[1]俞兴,王婷,杨济洲,等.经皮椎体成形术和经皮椎体后凸成形术治疗Kmmell病的对比研究[J].中医正骨,2018,30(06):23-29.
　YU Xing,WANG Ting,YANG Jizhou,et al.A retrospective trial of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of Kmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(06):23-29.
点击复制

经皮椎体成形术和经皮椎体后凸成形术治疗Kümmell病的对比 研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年06期
页码:
23-29
栏目:
kümmell病
出版日期:
2018-06-20

文章信息/Info

Title:
A retrospective trial of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of Kümmell's diseases
作者:
俞兴; 王婷;  杨济洲; 毕连涌; 杨永栋; 王逢贤; 曲弋; 赵子义; 赵丁岩
北京中医药大学东直门医院,北京 100700
Author(s):
YU Xing; WANG Ting; YANG Jizhou; BI Lianyong; YANG Yongdong; WANG Fengxian; QU Yi; ZHAO Ziyi; ZHAO Dingyan
Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100700,China
关键词:
骨质疏松性骨折;  脊柱骨折;  Kü; mmell病;  椎体成形术;  椎体后凸成形术
Keywords:
osteoporotic fractures;  spinal fractures;  Kü; mmell's disease;  vertebroplasty;  kyphoplasty
文献标志码:
A
摘要:
目的:比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗Kümmell病的临床疗效和安全性。方法:回顾性分析48例Kümmell病患者的病例资料,其中采用PKP治疗28例,采用PVP治疗20例。男5例,女43例; 年龄60～75岁,中位数67岁; 病变椎体位于T102例、T119例、T1215例、L114例、L24例、L31例、L41例、T12和L11例、T9和T121例。比较2组患者的手术时间、骨水泥注射量及并发症发生情况,以及术前、术后2 d、术后1个月及末次随访时2组患者的腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、伤椎前缘高度、伤椎与邻椎前缘高度比值、伤椎后凸Cobb角。结果:①手术时间和骨水泥注射量。PKP组手术时间长于PVP组[(68.35±11.63)min,(45.29±9.76)min,t=-7.454,P=0.000],骨水泥注射量少于PVP组 [(2.95±0.56)mL,(3.29±0.66)mL,t=1.856,P=0.070]。②腰背部疼痛VAS评分。时间因素与分组因素不存在交互效应(F=0.076,P=0.785); 2组患者腰背部疼痛VAS评分比较,组间差异无统计学意义,即不存在分组效应(F=0.132,P=0.895); 手术前后不同时间点之间腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=710.533,P=0.000); 2组患者腰背部疼痛VAS评分随时间均呈降低趋势,且2组的降低趋势完全一致[(8.00±0.82)分,(3.18±0.61)分,(2.25±1.04)分,(1.82±0.95)分,F=301.206,P=0.000;(7.85±0.93)分,(2.90±0.64)分,(2.30±0.98)分,(2.00±0.97)分,F=189.922,P=0.000]。③ODI。时间因素与分组因素不存在交互效应(F=0.785,P=0.380); 2组患者ODI比较,组间差异无统计学意义,即不存在分组效应(F=-0.341,P=0.733); 手术前后不同时间点之间ODI的差异有统计学意义,即存在时间效应(F=689.909,P=0.000); 2组患者ODI随时间均呈降低趋势,且2组的降低趋势完全一致(69.79±10.84,38.39±5.65,25.50±4.14,21.61±3.75,F=296.004,P=0.000; 71.55±9.57,40.50±4.38,27.05±3.71,20.25±3.39,F=304.494,P=0.000)。④伤椎前缘高度。时间因素与分组因素存在交互效应(F=11.128,P=0.002); 2组患者伤椎前缘高度比较,组间差异有统计学意义,即存在分组效应(F=-5.030,P=0.000); 手术前后不同时间点之间伤椎前缘高度的差异有统计学意义,即存在时间效应(F=182.068,P=0.000); 术前和末次随访时,2组患者伤椎前缘高度比较,差异无统计学意义[(13.33±1.33)mm,(14.05±1.21)mm,t=-1.898,P=0.064;(17.09±1.52)mm,(17.75±1.63)mm,t=-1.441,P=0.156]; 术后2 d和术后1个月,PKP组伤椎前缘高度均小于PVP组[(19.02±1.51)mm,(20.55±0.72)mm,t=-4.207,P=0.000;(17.56±1.87)mm,(18.75±2.09)mm,t=-2.075,P=0.044]。⑤伤椎与邻椎前缘高度比值。时间因素与分组因素存在交互效应(F=13.048,P=0.001); 2组患者伤椎与邻椎前缘高度比值比较,组间差异有统计学意义,即存在分组效应(F=-1.605,P=0.011); 手术前后不同时间点之间伤椎与邻椎前缘高度比值的差异有统计学意义,即存在时间效应(F=501.461,P=0.000); 术前和末次随访时,2组患者伤椎与邻椎前缘高度比值比较,差异无统计学意义[(49.07±2.17)%,(50.78±3.84)%,t=-1.959,P=0.056;(73.50±3.48)%,(74.65±4.19)%,t=-1.036,P=0.306]; 术后2 d和术后1个月,PKP组伤椎与邻椎前缘高度比值均小于PVP组[(74.81±3.65)%,(78.58±6.73)%,t=-2.497,P=0.016;(73.89±4.24)%,(76.85±3.73)%,t=-2.501,P=0.016]。⑥伤椎后凸Cobb角。时间因素与分组因素存在交互效应(F=10.777,P=0.002); 2组患者伤椎后凸Cobb角比较,组间差异有统计学意义,即存在分组效应(F=-2.224,P=0.027); 手术前后不同时间点之间伤椎后凸Cobb角的差异有统计学意义,即存在时间效应(F=89.178,P=0.000); 术前和末次随访时,2组患者伤椎后凸Cobb角比较,差异无统计学意义(20.70°±1.71°,19.89°±1.19°,t=-1.930,P=0.060; 13.59°±2.42°,13.39°±2.65°,t=-0.281,P=0.780); 术后2 d和术后1个月,PKP组伤椎后凸Cobb角均大于PVP组(16.78°±2.27°,14.69°±3.33°,t=-2.417,P=0.020; 14.50°±2.65°,12.89°±2.11°,t=0.140,P=0.024)。⑦安全性。PVP组1例出现骨水泥椎旁渗漏,PKP组2例出现骨水泥上椎间隙内渗漏,2组患者均未出现伤椎再骨折和邻椎骨折等并发症; 2组并发症发生率比较,差异无统计学意义(P=1.000)。结论:采用PVP与PKP治疗Kümmell病,均能缓解腰背部疼痛,恢复椎体高度,纠正后凸畸形,改善脊柱功能,且并发症少。前者在缩短手术时间、恢复椎体高度、纠正后凸畸形方面优于后者,但后者较前者骨水泥注射量少。
