经皮椎体成形二次骨水泥注射治疗弥散不良的Kümmel病
|
摘要
目的:探讨经皮椎体成形手术二次注射骨水泥治疗术中骨水泥弥散不良的Kümmel病的临床疗效。方法:对2014年2月至2017年12月收治的88例Kümmel病患者的临床资料进行回顾性分析,其中16例术中发现骨水泥弥散不良采用二次骨水泥注射,男1例,女15例;年龄63～82岁,平均72.7岁;T_(10)1例,T_(11)1例,T_(12)3例,L18例,L_21例,L_32例。观察术前、术后2 d、末次随访时的VAS评分、ODI评分,伴有椎体裂隙骨折椎后凸角和椎体前缘高度矫正情况并记录并发症发生情况。结果:16例患者均获得随访,时间5～22个月,平均14.1个月。术前、术后2 d、末次随访时的ODI评分分别为72.3±12.1、56.8±5.0、12.1±5.3,术后2 d较术前、末次随访较术后2 d均有显著改善(P<0.01);术前、术后2 d、末次随访时的VAS评分分别为7.8±0.6、3.0±0.4、2.4±0.7,术后2 d较术前改善(P<0.01),末次随访较术后2 d改善(P<0.05)。术前、术后2 d、末次随访时的椎体前缘压缩率分别为(37.8±5.4)%、(4.7±1.4)%、(4.9±1.5)%,术后2 d较术前改善(P<0.01),末次随访时较术后2 d无明显丢失(P>0.05);术前、术后2 d、末次随访时的裂隙椎Cobb角分别为(15.1±2.0)°、(4.4±2.2)°、(4.8±2.4)°,术后2 d较术前改善(P<0.01),末次随访较术后2 d无明显丢失(P>0.05)。骨水泥渗漏3例,无肺栓塞及神经损伤发生,邻椎骨折发生4例,手术后随访无手术椎再塌陷发生。结论:采用经皮椎体成形手术治疗Kümmel病,首次骨水泥注射发现骨水泥弥散不良,采用二次补救骨水泥注射,仍能取得满意的临床疗效,可以有效预防手术椎再塌陷发生。
Objective:To investigate clinical effect of percutaneous vertebroplasty with second injection for poor dispersion bone cement of Kümmel disease. Methods:Eighty eight patients with Kümmel disease were treated with vertebroplasty from February 2014 to December 2017,and 16 patients were found cement dispersion unsatisfactory during initial cement injection and were undertaken second cement injection during operation. Among patients,there were 1 male and 15 females aged from 63 to 82 years old with an average age of 72.7 years old. Distribution of fractured vertebrae were followed :1 patient was on T_(10),1 patient was on T_(11),3 patients were on T_(12),8 patients were on L_1,1 patient was on L_2,and 2 patients were on L_3. VAS and ODI score were compared before operation,2 days after operation and the latest following up,anterior vertebral height and local kyphosis angle of fractured vertebrae with intravertebral cleft were also observed. Postoperative complication was recorded. Results:All patients were followed up from 5 to 22 months with average of 14.1 months. ODI score before operation,2 days after operation and the latest following up were 72.3±12.1,56.8±5.0 and 12.1±5.3 respectively;VAS score before operation,2 days after operation and the latest following-up were 7.8±0.6,3.0±0.4 and 2.4±0.7,respectively;ODI score at 2 days was improved compared with before operation,while ODI and VAS score at the latest following up was improved than that of 2 days after operation. Vertebral anterior compression rate and Cobb angle of the fractured vertebrae with intravertebral cleft were respectively corrected from(37.8 ±5.4)% and(15.1 ±2.0)° preoperative,to(4.7 ±1.4)% and(4.4 ±2.2)° at 2 days after operation,(4.9 ±1.5)% and(4.8±2.4)° at the latest following up,there was significant difference between before operation and 2 days after operation,while there was no difference between 2 days after operation and the latest following-up. Three patients occurred cement leakage without pulmonary embolism and neurological impairment. Four patients occurred adjacent vertebrae fracture.There was no incidence of recollapsed vertebrae during follow-up period. Conclusion:Percutaneous vertebroplasty for Kümmel disease could receive satisfactory clinical results when cement dispersion was inadequate during initial cement injection by the second injection,and effectively prevent occurrence of vertebral re collapse.
