单侧穿刺经皮椎体后凸成形与椎体成形骨水泥注射治疗Kummell病的对比
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摘要
背景:经皮椎体成形和经皮椎体后凸成形骨水泥注射治疗均是治疗Ⅰ或Ⅱ型Kummell病的有效微创治疗方式,但究竟哪种治疗效果更具优势目前仍不清楚。目的:对比单侧穿刺皮椎体成形与经皮椎体后凸成形骨水泥注射治疗Ⅰ或Ⅱ型Kummell病的临床疗效。方法:选择2014年1月至2017年9月永州市中心医院骨科收治的51例单椎体Kummell病患者,其中男14例,女37例,年龄60-89岁,责任椎体T10-L3,其中27例进行单侧穿刺椎体成形骨水泥注射治疗(椎体成形组),24例进行单侧穿刺椎体后凸成形骨水泥注射治疗(椎体后凸成形组),记录术后及术后骨水泥渗漏、一过性发热及再骨折情况。治疗前、治疗后1d及末次随访时,影像学评估伤椎椎体前缘高度与椎体后凸Cobb’s角;治疗前及治疗后1d、1个月、6个月及12个月,进行疼痛目测类比评分与Oswestry功能障碍指数评估。试验方案已获得湖南省永州市中心医院伦理审批。结果与结论:①两组骨水泥渗漏、一过性发热及再骨折发生情况比较差异均无显著性意义(P> 0.05);②两组治疗后的伤椎椎体前缘高度与椎体后凸Cobb’s角均较治疗前明显改善(P <0.05),且椎体后凸成形组改善程度优于椎体成形组(P <0.05);③两组治疗后的目测类比评分与Oswestry功能障碍指数评分均低于治疗前(P <0.05),两组治疗后的目测类比评分与Oswestry功能障碍指数评分总体比较差异无显著性意义(P> 0.05);④结果表明,经皮椎体成形与经皮椎体后凸成形骨水泥注射治疗均可显著缓解Kummell病患者的疼痛,获得较好的治疗效果和安全性,但经皮椎体后凸成形骨水泥注射治疗可获得更好的椎体高度和后凸角度复位。
BACKGROUND: Percutaneous vertebroplasty and percutaneous kyphoplasty are effective minimally invasive treatments for type I or II Kummell disease, but it is still unclear which treatment is better. OBJECTIVE: To compare the clinical efficacy of unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of type I or II Kummell disease. METHODS: Fifty-one patients with Kummell disease were admitted at the Department of Orthopedics, the Central Hospital of Yongzhou from January 2014 to September 2017, including 14 males and 37 females, aged 60-89 years old, responsible for T10-L3. Of which, 27 patients underwent unilateral puncture vertebroplasty with cement injection, and 24 patients underwent unilateral puncture kyphoplasty with cement injection. Intraoperative and postoperative cement leakage, transient fever and re-fracture were recorded. Before treatment, 1 day after treatment and at the last follow-up, the height of the vertebral body of the injured vertebrae and the Cobb angle were evaluated by imaging. Visual Analogue Scale and Oswestry dysfunction index were assessed before treatment and 1 day, 1, 6 and 12 months after treatment. The study was approved by the Ethics Committee of the Central Hospital of Yongzhou, Hunan Province. RESULTS AND CONCLUSION:(1) There was no significant difference in the occurrence of cement leakage, transient fever and re-fracture between two groups(P > 0.05).(2) The height of the anterior edge of the injured vertebral body and the Cobb angle in the two groups were significantly improved after treatment(P < 0.05), and the improvement in the puncture kyphoplasty group was better than that in the puncture vertebroplasty group(P < 0.05).(3) The Visual Analogue Scale and Oswestry dysfunction index scores after treatment in the two groups were lower than those before treatment(P < 0.05). There was no significant difference in the scores between two groups(P > 0.05).(4) These results show that percutaneous kyphoplasty or percutaneous vertebroplasty can significantly alleviate the pain of patients with Kummell disease and obtain good effectiveness and safety. In contrast, percutaneous kyphoplasty can achieve better imaging height and Cobb angle reduction.
