Ⅲ期Kümmell′s病的过伸位CT分型及其意义

CT classification at extension and its significance for stage Ⅲ Kümmell′s disease

中文关键词:  Kümmell′s病  过伸位CT  分型  椎体强化术  截骨矫形术

英文关键词:Kümmell′s diease  Subtypes  CT reconstruction image on extension position  Percutaneous vertebral augmentation  Osteotomy and deformity correction

中文摘要:

  【摘要】 目的：探讨Ⅲ期Kümmell′s病的过伸位CT分型及其临床意义。方法：回顾性分析2008年1月～2010年9月收治骨质疏松椎体压缩骨折患者中的11例Ⅲ期Kümmell′s病患者，男2例，女9例，年龄54～87岁，平均71.4岁。单节段10例，其中T12 5例，L1 1例，L2 3例，L4 1例；双节段（T11、L1）1例。根据术前过伸位CT多平面重建检查中病椎塌陷的复位程度是否≥50%及继发性椎管狭窄是否解除，将患者分为可复型（A型）、难复型（B型）。参考Denis三柱学说的前中柱定义（椎体前1/2为前柱、后1/2为中柱），将A型分为两个亚型，骨折椎后方骨折块前后径与椎体前后径之比≥1/2者定义为可复、骨折稳定型（A1型），＜1/2者定义为可复、骨折不稳定型（A2型）。A1型采用过伸体位下椎体强化术，A2型采用过伸体位下原位固定融合、病椎强化术，B型针对责任椎体选择后路截骨减压、融合内固定术。记录术前、术后3个月及末次随访时的VAS评分、ODI和病椎局部矢状面Cobb角，记录手术并发症。结果：根据过伸位CT分型标准分型，A1型5例，A2型3例，B型3例。椎体强化术中2例（A1型1例，A2型1例）发生椎间隙内少量骨水泥渗漏，但术中及术后无任何不适。1例术前合并高血压病3级的B型患者术后出现右心衰竭、房颤，经积极内科处理后病情稳定。随访6～33个月，平均18个月。每例患者术后3个月及末次随访时的Cobb角、VAS评分、ODI与术前比较均有明显改善。结论：Ⅲ期Kümmell′s病患者根据过伸位CT病椎复位情况可分为A1型、A2型和B型，根据不同分型采用相应的治疗方法，可获得满意疗效。

英文摘要:

  【Abstract】 Objectives: To investigate the chlinical value of CT classification at extension position and its significance for stage Ⅲ Kümmell′s disease. Methods: 11 cases of stage Ⅲ Kümmell′s disease between January 2008 and September 2010 were reviewed retrospectively. There were 2 males and 9 females with the average age of 71.4 years(range, 54-87 years). Single level was involved in 10 cases including 5 T12, 1 L1, 3 L2 and 1 L4; two levels was involved in 1 case(T11, L1). Based on the reduction of diseased vertebral collapse over 50% or not and secondary vertebral canal stenosis removal or not on CT scan at extension position, all cases were classified into reducible type(type A, reduction ≥50%) and irreducible type(type B, reduction ＜50%). In the group of type A, according to Denis classification, cases were divided into two subtypes: stable type(A1, with the rate of anteroposterior diameter of fractured body/anteroposterior diameter of vertebral body ≥50%) and unstable type(A2, with that rate ＜50%). Cases with type A1 experienced vertebral augmentation at extension position; cases with type A2 underwent internal fixation, fusion and vertebral augmentation at extension position; cases with type B underwent posterior osteotomy and fusion. The clinical outcomes were evaluated by visual analog scale(VAS), kyphosis angle(Cobb′s), and ODI at preoperative, 3 months and the final follow-up respectively. Furthermore, all perioperative complications were recorded. Results: There were 5 cases with type A1, 3 type A2 and 3 type B. All of the patients were followed up for an average of 18 months(range, 6-33 months). 2 cases experiencing vertebral augmentation(1 A1 and 1 A2) were noted bone cement leakage, but no symptom was noted. 1 case of type B was complicated with severe hypertension, right heart failure and atrial fibrillation after operation, and was alleviated by active intervention. The kyphosis Cobb angles, VAS scores, ODI at 3 months and final follow-up improved significantly. Conclusions: Based on CT reconstruction at extension position, stage Ⅲ Kümmell′s disease can be divided into three types which are type A1, A2 and B respectively, which is meaningful for determining individualized management.