Objective:To investigate clinical effect of percutaneous vertebroplasty with second injection for poor dispersion bone cement of Kümmel disease. Methods:Eighty eight patients with Kümmel disease were treated with vertebroplasty from February 2014 to December 2017,and 16 patients were found cement dispersion unsatisfactory during initial cement injection and were undertaken second cement injection during operation. Among patients,there were 1 male and 15 females aged from 63 to 82 years old with an average age of 72.7 years old. Distribution of fractured vertebrae were followed :1 patient was on T_(10),1 patient was on T_(11),3 patients were on T_(12),8 patients were on L_1,1 patient was on L_2,and 2 patients were on L_3. VAS and ODI score were compared before operation,2 days after operation and the latest following up,anterior vertebral height and local kyphosis angle of fractured vertebrae with intravertebral cleft were also observed. Postoperative complication was recorded. Results:All patients were followed up from 5 to 22 months with average of 14.1 months. ODI score before operation,2 days after operation and the latest following up were 72.3±12.1,56.8±5.0 and 12.1±5.3 respectively;VAS score before operation,2 days after operation and the latest following-up were 7.8±0.6,3.0±0.4 and 2.4±0.7,respectively;ODI score at 2 days was improved compared with before operation,while ODI and VAS score at the latest following up was improved than that of 2 days after operation. Vertebral anterior compression rate and Cobb angle of the fractured vertebrae with intravertebral cleft were respectively corrected from(37.8 ±5.4)% and(15.1 ±2.0)° preoperative,to(4.7 ±1.4)% and(4.4 ±2.2)° at 2 days after operation,(4.9 ±1.5)% and(4.8±2.4)° at the latest following up,there was significant difference between before operation and 2 days after operation,while there was no difference between 2 days after operation and the latest following-up. Three patients occurred cement leakage without pulmonary embolism and neurological impairment. Four patients occurred adjacent vertebrae fracture.There was no incidence of recollapsed vertebrae during follow-up period. Conclusion:Percutaneous vertebroplasty for Kümmel disease could receive satisfactory clinical results when cement dispersion was inadequate during initial cement injection by the second injection,and effectively prevent occurrence of vertebral re collapse.
引文
[1]Linn J,Birkenmaier C,Hoffmann RT,et al.The intravertebral cleft in acute osteoporotic fractures:fluid in magnetic resonance imaging vacuum in computed tomography[J].Spine(Phila Pa 1976),2009,34(2):E88-93.
[2]Matzaroglou C,Georgiou CS,Assimakopoulos K,et al.Kümmell's disease:pathophysiology,diagnosis,treatment and the role of nuclear medicine.Rationale according to our experience[J].Hell J Nucl Med,2011,14(3):291-299.
[3]端磊,杨光川,汤伟忠,等.经皮椎体成形术治疗伴有椎体内裂隙样变的脊柱压缩骨折的疗效观察[J].中国骨伤,2018,31(4):328-332.DUAN L,YANG GC,TANG WZ,et al.Observation of clinical effects of percutaneous vertebroplasty in the treatment of vertebral compression fractures complicated with intravertebral clefts[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(4):328-332.Chinese with abstract in English.
[4]Kim YY,Rhyu KW.Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture[J].Eur Spine J,2010,19(11):1907-1912.
[5]Jeong YH,Lee CJ,Yeon JT,et al.Insufficient penetration of bone cement into the trabecular bone:a potential risk for delayed bone cement displacement after kyphoplasty[J].Reg Anesth Pain Med,2016,41(5):616-618.
[6]Yu CW,Hsu CY,Shih TT,et al.Vertebral osteonecrosis:MR imaging findings and related changes on adjacent levels[J].AJNR Am JNeuroradiol,2007,28(1):42-47.
[7]Li KC,Li AF,Hsieh CH,et al.Another option to treat Kümmell's disease with cord compression[J].Eur Spine J,2007,16(9):1479-1487.
[8]Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[9]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[10]杨惠林,牛国旗,王根林,等.椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折[J].中华骨科杂志,2006,26(3):165-169.YANG HL,NIU GQ,WANG GL,et al.Kyphoplasty for the treatment of osteoporotic vertebral fractures with vertebral body wall incompetence[J].Zhonghua Gu Ke Za Zhi,2006,26(3):165-169.Chinese.
[11]Lin WC,Lee YC,Lee CH,et al.Refractures in cemented vertebrae after percutaneous vertebroplasty:a retrospective analysis[J].Eur Spine J,2008,17(4):592-599.
[12]He SC,Teng GJ,Deng G,et al.Repeat vertebroplasty for unrelieved pain at previously treated vertebral levels with osteoporotic vertebral compression fractures[J].Spine(Phila Pa 1976),2008,33(6):640-647.
[13]Hey HW,Tan JH,Tan CS,et al.Subsequent vertebral fractures post cement augmentation of the thoracolumbar spine:does it correlate with level specific bone mineral density scores[J].Spine(Phila Pa1976),2015,40(24):1903-1909.
[14]Chiu YC,Yang SC,Chen HS,et al.Clinical evaluation of repeat percutaneous vertebroplasty for symptomatic cemented vertebrae[J].J Spinal Disord Tech,2012,25(8):E245-253.
