经皮椎体成形二次骨水泥注射治疗弥散不良的Kümmel病

目的:探讨经皮椎体成形手术二次注射骨水泥治疗术中骨水泥弥散不良的Kümmel病的临床疗效。方法:对2014年2月至2017年12月收治的88例Kümmel病患者的临床资料进行回顾性分析,其中16例术中发现骨水泥弥散不良采用二次骨水泥注射,男1例,女15例;年龄63～82岁,平均72.7岁;T_(10)1例,T_(11)1例,T_(12)3例,L18例,L_21例,L_32例。观察术前、术后2 d、末次随访时的VAS评分、ODI评分,伴有椎体裂隙骨折椎后凸角和椎体前缘高度矫正情况并记录并发症发生情况。结果:16例患者均获得随访,时间5～22个月,平均14.1个月。术前、术后2 d、末次随访时的ODI评分分别为72.3±12.1、56.8±5.0、12.1±5.3,术后2 d较术前、末次随访较术后2 d均有显著改善(P0.01);术前、术后2 d、末次随访时的VAS评分分别为7.8±0.6、3.0±0.4、2.4±0.7,术后2 d较术前改善(P0.01),末次随访较术后2 d改善(P0.05)。术前、术后2 d、末次随访时的椎体前缘压缩率分别为(37.8±5.4)%、(4.7±1.4)%、(4.9±1.5)%,术后2 d较术前改善(P0.01),末次随访时较术后2 d无明显丢失(P0.05);术前、术后2 d、末次随访时的裂隙椎Cobb角分别为(15.1±2.0)°、(4.4±2.2)°、(4.8±2.4)°,术后2 d较术前改善(P0.01),末次随访较术后2 d无明显丢失(P0.05)。骨水泥渗漏3例,无肺栓塞及神经损伤发生,邻椎骨折发生4例,手术后随访无手术椎再塌陷发生。结论:采用经皮椎体成形手术治疗Kümmel病,首次骨水泥注射发现骨水泥弥散不良,采用二次补救骨水泥注射,仍能取得满意的临床疗效,可以有效预防手术椎再塌陷发生。

Application of percutaneous vertebroplasty with the second injection for poor dispersion bone cement of Kümmel disease

Objective:To investigate clinical effect of percutaneous vertebroplasty with second injection for poor dispersion bone cement of Kümmel disease.Methods:Eighty-eight patients with Kümmel disease were treated with vertebroplasty from February 2014 to December 2017,and 16 patients were found cement dispersion unsatisfactory during initial cement injection and were undertaken second cement injection during operation. Among patients,there were 1 male and 15 females aged from 63 to 82 years old with an average age of 72.7 years old. Distribution of fractured vertebrae were followed:1 patient was on T₁₀,1 patient was on T₁₁,3 patients were on T₁₂,8 patients were on L₁,1 patient was on L₂,and 2 patients were on L₃. VAS and ODI score were compared before operation,2 days after operation and the latest following-up,anterior vertebral height and local kyphosis angle of fractured vertebrae with intravertebral cleft were also observed. Postoperative complication was recorded.Results:All patients were followed up from 5 to 22 months with average of 14.1 months. ODI score before operation,2 days after operation and the latest following-up were 72.3±12.1,56.8±5.0 and 12.1±5.3 respectively;VAS score before operation,2 days after operation and the latest following-up were 7.8±0.6,3.0±0.4 and 2.4±0.7,respectively;ODI score at 2 days was improved compared with before operation,while ODI and VAS score at the latest following-up was improved than that of 2 days after operation. Vertebral anterior compression rate and Cobb angle of the fractured vertebrae with intravertebral cleft were respectively corrected from (37.8±5.4)% and (15.1±2.0)°preoperative,to (4.7±1.4)% and (4.4±2.2)° at 2 days after operation,(4.9±1.5)% and (4.8±2.4)° at the latest following-up,there was significant difference between before operation and 2 days after operation,while there was no difference between 2 days after operation and the latest following-up. Three patients occurred cement leakage without pulmonary embolism and neurological impairment. Four patients occurred adjacent vertebrae fracture. There was no incidence of recollapsed vertebrae during follow-up period.Conclusion:Percutaneous vertebroplasty for Kümmel disease could receive satisfactory clinical results when cement dispersion was inadequate during initial cement injection by the second injection,and effectively prevent occurrence of vertebral re-collapse.