A组),22例采用常规PVP治疗(B组)。记录并比较2组手术时间、骨水泥注入量、手术前后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、伤椎前缘高度、伤椎中部高度及伤椎Cobb角。记录2组术后骨水泥渗漏、邻椎再骨折、骨水泥松动等并发症的发生情况。结果所有手术顺利完成,患者随访时间>6个月。2组患者术后VAS评分、ODI、伤椎前缘高度、伤椎中部高度及伤椎Cobb角较术前改善,且A组伤椎前缘高度及伤椎Cobb角改善情况优于B组,差异均有统计学意义(P<0.05)。发生术后骨水泥渗漏、松动患者例数A组少于B组,差异有统计学意义(P<0.05)。结论术前过伸复位有利于恢复伤椎前缘高度,改善局部后凸畸形,但椎体前缘裂隙增大,PVP术中采用温度梯度法注射骨水泥有利于封堵椎体前缘裂隙,减少骨水泥渗漏,增加骨水泥与骨小梁的铆合作用,降低骨水泥松动、移位风险。Objective To investigate the clinical effects of hyperextension reduction combined with bone cement injection by temperature gradient method in percutaneous vertebroplasty(PVP)for the treatment of stageⅡKümmell disease.Methods From January 2018 to June 2022,a total of 33 patients with stageⅡKümmell disease were treated.Among them,21 cases were treated with hyperextension reduction combined with bone cement injection by temperature gradient method in PVP(group A),and 22 were treated with conventional PVP(group B).The operation time,bone cement injection volume,and visual analogue scale(VAS)scores,Oswestry disability index(ODI),anterior height,middle height and Cobb angle of the injured vertebrae at preand post-operation were recorded and compared between the 2 groups.The occurrence of postoperative complications,such as bone cement leakage,adjacent vertebral fractures and loosening of bone cement in the 2 groups were recorded.Results All the operations were successfully completed.All the patients were followed up for more than 6 months.The VAS scores,ODI,and anterior height,middle height and Cobb angle of the injured vertebrae in the 2 groups at post-operation improved compared to those at pre-operation,and the improvement of anterior height and Cobb angle of the injured vertebrae in group A were better than those in group B,all with a statistical significance(P<0.05).The number of patients with postoperative bone cement leakage and loosening in group A was less than that in group B,and the difference was statistically significant(P<0.05).Conclusions Hyperextension reduction is propitious to recover anterior height of the injured vertebrae and improve local kyphosis,but the anterior edge fissure of the vertebral body increases.Therefore,the temperature gradient method for bone cement injection during PVP is beneficial for sealing the anterior edge fissure of the vertebral body,reducing cement leakage,increasing the riveting effect between bone cement and trabeculae,and reducing the risk of cement loosening a

关 键 词：胸椎 腰椎 脊柱骨折 骨折 压缩性 骨质疏松 脊柱后凸 骨代用品 椎体成形术 

分 类 号：R683.2[医药卫生—骨科学]