BACKGROUND: Percutaneous vertebroplasty and percutaneous kyphoplasty are effective minimally invasive treatments for type I or II Kummell disease, but it is still unclear which treatment is better. OBJECTIVE: To compare the clinical efficacy of unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of type I or II Kummell disease. METHODS: Fifty-one patients with Kummell disease were admitted at the Department of Orthopedics, the Central Hospital of Yongzhou from January 2014 to September 2017, including 14 males and 37 females, aged 60-89 years old, responsible for T10-L3. Of which, 27 patients underwent unilateral puncture vertebroplasty with cement injection, and 24 patients underwent unilateral puncture kyphoplasty with cement injection. Intraoperative and postoperative cement leakage, transient fever and re-fracture were recorded. Before treatment, 1 day after treatment and at the last follow-up, the height of the vertebral body of the injured vertebrae and the Cobb angle were evaluated by imaging. Visual Analogue Scale and Oswestry dysfunction index were assessed before treatment and 1 day, 1, 6 and 12 months after treatment. The study was approved by the Ethics Committee of the Central Hospital of Yongzhou, Hunan Province. RESULTS AND CONCLUSION:(1) There was no significant difference in the occurrence of cement leakage, transient fever and re-fracture between two groups(P > 0.05).(2) The height of the anterior edge of the injured vertebral body and the Cobb angle in the two groups were significantly improved after treatment(P < 0.05), and the improvement in the puncture kyphoplasty group was better than that in the puncture vertebroplasty group(P < 0.05).(3) The Visual Analogue Scale and Oswestry dysfunction index scores after treatment in the two groups were lower than those before treatment(P < 0.05). There was no significant difference in the scores between two groups(P > 0.05).(4) These results show that percutaneous kyphoplasty or percutaneous vertebroplasty can significantly alleviate the pain of patients with Kummell disease and obtain good effectiveness and safety. In contrast, percutaneous kyphoplasty can achieve better imaging height and Cobb angle reduction.
引文
[1]Lim J,Choi SW,Youm JY,et al.Posttraumatic Delayed Vertebral Collapse:Kummell's Disease.J Korean Neurosurg Soc.2018;61(1):1-9.
[2]He D,Yu W,Chen Z,et al.Pathogenesis of the intravertebral vacuum of Kummell's disease.Exp Ther Med.2016;12(2):879-882.
[3]谢胜荣,卢小刚,伍成东,等.Kummell病的发病机制研究进展[J].中华临床医师杂志(电子版),2014,8(20):3675-3678.
[4]张磊磊,李健.Kummell病的研究进展[J].中国矫形外科杂志,2015,23(9):816-819.
[5]Li KC,Li AF,Hsieh CH,et al.Another option to treat Kummell's disease with cord compression.Eur Spine J.2007;16(9):1479-1487.
[6]Zhang C,Wang G,Liu X,et al.Failed percutaneous kyphoplasty in treatment of stage 3 Kummell disease:A case report and literature review.Medicine(Baltimore).2017;96(47):e8895.
[7]李业成,张巍,张成亮,等.骨水泥强化椎弓根螺钉固定结合椎体后凸成形术治疗Ⅲ型Kummell病[J].实用骨科杂志,2017,23(6):496-499.
[8]Kim P,Kim SW.Balloon Kyphoplasty:An Effective Treatment for Kummell Disease?Korean J Spine.2016;13(3):102-106.
[9]Chen GD,Lu Q,Wang GL,et al.Percutaneous Kyphoplasty for Kummell Disease with Severe Spinal Canal Stenosis.Pain Physician.2015;18(6):E1021-E1028.
[10]Matzaroglou C,Georgiou CS,Panagopoulos A,et al.Kummell's Disease:Clarifying the Mechanisms and Patients'Inclusion Criteria.Open Orthop J.2014;8:288-297.
[11]李良辰,何登伟,黄文君,等.Kummell病椎体裂隙征发生机制的研究进展[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(4):363-366.
[12]俞海明,李毅中,姚学东,等.经皮椎体成形或经皮椎体后凸成形治疗伴椎体后壁塌陷Kummell病:如何个体化选择?[J].中国组织工程研究,2016,20(26):3856-3862.
[13]Lee K,Adsul N,Kim HS,et al.Percutaneous Pedicle Screw Fixation with Bone Cement Augmentation Under Epidural Anesthesia for Treatment of Kummell Disease in Extremely Old Age.World Neurosurg.2018;119:506-510.
