体位复位结合PVP与PKP治疗Kümmell病的疗效对比
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摘要
目的比较体位复位结合经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗Kümmell病的临床疗效。方法贵阳市第四人民医院脊柱外科2016年3月—2018年3月收治40例Kümmell病患者,其中20例采用体位复位结合PVP治疗(PVP组),另20例采用PKP治疗(PKP组)。PVP组男性5例,女性15例,平均年龄(76.20±4.94)岁;PKP组男性7例,女性13例;平均年龄(75.45±5.49)岁。比较两组患者的手术时间、透视次数、骨水泥注入量、骨水泥渗漏率、治疗费用,术前及术后3个月两组患者的椎体前缘高度、椎体后凸角度、VAS评分和ODI指数。结果 PVP组的手术时间(31.20±3.95)min、透视次数(20.30±3.52)次、治疗费用(1.46±0.17)万元均少于PKP组[(55.50±4.43)min、(32.10±4.18)次、(3.41±0.15)万元],差异有统计学意义(P<0.05)。两组骨水泥注入量[(3.71±0.29)mL vs.(3.99±0.72)mL]、渗漏率(5/20 vs. 3/20)比较差异无统计学意义(P>0.05)。两组患者术后3个月椎体前缘高度、椎体后凸角度、VAS评分、ODI指数较术前改善,差异有统计学意义(P<0.05),但两组比较差异无统计学意义(P>0.05)。结论体位复位结合PVP治疗Kümmell病在恢复椎体形态、缓解疼痛症状及安全性方面可获得与PKP手术相似的效果,但前者手术时间短、术中透视次数少及治疗费用低。
Objective To compare the clinical efficacy between postural reduction with percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of Kümmell's disease. Methods Forty patients with Kümmell's disease were recruited from Mar. 2016 to Mar.2018. Twenty patients(PVP group,5 males and 15 females aged [76.20±4.94] years) were treated with postural reduction combined with PVP,and another twenty patients(PKP group,7 males and 13 females aged [75.45±5.49] years) were treated with PKP. The operative time,intraoperative X-ray times,the amount of bone cement injection,leakage of bone cement,cost of treatment,and anterior vertebral height,vertebral kyphosis angle,visual analog scales(VAS),Oswestry disability questionnaire(ODI) before operation and at 3 months after operation were compared between the two groups. Results The operative time(31.20±3.95)min,intraoperative X-ray times(20.30±3.52)times,cost of treatment(14.6±1.7)thousand yuanof PVP group were less than those of PKP group([55.50±4.43]min,[32.10±4.18] times,[34.1±1.5] thousand yuan),and there was a significant difference between the two groups(P<0.05).There was no difference in the amount of bone cement injection([3.71±0.29]mL vs. [3.99±0.72]mL)and leakage of bone cement(5/20 vs. 3/20)(P>0.05).There was significant improvement of anterior vertebral height,vertebral kyphosis angle,VAS and ODI scores of the postoperative 3 months compared with preoperative in two groups(P<0.05),but there was no significant difference between the two groups(P>0.05). Conclusion Postural reduction combined with PVP in the treatment of Kümmell's disease can achieve similar results as PKP in restoring vertebral shape,relieving pain symptoms and safety,but the former has shorter operation time,fewer intraoperative fluoroscopy times and lower cost.
Objective To compare the clinical efficacy between postural reduction with percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of Kümmell's disease. Methods Forty patients with Kümmell's disease were recruited from Mar. 2016 to Mar.2018. Twenty patients(PVP group,5 males and 15 females aged [76.20±4.94] years) were treated with postural reduction combined with PVP,and another twenty patients(PKP group,7 males and 13 females aged [75.45±5.49] years) were treated with PKP. The operative time,intraoperative X-ray times,the amount of bone cement injection,leakage of bone cement,cost of treatment,and anterior vertebral height,vertebral kyphosis angle,visual analog scales(VAS),Oswestry disability questionnaire(ODI) before operation and at 3 months after operation were compared between the two groups. Results The operative time(31.20±3.95)min,intraoperative X-ray times(20.30±3.52)times,cost of treatment(14.6±1.7)thousand yuanof PVP group were less than those of PKP group([55.50±4.43]min,[32.10±4.18] times,[34.1±1.5] thousand yuan),and there was a significant difference between the two groups(P<0.05).There was no difference in the amount of bone cement injection([3.71±0.29]mL vs. [3.99±0.72]mL)and leakage of bone cement(5/20 vs. 3/20)(P>0.05).There was significant improvement of anterior vertebral height,vertebral kyphosis angle,VAS and ODI scores of the postoperative 3 months compared with preoperative in two groups(P<0.05),but there was no significant difference between the two groups(P>0.05). Conclusion Postural reduction combined with PVP in the treatment of Kümmell's disease can achieve similar results as PKP in restoring vertebral shape,relieving pain symptoms and safety,but the former has shorter operation time,fewer intraoperative fluoroscopy times and lower cost.
