经皮椎体强化术治疗无神经症状Kümmell病的中长期疗效

Mid-to-long term efficacy analysis of percutaneous vertebral augamentation applied on the Kümmell′s disease without neurological deficit

中文关键词:  Kümmell病  椎体强化术  骨质疏松

英文关键词:Kümmell disease  Percutaneous vertebral augmentation  Osteoporosis

中文摘要:

  【摘要】 目的：探讨经皮椎体强化术治疗无神经症状Kümmell病的中长期疗效。方法：回顾性分析2009年6月~2013年6月采用经皮椎体强化术治疗且随访时间>2年的32例无神经症状Kümmell病患者的临床资料，其中男4例，女28例，年龄69.95±7.72岁（56~87岁），骨密度T值-3.43±0.22SD（-2.5~-5.1SD）。记录术前、术后3d及末次随访时的VAS评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、伤椎椎体前缘高度、伤椎椎体中线高度、伤椎局部矢状位Cobb角、骨水泥强化椎体形态学改变等。结果：7例患者出现骨水泥渗漏，未出现明显临床症状。随访时间为2.81±0.97年（2~6年）。椎体强化术后3d伤椎椎体高度和局部后凸角度与术前相比均得到显著改善（P<0.05）；末次随访时，复位的椎体出现再塌陷，局部后凸角度加重（P<0.05）。术后3d VAS评分和ODI与术前相比均显著下降（P<0.05），末次随访时与术后3d比较均无统计学差异（P>0.05）。随访过程中，所有患者骨水泥椎体均与相邻椎体自发性融合，6例出现骨水泥碎裂和移位，8例骨水泥周围出现透亮线。结论：椎体强化术治疗无神经症状的Kümmell病术后即刻疗效显著，但中长期随访时，骨水泥强化椎体出现塌陷及后凸角度增大，不能提供足够的稳定。

英文摘要:

  【Abstract】 Objectives: To evaluate the mid-long term efficacy and safety of percutaneous vertebral augmentation(PVA) applied on the Kümmell′s disease without neurological deficit. Methods: From June 2009 to June 2013, 32 patients(4 males and 28 females, 69.95±7.72 years old on average) with Kümmell′s disease of non-neurological deficit receiving percutaneous vertebral augmentation were reviewed. The average T score of bone mineral density was -3.43±0.22SD. The radiological variations including the Cobb angle, anterior and middle height of index vertebra and the type of bone-cement distribution obtained from X-ray were recorded preoperatively, at 3 days postoperatively and the final follow-up. Meanwhile, the visual analogue scale(VAS) and Oswestry disability index(ODI) scores were also evaluated. Results: The average follow-up time was 2.81±0.97 years(2-6 years). 7 cases were observed with asymptomatic bone-cement leakage. The vertebral height and the Cobb angle significantly improved after operation(P＜0.05), however, aggravated at the final follow-up(P＜0.05). The ODI and VAS scores decreased significantly after operation(P＜0.05), but increased a little without significant difference at the final follow-up compared with those at 3 days postoperatively. In addition, three types of morphological changes of bone-cement vertebrae were detected: (1)spontaneous fusion with adjacent vertebrae occurring in all cases; (2)cement fragmentation or migration found in 6 cases; (3)bright lines found in 8 cases. Conclusions: PVA in treatment of the Kümmell′s disease without neurological deficit abtains a significant short-term efficacy. However, PVA is unable to provide adequate stability in mid-long term follow-up，due to the height loss and kyphosis of the index vertebra aggravating. Close follow-up is mandatory.