[14]Fabbriciani G,Pirro M,Floridi P,et al.Osteoanabolic therapy:a non-surgical option of treatment for Kummell's disease?Rheumatol Int.2012;32(5):1371-1374.
[15]Cho Y.Corpectomy and circumferential fusion for advanced thoracolumbar Kummell's disease.Musculoskelet Surg.2017;101(3):269-274.
[16]Zhang GQ,Gao YZ,Zheng J,et al.Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kummell's disease with neurological deficits.Exp Ther Med.2013;5(2):517-522.
[17]Chen L,Dong R,Gu Y,et al.Comparison between Balloon Kyphoplasty and Short Segmental Fixation Combined with Vertebroplasty in the Treatment of Kummell's Disease.Pain Physician.2015;18(4):373-381.
[18]Park JW,Park JH,Jeon HJ,et al.Kummell's Disease Treated with Percutaneous Vertebroplasty:Minimum 1 Year Follow-Up.Korean J Neurotrauma.2017;13(2):119-123.
[19]梁德,江晓兵,姚珍松,等.过伸体位下椎体成形术治疗Kümmell病的近期疗效[J].中国脊柱脊髓杂志,2010,20(3):260-261.
[20]Xia YH,Chen F,Zhang L,et al.Percutaneous kyphoplasty treatment evaluation for patients with Kummell disease based on a two-year follow-up.Exp Ther Med.2018;16(4):3617-3622.
[21]Zhang J,Fan Y,He X,et al.Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kummell's disease?Acomparison of two minimally invasive procedures.Int Orthop.2018;42(6):1321-1326.
[22]冯方,孙育良.经皮椎体成形术与经皮椎体后凸成形术治疗Kümmell病的疗效比较[J].中国骨与关节杂志,2018,7(3):225-229.
[23]李志君,慈元,郑玉鹏,等.聚对苯二甲酸乙二醇酯囊袋加压椎体后凸成形治疗Kummell病[J].中国组织工程研究,2018,22(34):5433-5438.
[24]路文超,王宇鹏,湛川,等.椎体后凸成形治疗Kummell病过程中发生的骨水泥渗漏[J].中国组织工程研究,2019,23(2):172-177.
[25]Graham J,Ahn C,Hai N,et al.Effect of bone density on vertebral strength and stiffness after percutaneous vertebroplasty.Spine(Phila Pa 1976).2007;32(18):E505-E511.
[26]Liebschner MA,Rosenberg WS,Keaveny TM.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty.Spine(Phila Pa 1976).2001;26(14):1547-1554.
[27]任海龙,王吉兴,陈建庭,等.单侧与双侧穿刺经皮椎体成形术治疗Kummell's病的临床对比[J].南方医科大学学报,2014,34(9):1370-1374.
[28]Zhang GQ,Gao YZ,Chen SL,et al.Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kummell's disease:A retrospective study.Indian J Orthop.2015;49(6):577-582.
[29]Wu AM,Chi YL,Ni WF.Vertebral compression fracture with intravertebral vacuum cleft sign:pathogenesis,image,and surgical intervention.Asian Spine J.2013;7(2):148-155.
[2]He D,Yu W,Chen Z,et al.Pathogenesis of the intravertebral vacuum of Kummell's disease.Exp Ther Med.2016;12(2):879-882.
[3]谢胜荣,卢小刚,伍成东,等.Kummell病的发病机制研究进展[J].中华临床医师杂志(电子版),2014,8(20):3675-3678.
[4]张磊磊,李健.Kummell病的研究进展[J].中国矫形外科杂志,2015,23(9):816-819.
[5]Li KC,Li AF,Hsieh CH,et al.Another option to treat Kummell's disease with cord compression.Eur Spine J.2007;16(9):1479-1487.
[6]Zhang C,Wang G,Liu X,et al.Failed percutaneous kyphoplasty in treatment of stage 3 Kummell disease:A case report and literature review.Medicine(Baltimore).2017;96(47):e8895.
[7]李业成,张巍,张成亮,等.骨水泥强化椎弓根螺钉固定结合椎体后凸成形术治疗Ⅲ型Kummell病[J].实用骨科杂志,2017,23(6):496-499.
