体位过伸复位配合单侧穿刺椎体成形骨水泥注射治疗老年胸腰椎Kümmell病

摘要

背景:国内有研究报道过伸复位椎体成形骨水泥注射治疗胸腰椎新鲜骨质疏松性压缩骨折取得了良好的临床效果.目的:分析采用过伸复位法配合单侧穿刺椎体成形骨水泥注射治疗老年Kümmell病的临床效果.方法:纳入22例老年Kümmell病患者,其中男8例,女14例,年龄59-84岁,涉及T11椎体2个,T12椎体8个,L1椎体7个,L2椎体4个,L3椎体2个,L4椎体2个,L5椎体1个,均在过伸复位下进行单侧穿刺骨水泥椎体成形骨水泥注射治疗,检测治疗前后的目测类比评分、Oswestry功能障碍指数、伤椎后凸Cobb角及伤椎椎体前缘、中缘与后缘高度的变化.结果与结论:①22例患者均顺利完成手术,术后24 h内疼痛缓解或消失,未出现脊髓神经损伤、肺栓塞等并发症,发生骨水泥渗漏1例,未引起明显临床症状;随访期间2例发生非相邻椎体骨折;②患者治疗后1d、末次随访的目测类比评分、Oswestry功能障碍指数均较治疗前明显降低(P＜0.05);③患者治疗后1d、末次随访的伤椎椎体前缘、中缘及后缘高度均较治疗前明显升高(P＜0.05),伤椎后凸Cobb角较治疗前明显降低(P＜0.05);④结果表明,过伸复位配合单侧穿刺椎体成形骨水泥注射治疗老年Kümmell病,可有效改善腰背痛,部分恢复椎体高度,减小后凸畸形,改善功能障碍.%BACKGROUND:Percutaneous vertebroplasty with bone cement plus hyperextension position reset for acute thoracolumbar vertebral osteoporotic compression fractures has been reported to achieve good clinical efficacy.OBJECTIVE:To evaluate the efficacy of unilateral percutaneous vertebroplasty with bone cement plus hyperextension position reset for Kümmell disease in the elderly.METHODS:Twenty-two old patients with Kümmell disease were included,involving 8 males and 14 females,aged 55-84 years old,and the injuried vertebrae included T11 (n=2),T12 (n=8),L1 (n=7),L2 (n=4),L3 (n=2),L4 (n=2),and L5 (n=1).All patients underwent the unilateral percutaneous vertebroplasty with bone cement plus hyperextension position reset.The visual analogue scale and the Oswestry Disability Index scores,vertebral body height as well as vertebral kyphosis angle were determined before and after treatment.RESULTS AND CONCLUSION:(1) All patients were successfully operated,pain relieved or disappeared within 24 hours postoperatively.No spinal cord injury,pulmonary embolism and other complications were found.One patient presented with cement leakage without obvious clinical symptoms;two patients had non-adjacent vertebral fractures during follow-up.(2) The visual analogue scale and Oswestry Disability Index scores at 1 day postoperatively were significantly lower than those at baseline (P ＜ 0.05).(3) The anterior,medial and posterior height of involved vertebral body,kyphotic angle of involved vertebral body at 1 day postoperatively were significantly higher than those at baseline (P ＜ 0.05).(4) These results manifest that unilateral percutaneous vertebropiasty with bone cement plus hyperextension position reset to treat Kümmell disease in the elderly can significantly relieve back pain,restore partial vertebral height,correct local kyphosis and improve functional recovery of the injured vertebrae.