Abstract:
Objective:To compare the clinical curative effects and safety of percutaneous vertebroplasty(PVP)versus percutaneous kyphoplasty(PKP)for treatment of Kümmell's diseases.Methods:The medical records of 48 patients with Kümmell's diseases were analyzed retrospectively.Twenty-eight patients were treated with PKP(PKP group),while the others were treated with PVP(PVP group).The patients consisted of 5 males and 43 females,and ranged in age from 60 to 75 years(Median=67 yrs).The pathological changes located at T10(2),T11(9),T12(15),L1(14),L2(4),L3(1),L4(1),T12 and L1(1)and T9 and T12(1).The operative time,consumption of bone cements,complications were compared between the 2 groups respectively.Moreover,low back pain visual analogue scale(VAS)scores,Oswestry disability index(ODI),injured vertebrae anterior border height,ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height and kyphotic Cobb angle of injured vertebrae measured before the surgery,at 2 days and 1 month after the surgery and at last follow-up were compared between the 2 groups respectively.Results:The operative time was longer and the consumption of bone cements was less in PKP group compared to PVP group(68.35+/-11.63 vs 45.29+/-9.76 min,t=-7.454,P=0.000; 2.95+/-0.56 vs 3.29+/-0.66 mL,t=1.856,P=0.070).There was no interaction between time factor and group factor in low back pain VAS scores(F=0.076,P=0.785).There was no statistical difference in the low back pain VAS scores between the 2 groups,in other words,there was no group effect(F=0.132,P=0.895).There was statistical difference in the low back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=710.533,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of low back pain VAS scores(8.00+/-0.82,3.18+/-0.61,2.25+/-1.04,1.82+/-0.95 points,F=301.206,P=0.000; 7.85+/-0.93,2.90+/-0.64,2.30+/-0.98,2.00+/-0.97 points,F=189.922,P=0.000).There was no interaction between time factor and group factor in ODI(F=0.785,P=0.380).There was no statistical difference in ODI between the 2 groups,in other words,there was no group effect(F=-0.341,P=0.733).There was statistical difference in ODI between different timepoints before and after the surgery,in other words,there was time effect(F=689.909,P=0.000).The ODI presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of ODI(69.79+/-10.84,38.39+/-5.65,25.50+/-4.14,21.61+/-3.75,F=296.004,P=0.000; 71.55+/-9.57,40.50+/-4.38,27.05+/-3.71,20.25+/-3.39,F=304.494,P=0.000).There was interaction between time factor and group factor in injured vertebrae anterior border height(F=11.128,P=0.002).There was statistical difference in injured vertebrae anterior border height between the 2 groups,in other words,there was group effect(F=-5.030,P=0.000).There was statistical difference in injured vertebrae anterior border height between different timepoints before and after the surgery,in other words,there was time