明胶海绵在经皮椎体后凸成形术中预防Kümmell病椎体前壁骨水泥渗漏的临床观察

目的:评价经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)术中应用明胶海绵预防Kümmell病患者椎体前壁骨水泥渗漏的效果。方法:选取2017年6月至2019年12月期间13例临床诊断为Kümmell病的患者,予以行PKP术治疗,同时术中应用明胶海绵置入椎体前壁处预防骨水泥渗漏,其中男3例,女10例,年龄(73.84±8.44)岁。采用视觉模拟量表(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)分别对治疗前后患者的疼痛程度及胸腰椎功能进行评估,并通过X线观察患者术后骨水泥渗漏情况。结果:治疗前及治疗后1 d、3个月VAS评分分别为(7.31±0.83)分、(2.92±1.13)分、(1.69±1.11)分,治疗后1 d、3个月VAS评分较治疗前降低(P0.05),患者术后疼痛明显缓解。治疗前、治疗后3个月ODI分别是(71.08±9.46)%、(17.85±7.82)%,治疗后3个月的ODI较治疗前改善(P0.05),患者术后胸腰椎功能较术前明显改善。术后X线片示椎体前壁无骨水泥渗漏。结论:明胶海绵可预防Kümmell病椎体前壁骨水泥的渗漏,降低椎体前方主动脉等软组织的热损伤和机械损伤风险,不影响患者术后疼痛的缓解和胸腰椎功能的恢复。

Clinical observation of gelfoam in preventing cement leakage via the anterior vertebral wall in Kümmell's patients treated with percutaneous kyphoplasty

Objective: To evaluate the efficacy of gelfoam granules application in prevention of cement leakage via anterior vertebral wall in Kümmell''s patients treated with percutaneous kyphoplasty (PKP).Methods: From June 2017 to December 2019,13 patients with Kümmell disease were treated with PKP,and gelatin sponge was inserted into the anterior wall of vertebral body to prevent bone cement leakage. There were 3 males and 10 females,with an average age of (73.84±8.44) years. The visual analogue scale(VAS) was used to record the degree of pain before treatment and 1 day and 3 months after treatment; Oswestry Disability Index(ODI) was used to evaluate the thoracolumbar function before treatment and 3 months after treatment;X-ray was used to observe the bone cement leakage after operation.Results: The VAS scores were 7.31±0.83,2.92±1.13 and 1.69±1.11 before treatment and 1 day and 3 months after treatment,respectively. The VAS scores on the 1st day and 3 months after treatment were lower than those before treatment(P<0.05),and the postoperative pain was significantly relieved. The ODI before treatment and 3 months after treatment were(71.08±9.46)%,(17.85±7.82)%,respectively. The ODI at 3 months after treatment was improved compared with that before treatment (P<0.05),and the postoperative thoracolumbar function was significantly improved compared with that before treatment. Postoperative X-ray showed no leakage of bone cement in the anterior wall of vertebral body.Conclusion: The application of gelfoam granules in PKP can effectively prevent the leakage of bone cement via the anterior vertebral wall of Kümmell patients,and reduce the risk of thermal and mechanical injury of soft tissues such as the aorta in front of the vertebral body,and does not affect the postoperative pain relief and the recovery of thoracolumbar function.