[15]Heo DH,Chin DK,Yoon YS,et al.Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty[J].Osteoporos Int,2009,20(3):473-480.
[16]Huang KY,Yan JJ,Lin RM.Histopathologic findings of retrieved specimens of vertebroplasty with polymethylmethacrylate cement:case control study[J].Spine(Phila Pa 1976),2005,30(19):E585-588.
[17]Lim J,Choi SW,Youm JY,et al.Posttraumatic delayed vertebral collapse:Kümmell's disease[J].J Korean Neurosurg Soc,2018,61(1):1-9.
[18]Chen YJ,Chen WH,Chen HT,et al.Repeat needle insertion in vertebroplasty to prevent re collapse of the treated vertebrae[J].Euro J Rad,2012,81(3):558-561.
[19]Trout AT,Kallmes DH,Kaufmann TJ.New fractures after vertebroplasty:adjacent fractures occur significantly sooner[J].AJNRAm J Neuroradiol,2006,27(1):217-223.
[2]Matzaroglou C,Georgiou CS,Assimakopoulos K,et al.Kümmell's disease:pathophysiology,diagnosis,treatment and the role of nuclear medicine.Rationale according to our experience[J].Hell J Nucl Med,2011,14(3):291-299.
[3]端磊,杨光川,汤伟忠,等.经皮椎体成形术治疗伴有椎体内裂隙样变的脊柱压缩骨折的疗效观察[J].中国骨伤,2018,31(4):328-332.DUAN L,YANG GC,TANG WZ,et al.Observation of clinical effects of percutaneous vertebroplasty in the treatment of vertebral compression fractures complicated with intravertebral clefts[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(4):328-332.Chinese with abstract in English.
[4]Kim YY,Rhyu KW.Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture[J].Eur Spine J,2010,19(11):1907-1912.
[5]Jeong YH,Lee CJ,Yeon JT,et al.Insufficient penetration of bone cement into the trabecular bone:a potential risk for delayed bone cement displacement after kyphoplasty[J].Reg Anesth Pain Med,2016,41(5):616-618.
[6]Yu CW,Hsu CY,Shih TT,et al.Vertebral osteonecrosis:MR imaging findings and related changes on adjacent levels[J].AJNR Am JNeuroradiol,2007,28(1):42-47.
[7]Li KC,Li AF,Hsieh CH,et al.Another option to treat Kümmell's disease with cord compression[J].Eur Spine J,2007,16(9):1479-1487.
[8]Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[9]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[10]杨惠林,牛国旗,王根林,等.椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折[J].中华骨科杂志,2006,26(3):165-169.YANG HL,NIU GQ,WANG GL,et al.Kyphoplasty for the treatment of osteoporotic vertebral fractures with vertebral body wall incompetence[J].Zhonghua Gu Ke Za Zhi,2006,26(3):165-169.Chinese.
[11]Lin WC,Lee YC,Lee CH,et al.Refractures in cemented vertebrae after percutaneous vertebroplasty:a retrospective analysis[J].Eur Spine J,2008,17(4):592-599.
[12]He SC,Teng GJ,Deng G,et al.Repeat vertebroplasty for unrelieved pain at previously treated vertebral levels with osteoporotic vertebral compression fractures[J].Spine(Phila Pa 1976),2008,33(6):640-647.
[13]Hey HW,Tan JH,Tan CS,et al.Subsequent vertebral fractures post cement augmentation of the thoracolumbar spine:does it correlate with level specific bone mineral density scores[J].Spine(Phila Pa1976),2015,40(24):1903-1909.
[14]Chiu YC,Yang SC,Chen HS,et al.Clinical evaluation of repeat percutaneous vertebroplasty for symptomatic cemented vertebrae[J].J Spinal Disord Tech,2012,25(8):E245-253.
[15]Heo DH,Chin DK,Yoon YS,et al.Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty[J].Osteoporos Int,2009,20(3):473-480.
[16]Huang KY,Yan JJ,Lin RM.Histopathologic findings of retrieved specimens of vertebroplasty with polymethylmethacrylate cement:case control study[J].Spine(Phila Pa 1976),2005,30(19):E585-588.
[17]Lim J,Choi SW,Youm JY,et al.Posttraumatic delayed vertebral collapse:Kümmell's disease[J].J Korean Neurosurg Soc,2018,61(1):1-9.
[18]Chen YJ,Chen WH,Chen HT,et al.Repeat needle insertion in vertebroplasty to prevent re collapse of the treated vertebrae[J].Euro J Rad,2012,81(3):558-561.
[19]Trout AT,Kallmes DH,Kaufmann TJ.New fractures after vertebroplasty:adjacent fractures occur significantly sooner[J].AJNRAm J Neuroradiol,2006,27(1):217-223.