摘要
[目的]比较单侧囊壁穿刺与囊内穿刺经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗I、II期Kümmell病患者的临床疗效。[方法]回顾性分析2017年3月—2021年2月行PVP治疗的56例I、II期Kümmell病患者的临床资料,根据医患沟通结果,30例采用经囊壁穿刺治疗(囊壁组),26例采用囊内穿刺治疗(囊内组)。比较两组围手术期、随访和影像资料。[结果]所有患者均顺利完成手术,两组患者手术时间、首次穿刺成功率、骨水泥渗漏率、下地行走时间、住院时间的差异均无统计学意义(P>0.05)。囊壁组术中透视次数[(12.4±1.6)次vs(9.2±1.7)次,P<0.05]和骨水泥注入量[(4.7±0.2)ml vs(4.3±0.2)ml,P<0.05]均显著多于囊内组。随访时间平均(17.4±2.4)个月。术后随时间推移,两组VAS、ODI评分均显著减少(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,术后3 d及末次随访时,两组患者Cobb角、伤椎前缘高度和中线高度均较术前显著改善(P<0.05)。术前两组患者上述影像指标的差异均无统计学意义(P>0.05),囊壁组伤椎前缘高度[术后3 d(20.5±1.9)mm vs(19.5±1.7)mm,P<0.05;末次随访时(20.1±1.9)mm vs(18.0±2.0)mm,P<0.05]、伤椎中线高度[术后3d(18.0±1.4)mm vs(17.2±1.2)mm,P<0.05;末次随访时(17.5±1.4)mm vs(16.6±1.2)mm,P<0.05]和局部后凸角[术后3 d(13.9±4.2)°vs(16.5±5.4)°,P<0.05;末次随访时(14.4±4.6)°vs(17.9±5.7)°,P<0.05]均显著优于囊内组。[结论]对于I期和II期Kümmell病,单侧囊壁穿刺经皮椎体成形术在恢复和维持病变椎体形态方面的效果明显好于囊内穿刺成形术。
[Objective]To compare the clinical outcomes of unilateral cyst-wall puncture(CWP)versus intracystic puncture(ICP)in percutaneous vertebroplasty(PVP)for stage I and II Kümmell's disease.[Methods]A retrospective study was conducted on 56 patients who underwent PVP for stage I and II Kümmell's disease from March 2017 to February 2021.According to doctor-patient communication,30 patients received CWP-PVP,while the remaining 26 patients received ICP-PVP.The perioperative,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups had corresponding procedure performed successfully without serious intraoperative complications.Although there were no significant differences in the operation time,first puncture success rate,bone cement leakage rate,walking time and hospital stay between the two groups(P>0.05),the CWP group had significantly more intraoperative fluoroscopy times[(12.4±1.6)times vs(9.2±1.7)times,P<0.05)].Radiographically,the Cobb angle,anterior and midline vertebral heights of injured vertebra were significantly improved in both groups at 3 days postoperatively and the last follow-up(P<0.05),however,the CWP group proved significantly superior to the ICP group in terms of anterior vertebral height[3 days postoperatively(20.5±1.9)mm vs(19.5±1.7)mm,P<0.05;the last follow-up(20.1±1.9)mm vs(18.0±2.0)mm,P<0.05],the middle vertebral height[3days postoperatively(18.0±1.4)mm vs(17.2±1.2)mm,P<0.05;the last follow-up(17.5±1.4)mm vs(16.6±1.2)mm,P<0.05],and the local kyphotic angle[3 days postoperatively(13.9±4.2)°vs(16.5±5.4)°,P<0.05;the latest follow-up(14.4±4.6)°vs(17.9±5.7)°,P<0.05].[Conclusion]The unilateral cyst-wall-puncture percutaneous vertebroplasty does achieve considerably better consequences to recover and maintain morphology of the affected vertebrae than the intracystic counterpart for stage I and II Kümmell's disease.
作者
孔凡国
王晓博
潘其鹏
张昌盛
王文举
乔杨
朱卉敏
KONG Fan-guo;WANG Xiao-bo;PAN Qi-peng;ZHANG Chang-sheng;WANG Wen-ju;QIAO Yang;ZHU Hui-min(Department of Minimally Invasive Spine Surgery,Orthopaedic Hospital of Henan Province,Zhengzhou 450016,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2023年第21期1943-1948,共6页
Orthopedic Journal of China
基金
河南省中医药科学研究专项项目(编号:20-21ZY1058
20-21ZY2243)
洛阳市公益性行业医疗卫生专项项目(编号:2022008A)。
关键词
Kümmell病
经皮椎体成形术
囊壁穿刺
囊内穿刺
Kummell's disease
percutaneous vertebroplasty
cyst-wall puncture
intracystic puncture