引文
[1] 王根林,杨惠林,孟斌,等.椎体后凸成形术治疗骨质疏松性Kümmell病[J].中国脊柱脊髓杂志,2011,21(1):46-49.
[2] 李煜明,孙强,王黎明,等.椎体骨折不愈合微创治疗手术方式的选择[J].中国骨质疏松杂志,2013,19(9):973-976,980.
[3] 王小伟,李勇光.骨质疏松性椎体骨坏死非手术治疗和椎体成形术临床对比分析[J].创伤外科杂志,2016,18(11):683-686.
[4] Eom KS,Kim TY.Percutaneous vertebroplasty-induced adjacent vertebral compression fracture[J].Pain Physician,2012,15(4):E527-532.
[5] Wang HS,Kim HS,Ju CI,et al.Delayed bone cement displacement following balloon kyphoplasty [J].J Korean Neurosurg Soc,2008,43(4):212-214.
[6] 张嘉男,杨光,高林,等.Kümmell病的影像学研究进展[J].实用骨科杂志,2016,22(4):339-342
[7] 邓爱民,张印,李国祥,等.经皮椎体成形术及经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的临床疗效对比[J].创伤外科杂志,2015,17(4):304-307.
[8] 张成亮,刘守正,李业成,等.体位复位分次灌注骨水泥治疗Kümmell病[J].实用骨科杂志,2015,21(9):825-828.
[9] 刘滔,张志明,史金辉,等.骨水泥温度梯度灌注技术在经皮椎体后凸成形术中的应用[J].中国脊柱脊髓杂志,2015,25(12):1073-1078.
[10] 薛海鹏,吴燕,徐展望,等.骨水泥填充囊结合体位复位治疗老年Kümmell病[J].中国矫形外科杂志,2018,26(3):271-274.
[11] 何升华,马笃军,余伟吉,等.过伸牵引弹性按压法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床研究[J].中医正骨,2014,26(3):25-29.
[12] 李楠,张贵林,何达,等.骨水泥的分布与剂量对椎体成形术疗效影响的研究[J].中国骨与关节损伤杂志,2015,30(1):66-68.
[2] 李煜明,孙强,王黎明,等.椎体骨折不愈合微创治疗手术方式的选择[J].中国骨质疏松杂志,2013,19(9):973-976,980.
[3] 王小伟,李勇光.骨质疏松性椎体骨坏死非手术治疗和椎体成形术临床对比分析[J].创伤外科杂志,2016,18(11):683-686.
[4] Eom KS,Kim TY.Percutaneous vertebroplasty-induced adjacent vertebral compression fracture[J].Pain Physician,2012,15(4):E527-532.
[5] Wang HS,Kim HS,Ju CI,et al.Delayed bone cement displacement following balloon kyphoplasty [J].J Korean Neurosurg Soc,2008,43(4):212-214.
[6] 张嘉男,杨光,高林,等.Kümmell病的影像学研究进展[J].实用骨科杂志,2016,22(4):339-342
[7] 邓爱民,张印,李国祥,等.经皮椎体成形术及经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的临床疗效对比[J].创伤外科杂志,2015,17(4):304-307.
[8] 张成亮,刘守正,李业成,等.体位复位分次灌注骨水泥治疗Kümmell病[J].实用骨科杂志,2015,21(9):825-828.
[9] 刘滔,张志明,史金辉,等.骨水泥温度梯度灌注技术在经皮椎体后凸成形术中的应用[J].中国脊柱脊髓杂志,2015,25(12):1073-1078.
[10] 薛海鹏,吴燕,徐展望,等.骨水泥填充囊结合体位复位治疗老年Kümmell病[J].中国矫形外科杂志,2018,26(3):271-274.
[11] 何升华,马笃军,余伟吉,等.过伸牵引弹性按压法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床研究[J].中医正骨,2014,26(3):25-29.
[12] 李楠,张贵林,何达,等.骨水泥的分布与剂量对椎体成形术疗效影响的研究[J].中国骨与关节损伤杂志,2015,30(1):66-68.
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