摘要
目的比较骨填充网袋椎体成形术(Vesselplasty)与经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗Kümmell病的临床疗效。方法2015年1月—2018年12月收治63例Kümmell病患者,其中28例采用Vesselplasty治疗(Vesselplasty组),35例采用PKP治疗(PKP组)。两组患者性别、年龄、病程、骨密度T值、骨折节段及术前疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎前缘高度、后凸Cobb角等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、术中透视时间、骨水泥注射量、骨水泥渗漏率、骨水泥弥散面积率和随访期间并发症发生情况,以及术前、术后1 d、末次随访时VAS评分、ODI、伤椎前缘高度、后凸Cobb角。结果两组患者均获随访,随访时间12~36个月,平均24.2个月。Vesselplasty组手术时间、术中透视时间、骨水泥注射量、骨水泥弥散面积率均明显小于PKP组(P<0.05)。Vesselplasty组骨水泥渗漏率(7.14%)明显低于PKP组(34.29%)(χ^2=5.153,P=0.023)。两组患者术后1 d及末次随访时VAS评分、ODI、伤椎前缘高度、后凸Cobb角均较术前显著改善(P<0.05),术后两组间比较差异均无统计学意义(P>0.05)。随访期间两组均未见术椎再塌陷,Vesselplasty组邻椎骨折发生率(7.14%)与PKP组(14.29%)比较,差异无统计学意义(χ^2=0.243,P=0.622)。结论Vesselplasty和PKP治疗Kümmell病疗效相似,均能有效缓解患者疼痛症状,改善生活质量,部分恢复伤椎高度,矫正椎体后凸。但前者具有手术时间短、术中透视时间少、骨水泥渗漏少等优势。
Objective To investigate the effectiveness of Vesselplasty and percutaneous kyphoplasty(PKP)in treatment of Kümmell disease.Methods Between January 2015 and December 2018,63 patients with Kümmell disease were treated.Among them,28 cases were treated with Vesselplasty(Vesselplasty group)and 35 cases were treated with PKP(PKP group).There was no significant difference in gender,age,disease duration,bone mineral density(T value),fracture distribution,and preoperative pain visual analogue scale(VAS)score,Oswestry Disability Index(ODI),anterior height of injured vertebrae,and kyphosis Cobb angle between the two groups(P>0.05).The operation time,intraoperative fluoroscopy time,bone cement injection volume,the leakage rate of bone cement,the diffusion area ratio of bone cement,and the complications of the two groups were recorded.VAS score,ODI,anterior height of injured vertebrae,and kyphosis Cobb angle were compared between the two groups before operation and at 1 day after operation and last followup.Results All patients of the two groups were followed up 12-36 months,with an average of 24.2 months.The operation time,intraoperative fluoroscopy time,bone cement injection volume,and diffusion area ratio of bone cement were significantly lower in the Vesselplasty group than in the PKP group(P<0.05).The leakage rate of bone cement was significantly lower in the Vesselplasty group(7.14%)than in the PKP group(34.29%)(χ^2=5.153,P=0.023).At 1 day after operation and last follow-up,the VAS score,ODI,anterior height of injured vertebrae,and kyphosis Cobb angle of the two groups were superior to those before operation(P<0.05),and no significant difference between the two groups(P>0.05).During the follow-up,there was no re-collapse of vertebrae,and the adjacent vertebrae fracture occurred in 2 cases of the Vesselplasty group and 5 cases of PKP group.There was no significant difference in the incidence of adjacent vertebrae fracture between the Vesselplasty group(7.14%)and the PKP group(14.29%)(χ^2=0.243,P=0.622).Conclusion Vesselplasty and PKP have similar effectiveness in the treatment of Kümmell disease.They can effectively relieve the pain symptoms,improve the quality of life,partially restore the height of injured vertebrae,and correct kyphosis.But the Vesselplasty has the advantages of shorter operation time,less intraoperative fluoroscopy time,and less bone cement leakage.
作者
孙育良
熊小明
万趸
邓轩赓
石华刚
宋偲茂
顾韬
侯伟
周杰
SUN Yuliang;XIONG Xiaoming;WAN Dun;DENG Xuangeng;SHI Huagang;SONG Simao;GU Tao;HOU Wei;ZHOU Jie(Department of Spine Surgery,Sichuan Provincial Orthopedics Hospital,Chengdu Sichuan,610041,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第12期1539-1544,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省科技厅支撑项目(2015SZ0190)
四川省医学会科研课题(S18078)。