effect(F=182.068,P=0.000).There was no statistical difference in injured vertebrae anterior border height between the 2 groups before the surgery and at last follow-up(13.33+/-1.33 vs 14.05+/-1.21 mm,t=-1.898,P=0.064; 17.09+/-1.52 vs 17.75+/-1.63 mm,t=-1.441,P=0.156).The injured vertebrae anterior border heights were lower in PKP group compared to PVP group at 2 days and 1 month after the surgery(19.02+/-1.51 vs 20.55+/-0.72 mm,t=-4.207,P=0.000; 17.56+/-1.87 vs 18.75+/-2.09 mm,t=-2.075,P=0.044).There was interaction between time factor and group factor in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height(F=13.048,P=0.001).There was statistical difference in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height between the 2 groups,in other words,there was group effect(F=-1.605,P=0.011).There was statistical difference in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height between different timepoints before and after the surgery,in other words,there was time effect(F=501.461,P=0.000).There was no statistical difference in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height between the 2 groups before the surgery and at last follow-up(49.07+/-2.17 vs 50.78+/-3.84%,t=-1.959,P=0.056; 73.50+/-3.48 vs 74.65+/-4.19%,t=-1.036,P=0.306).The ratios of injured vertebrae anterior border height to adjacent vertebrae anterior border height were smaller in PKP group compared to PVP group at 2 days and 1 month after the surgery(74.81+/-3.65 vs 78.58+/-6.73%,t=-2.497,P=0.016; 73.89+/-4.24 vs 76.85+/-3.73%,t=-2.501,P=0.016).There was interaction between time factor and group factor in kyphotic Cobb angle of injured vertebrae(F=10.777,P=0.002).There was statistical difference in kyphotic Cobb angle of injured vertebrae between the 2 groups,in other words,there was group effect(F=-2.224,P=0.027).There was statistical difference in kyphotic Cobb angle of injured vertebrae between different timepoints before and after the surgery,in other words,there was time effect(F=89.178,P=0.000).There was no statistical difference in kyphotic Cobb angle of injured vertebrae between the 2 groups before the surgery and at last follow-up(20.70+/-1.71 vs 19.89+/-1.19 degrees,t=-1.930,P=0.060; 13.59+/-2.42 vs 13.39+/-2.65 degrees,t=-0.281,P=0.780).The kyphotic Cobb angles of injured vertebraes were larger in PKP group compared to PVP group at 2 days and 1 month after the surgery(16.78+/-2.27 vs 14.69+/-3.33 degrees,t=-2.417,P=0.020; 14.50+/-2.65 vs 12.89+/-2.11 degrees,t=0.140,P=0.024).The bone cements leaked out of vertebral body(1)in PVP group and leaked into superior intervertebral space(2)in PKP group,and no complications such as injured vertebrae refractures and adjacent vertebrae fractures were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(P=1.000).Conclusion:Both PVP and PKP can alleviate low back pain,restore vertebral height,correct kyphotic deformity and improve spinal function in treatment of Kümmell's diseases,and both of them have less postoperative complications.However,the former surpasses the latter in shortening operation time,restoring vertebral height and correcting kyphotic deformity,while the latter needs less bone cements compared to the former.