[8]Kim P,Kim SW.Balloon Kyphoplasty:An Effective Treatment for Kummell Disease?Korean J Spine.2016;13(3):102-106.
[9]Chen GD,Lu Q,Wang GL,et al.Percutaneous Kyphoplasty for Kummell Disease with Severe Spinal Canal Stenosis.Pain Physician.2015;18(6):E1021-E1028.
[10]Matzaroglou C,Georgiou CS,Panagopoulos A,et al.Kummell's Disease:Clarifying the Mechanisms and Patients'Inclusion Criteria.Open Orthop J.2014;8:288-297.
[11]李良辰,何登伟,黄文君,等.Kummell病椎体裂隙征发生机制的研究进展[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(4):363-366.
[12]俞海明,李毅中,姚学东,等.经皮椎体成形或经皮椎体后凸成形治疗伴椎体后壁塌陷Kummell病:如何个体化选择?[J].中国组织工程研究,2016,20(26):3856-3862.
[13]Lee K,Adsul N,Kim HS,et al.Percutaneous Pedicle Screw Fixation with Bone Cement Augmentation Under Epidural Anesthesia for Treatment of Kummell Disease in Extremely Old Age.World Neurosurg.2018;119:506-510.
[14]Fabbriciani G,Pirro M,Floridi P,et al.Osteoanabolic therapy:a non-surgical option of treatment for Kummell's disease?Rheumatol Int.2012;32(5):1371-1374.
[15]Cho Y.Corpectomy and circumferential fusion for advanced thoracolumbar Kummell's disease.Musculoskelet Surg.2017;101(3):269-274.
[16]Zhang GQ,Gao YZ,Zheng J,et al.Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kummell's disease with neurological deficits.Exp Ther Med.2013;5(2):517-522.
[17]Chen L,Dong R,Gu Y,et al.Comparison between Balloon Kyphoplasty and Short Segmental Fixation Combined with Vertebroplasty in the Treatment of Kummell's Disease.Pain Physician.2015;18(4):373-381.
[18]Park JW,Park JH,Jeon HJ,et al.Kummell's Disease Treated with Percutaneous Vertebroplasty:Minimum 1 Year Follow-Up.Korean J Neurotrauma.2017;13(2):119-123.
[19]梁德,江晓兵,姚珍松,等.过伸体位下椎体成形术治疗Kümmell病的近期疗效[J].中国脊柱脊髓杂志,2010,20(3):260-261.
[20]Xia YH,Chen F,Zhang L,et al.Percutaneous kyphoplasty treatment evaluation for patients with Kummell disease based on a two-year follow-up.Exp Ther Med.2018;16(4):3617-3622.
[21]Zhang J,Fan Y,He X,et al.Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kummell's disease?Acomparison of two minimally invasive procedures.Int Orthop.2018;42(6):1321-1326.
[22]冯方,孙育良.经皮椎体成形术与经皮椎体后凸成形术治疗Kümmell病的疗效比较[J].中国骨与关节杂志,2018,7(3):225-229.
[23]李志君,慈元,郑玉鹏,等.聚对苯二甲酸乙二醇酯囊袋加压椎体后凸成形治疗Kummell病[J].中国组织工程研究,2018,22(34):5433-5438.
[24]路文超,王宇鹏,湛川,等.椎体后凸成形治疗Kummell病过程中发生的骨水泥渗漏[J].中国组织工程研究,2019,23(2):172-177.
[25]Graham J,Ahn C,Hai N,et al.Effect of bone density on vertebral strength and stiffness after percutaneous vertebroplasty.Spine(Phila Pa 1976).2007;32(18):E505-E511.
[26]Liebschner MA,Rosenberg WS,Keaveny TM.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty.Spine(Phila Pa 1976).2001;26(14):1547-1554.
[27]任海龙,王吉兴,陈建庭,等.单侧与双侧穿刺经皮椎体成形术治疗Kummell's病的临床对比[J].南方医科大学学报,2014,34(9):1370-1374.
[28]Zhang GQ,Gao YZ,Chen SL,et al.Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kummell's disease:A retrospective study.Indian J Orthop.2015;49(6):577-582.
[29]Wu AM,Chi YL,Ni WF.Vertebral compression fracture with intravertebral vacuum cleft sign:pathogenesis,image,and surgical intervention.Asian Spine J.2013;7(2):148-155.