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[1]俞興,王婷,楊濟(jì)洲,等.經(jīng)皮椎體成形術(shù)和經(jīng)皮椎體后凸成形術(shù)治療Kmmell病的對(duì)比研究[J].中醫(yī)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.
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經(jīng)皮椎體成形術(shù)和經(jīng)皮椎體后凸成形術(shù)治療Kümmell病的對(duì)比 研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年06期
頁碼:
23-29
欄目:
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:
俞興; 王婷;  楊濟(jì)洲; 畢連涌; 楊永棟; 王逢賢; 曲弋; 趙子義; 趙丁巖
北京中醫(yī)藥大學(xué)東直門醫(yī)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
關(guān)鍵詞:
骨質(zhì)疏松性骨折;  脊柱骨折;  Kü; mmell病;  椎體成形術(shù);  椎體后凸成形術(shù)
Keywords:
osteoporotic fractures;  spinal fractures;  Kü; mmell's disease;  vertebroplasty;  kyphoplasty
文獻(xiàn)標(biāo)志碼:
A
摘要:
目的:比較經(jīng)皮椎體成形術(shù)(percutaneous vertebroplasty,PVP)和經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)治療Kümmell病的臨床療效和安全性。方法:回顧性分析48例Kümmell病患者的病例資料,其中采用PKP治療28例,采用PVP治療20例。男5例,女43例; 年齡60～75歲,中位數(shù)67歲; 病變椎體位于T102例、T119例、T1215例、L114例、L24例、L31例、L41例、T12和L11例、T9和T121例。比較2組患者的手術(shù)時(shí)間、骨水泥注射量及并發(fā)癥發(fā)生情況,以及術(shù)前、術(shù)后2 d、術(shù)后1個(gè)月及末次隨訪時(shí)2組患者的腰背部疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、傷椎前緣高度、傷椎與鄰椎前緣高度比值、傷椎后凸Cobb角。結(jié)果:①手術(shù)時(shí)間和骨水泥注射量。PKP組手術(shù)時(shí)間長于PVP組[(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組 [(2.95±0.56)mL,(3.29±0.66)mL,t=1.856,P=0.070]。②腰背部疼痛VAS評(píng)分。時(shí)間因素與分組因素不存在交互效應(yīng)(F=0.076,P=0.785); 2組患者腰背部疼痛VAS評(píng)分比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.132,P=0.895); 手術(shù)前后不同時(shí)間點(diǎn)之間腰背部疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=710.533,P=0.000); 2組患者腰背部疼痛VAS評(píng)分隨時(shí)間均呈降低趨勢(shì),且2組的降低趨勢(shì)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。時(shí)間因素與分組因素不存在交互效應(yīng)(F=0.785,P=0.380); 2組患者ODI比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=-0.341,P=0.733); 手術(shù)前后不同時(shí)間點(diǎn)之間ODI的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=689.909,P=0.000); 2組患者ODI隨時(shí)間均呈降低趨勢(shì),且2組的降低趨勢(shì)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傷椎前緣高度。時(shí)間因素與分組因素存在交互效應(yīng)(F=11.128,P=0.002); 2組患者傷椎前緣高度比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=-5.030,P=0.000); 手術(shù)前后不同時(shí)間點(diǎn)之間傷椎前緣高度的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=182.068,P=0.000); 術(shù)前和末次隨訪時(shí),2組患者傷椎前緣高度比較,差異無統(tǒng)計(jì)學(xué)意義[(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]; 術(shù)后2 d和術(shù)后1個(gè)月,PKP組傷椎前緣高度均小于PVP組[(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傷椎與鄰椎前緣高度比值。時(shí)間因素與分組因素存在交互效應(yīng)(F=13.048,P=0.001); 2組患者傷椎與鄰椎前緣高度比值比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=-1.605,P=0.011); 手術(shù)前后不同時(shí)間點(diǎn)之間傷椎與鄰椎前緣高度比值的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=501.461,P=0.000); 術(shù)前和末次隨訪時(shí),2組患者傷椎與鄰椎前緣高度比值比較,差異無統(tǒng)計(jì)學(xué)意義[(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]; 術(shù)后2 d和術(shù)后1個(gè)月,PKP組傷椎與鄰椎前緣高度比值均小于PVP組[(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傷椎后凸Cobb角。時(shí)間因素與分組因素存在交互效應(yīng)(F=10.777,P=0.002); 2組患者傷椎后凸Cobb角比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=-2.224,P=0.027); 手術(shù)前后不同時(shí)間點(diǎn)之間傷椎后凸Cobb角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=89.178,P=0.000); 術(shù)前和末次隨訪時(shí),2組患者傷椎后凸Cobb角比較,差異無統(tǒng)計(jì)學(xué)意義(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); 術(shù)后2 d和術(shù)后1個(gè)月,PKP組傷椎后凸Cobb角均大于PVP組(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組1例出現(xiàn)骨水泥椎旁滲漏,PKP組2例出現(xiàn)骨水泥上椎間隙內(nèi)滲漏,2組患者均未出現(xiàn)傷椎再骨折和鄰椎骨折等并發(fā)癥; 2組并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P=1.000)。結(jié)論:采用PVP與PKP治療Kümmell病,均能緩解腰背部疼痛,恢復(fù)椎體高度,糾正后凸畸形,改善脊柱功能,且并發(fā)癥少。前者在縮短手術(shù)時(shí)間、恢復(fù)椎體高度、糾正后凸畸形方面優(yōu)于后者,但后者較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.

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更新日期/Last Update: 2018-10-30