参考文献/References:

[1] 印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648. [2] HA KY,LEE JS,KIM KW,et al.Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts[J].J Bone Joint Surg Br,2006,88(5):629-633. [3] LI H,LIANG CZ,CHEN QX.Kümmell's disease,an uncommon and complicated spinal disorder:a review[J].J Int Med Res,2012,40(2):406-414. [4] 拓源,郝定均,葛朝元,等.Kümmell 病的分期、分型与治疗进展[J].中国脊柱脊髓杂志,2017,27(7):638-642. [5] YOUNG WF, BROWN D, KENDLER A,et al.Delayed post-traumatic osteonecrosis of a vertebral body(Kummell's disease)[J].Acta Orthop Belg,2002,68(1):13-19. [6] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123. [7] CHOW JH,CHAN CC.Validation of the Chinese version of the Oswestry Disability Index[J].Work,2005,25(4):307-314. [8] MATZAROGLOU C,GEORGIOU CS,PANAGOPOULOS A,et al.Kümmell's disease: clarifying the mechanisms and patients' inclusion criteria[J].Open Orthop J,2014,8(1):288-297. [9] KIM DY,LEE SH,JANG JS,et al.Intervertebral vacuum phenomenon in osteoporotic compression fracture:report of 67 cases with quantitative evaluation of intravertbral instability[J]. J Neurosurg,2004,100(1 Suppl Spine):24-31. [10] FABBRICIANI G,PIRRO M,FLORIDI P,et al.Osteoanabolic therapy:a non-surgical option of treatment for Kümmell's disease?[J].Rheumatol Int,2012,32(5):1371-1374. [11] LEE SH,KIM ES,EOH W.Cement augmented anterior reconstruction with short posterior instrumentation:a less invasive surgical option for Kummell's disease with cord compression[J].J of Clinical Neuroscience,2011,18(4):509-514.[12] LI KC,WONG TU,KUNG FC,et al.Staging of Kummell's disease[J].J Musculoskel Res,2004,8(1):43-55. [13] 陈书连,王义生,刘宏建,等.椎体成形术和椎体后凸成形术治疗Kummell's病的比较[J].中华实验外科杂志,2012,29(3):523-525. [14] KRAUSS M,HIRSCHFELDER H,TOMANDL B,et al.Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts[J].Eur Radiol,2006,16(5):1015-1021. [15] HOPPE S,WANGLER S,AGHAYEV E,et al.Reduction of cement leakage by sequential PMMA application in a vertebroplasty model[J].Eur Spine J,2016,25(11):3450-3455. [16] 杨惠林,王根林,姜为民,等.分次灌注骨水泥技术治疗Kümmell病[J].脊柱外科杂志,2012,10(1):22-24.

相似文献/References:

[1]张亮,张莉,王莉佳,等.快速康复外科理念在椎弓根螺钉内固定治疗 胸腰椎骨折围手术期护理中的应用[J].中医正骨,2015,27(06):75.
[2]潘雄,刘其顺,应行,等.中药联合4步康复锻炼法对骨质疏松性椎体压缩 骨折患者生存质量的影响[J].中医正骨,2015,27(04):65.
[3]宋永枝,陈双玲.唑来膦酸静脉滴注联合鲑降钙素肌肉注射治疗 骨质疏松性长骨骨折[J].中医正骨,2016,28(01):70.
[4]孙兰芬,王龙强,刘润宏,等.颈椎骨折脱位合并脊髓损伤截瘫患者的围手术期护理[J].中医正骨,2016,28(03):79.
