“拖尾征”锚定骨水泥椎体后凸成形术对Kummell′s病的治疗效果

“Trailing sign” anchored cement kyphoplasty for Kummell′s disease

摘要:

目的 评价“拖尾征”锚定骨水泥椎体后凸成形术(PKP)治疗老年Kummell′s病患者的临床疗效。方法 回顾性分析2014年8月至2017年8月在航天中心医院行PKP术治疗的老年Kummell′s病患者的临床资料33例。依据手术方法分为2组:采用“拖尾征”锚定骨水泥PKP术治疗者为研究组(n＝16)；采用常规PKP术治疗者为对照组(n＝17)。 对比2组患者术中及术后并发症发生情况,随访24个月,对比2组患者术前、术后1d及术后24个月时的Oswestry功能障碍指数(ODI)、视觉模拟量表(VAS)评分、Cobb′s角等指标。2组间比较采用t检验或χ²检验。结果 所有患者均顺利完成手术。研究组与对照组患者的手术时间[(55.46±7.63)和(53.56±8.54)min]和骨水泥注入量[(5.8 ±0.6)和(5.6 ±0.8)ml]比较,差异均无统计学意义(P＞0.05)。与对照组相比,研究组患者术后24个月时的Cobb角显著降低[(14.23°±1.85°)和(17.54°±2.02°),P＜0.05],而伤椎前缘高度[(1.75±0.42)和(1.39±0.61)cm]和中线高度[(1.69±0.61)和(1.35±0.34)cm]均显著增加(P＜0.05)。研究组术后并发症发生率显著低于对照组[6.3%(1/16)和41.2%(7/17),P＜0.01]。结论 “拖尾征”锚定骨水泥PKP术与常规PKP术治疗老年Kummell′s病均能取得短期良好手术效果,但长期随访发现通过“拖尾征”锚定骨水泥可有效减少骨水泥移位的发生风险。

Abstract:

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) with “trailing sign” anchoring bone cement in the treatment of senile patients with Kummell′s disease. Methods A retrospective study was carried out on 33 aged patients with Kummell′s disease in our department from August 2014 to August 2017. According to the surgical procedure, they were divided into observation group (treated by PKP with “trailing sign”, n=16) and control group (routine PKP, n=16). The incidence rates of intra- and post-operative complications were compared between the 2 groups. All patients were followed up for 24 months. Oswestry disability index (ODI), visual analogue scale (VAS) score and Cobb′s angle before and at 1d and 24 months after surgery were compared between the 2 groups. SPSS statistics 18.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between the two groups. Results The operations were successfully completed on all 33 patients. There were no statistical differences in operation time [(55.46±7.63) vs (53.56±8.54)min] and amount of cement used [(5.8±0.6) vs (5.6±0.8)ml] between the two groups (P>0.05). In 24 months after surgery, the Cobb angle [(14.23°±1.85°) vs (17.54°±2.02°)] was statistically decreased, while the anterior height [(1.75±0.42) vs (1.39±0.61)cm] and midline height [(1.69±0.61) vs (1.35±0.34)cm] of injured vertebrae were increased significantly in the observation group than the control group (all P<0.05). The former group had obviously lower incidence rate of post-operative complications than the latter group [6.3%(1/16) vs 41.2%(7/17), P<0.01]. Conclusion Both PKP with “trailing sign” and routine PKP can achieve good short-term outcome in the treatment of Kummell′s disease in the elderly, but the former procedure effectively reduces the risk of bone cement displacement in long-term follow-up.