[5]吴鹏,王博,孔令成,等.强骨饮颗粒联合阿仑膦酸钠维D3片口服在原发性骨质疏松性髋部骨折术后抗骨质疏松治疗中的应用[J].中医正骨,2016,28(05):16.
　WU Peng,WANG Bo,KONG Lingcheng,et al.Oral application of Qiangguyin Keli(强骨饮颗粒)and alendronate sodium Vitamin D3 tablets in postoperative anti-osteoporosis treatment in patients with primary osteoporotic hip fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(06):16.
[6]梅 伟.胸腰椎骨折临床诊疗中的热点问题[J].中医正骨,2016,28(07):1.
[7]徐无忌,刘晓岚.体位复位结合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中医正骨,2016,28(07):20.
　XU Wuji,LIU Xiaolan.Effect of Qianggu Yin(强骨饮,QGY)on bone microstructure in the ovariectomized osteoporosis rats[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(06):20.
[8]李英周,叶锋,王晓,等.后路撬拨植骨椎弓根螺钉内固定治疗胸腰椎骨折[J].中医正骨,2016,28(07):46.
[9]王军,陈哲,王硕凡.胸腰椎骨折椎体植骨材料的临床应用进展[J].中医正骨,2016,28(07):64.
[10]史晓林,王健,王博,等.脆性骨折的防治进展[J].中医正骨,2017,29(05):20.
[11]陈建德,樊晓琦,夏炳江,等.球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响[J].中医正骨,2017,29(02):11.
　CHEN Jiande,FAN Xiaoqi,XIA Bingjiang,et al.Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):11.
[12]丁志清,颜峰,喻灿明,等.椎体后凸成形术后非典型骨水泥植入综合征死亡1例[J].中医正骨,2017,29(11):76.
[13]彭小东,张晓刚,赵文韬,等.有限元分析在过伸复位治疗骨质疏松性椎体压缩性骨折生物力学研究中的应用进展[J].中医正骨,2018,30(07):25.
[14]陈建德,樊晓琦,凌义龙.单侧椎弓根旁外侧入路与双侧椎弓根入路 经皮椎体后凸成形术治疗骨质疏松性胸椎 压缩性骨折的对比研究[J].中医正骨,2018,30(10):19.
　CHEN Jiande,FAN Xiaoqi,LING Yilong.A retrospective trial of percutaneous kyphoplasty through unilateral extrapedicular approach versus bilateral transpedicular approach for treatment of thoracic osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(06):19.
[15]于东方,王祥善,张华,等.经皮椎体成形术后手术椎体再骨折的病因、治疗及预防[J].中医正骨,2018,30(10):69.
[16]李兆勇,杨少锋,张晨阳.补肾活血方联合经皮椎体强化术治疗骨质疏松性椎体压缩骨折的系统评价[J].中医正骨,2019,31(03):28.
　LI Zhaoyong,YANG Shaofeng,ZHANG Chenyang.Oral application of Bushen Huoxue Fang(补肾活血方)combined with percutaneous vertebral augmentation for treatment of osteoporotic vertebral compression fractures:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(06):28.
[17]杨磊,崔宏勋,饶耀剑,等.弯角穿刺椎体成形装置辅助下单侧穿刺经皮椎体成形术治疗骨质疏松性椎体压缩骨折[J].中医正骨,2020,32(01):64.
[18]陈晨,安忠诚,张英健,等.椎体强化术后残留腰背痛的研究进展[J].中医正骨,2020,32(05):26.
[19]刘锐,龚德飞,班正涛,等.经皮椎体成形术治疗骨质疏松性椎体压缩骨折术中骨水泥渗漏的危险因素分析[J].中医正骨,2022,34(11):14.
　LIU Rui,GONG Defei,BAN Zhengtao,et al.Risk factors for bone cement leakage during percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(06):14.
[20]罗金金,丁彩田.骨质疏松性椎体压缩骨折经皮椎体后凸成形术后脊柱后凸畸形改善程度的影响因素分析[J].中医正骨,2022,34(08):8.
　LUO Jinjin,DING Caitian.Analysis of factors influencing the degree of improvement of spinal kyphosis deformity after percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(06):8.

更新日期/Last Update: 2018-10-30