低温与常温灌注椎体成形术治疗Kümmell病△

Low- temperature versus normal- temperature bone cement perfusion in percutaneous vertebroplasty for Kümmell，s dis⁃ ease

摘要:

[目的] 比较低温与常温间断灌注经皮椎体成形术 （percutaneous vertebroplasty, PVP） 治疗 Kümmell 病的临床疗效。 [方法]回顾性分析 2018 年 9 月—2021 年 8 月在本科应用 PVP 治疗的 60 例 Kümmell 病患者的临床资料，其中 30 例采用低温间断灌注组，另外 30 例采用常温灌注。比较两组患者的围手术期、随访和影像资料。[结果]两组患者均顺利完成手术，低温组的骨水泥可推注时间显著长于常温组 [(10.5±1.3)mm vs (4.9±1.0)min, P＜0.05]，且前者骨水泥渗漏率显著低于后者 （6.7% vs 36.7%, P＜0.05），两组间手术时间、术中透视次数、骨水泥注射量、下地行走时间、住院时间的差异均无统计学意义（P＞0.05）。 两组患者均获随访（15.0±1.8）个月，两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。与术前相比，两组患者出院及末次随访时，VAS、ODI 和 JOA 评分均显著改善 （P＜0.05）。术前两组上述指标的差异均无统计学意义 （P＜0.05），在出院时 [VAS (2.0±1.3) vs (2.9±1.3), P=0.010; ODI (27.7±3.5) vs (28.1±3.8), P=0.022; JOA (22.9±2.0) vs (21.7±1.7), P=0.010] 和末次随访时[VAS (2.1±1.2) vs (2.9±1.4), P=0.016; ODI (26.5±2.6) vs (27.7±3.7), P=0.034; JOA (22.5±1.5) vs (21.4±1.8), P=0.033] 低温组均显著优于常温组。影像方面，低温组的骨水泥弥散优良率显著高于常温组（56.7% vs 30.0%, P＜0.05）。与术前相比，术后即刻及末次随访时，两组患椎前缘相对高度、局部 Cobb 角均显著改善（P＜0.05），相应时间点，两组间患椎前缘相对高度与局部 Cobb 角的差异均无统计学意义（P＞0.05）。[结论]骨水泥低温间断灌注显著增加骨水泥有效推注时间，提高骨水泥在椎体中的弥散程度，降低骨水泥渗漏率。

Abstract:

[Objective] To compare the clinical efficacy of low-temperature (LT) versus normal-temperature (NT) bone cement perfu- sion in percutaneous vertebroplasty (PVP) for Kummell^，s disease. [Methods] A retrospective study was done on 60 patients who underwent PVP for Kümmell^，s disease in our department from September 2018 to August 2021. Of them, 30 patients received LT intermittent perfusion of bone cement, while the remaining 30 patients had PVP performed with bone cement injection under NT. The perioperative period, followup and imaging data of the two groups were compared. [Results] All the patients in both groups had PVP performed smoothly. The LT group got significantly longer injectable time of bone cement than the NT group [(10.5±1.3)mm vs (4.9±1.0)min, P＜0.05], while the former had sig- nificantly lower leakage rate of bone cement than the latter (6.7% vs 36.7%, P＜0.05), nevertheless there were no significant differences in op- eration time, intraoperative fluoroscopy times, bone cement injection amount, postoperative walking time and hospital stay between the two groups (P＞0.05). All of them in both groups were followed up for (15.0±1.8) months on a mean, and there was no significant difference in the time to return to full weight-bearing activities between the two groups (P＞0.05). Compared with those preoperatively, the VAS, ODI and JOA scores significantly improved in both groups at discharge and the latest follow-up (P＜0.05). Although there was no significant difference in the abovesaid scores between the two groups before surgery (P＞0.05), the LT group proved significantly superior to the NT group at discharge [VAS (2.0±1.3) vs (2.9±1.3), P=0.010; ODI (27.7±3.5) vs (28.1±3.8), P=0.022; JOA (22.9±2.0) vs (21.7±1.7), P=0.010] and at the latest fol- low-up [VAS (2.1±1.2) vs (2.9±1.4), P=0.016; ODI (26.5±2.6) vs (27.7±3.7), P=0.034; JOA (22.5±1.5) vs (21.4±1.8), P=0.033]. Radiographi-cally, the LT group was significantly superior to the NT group in term of satisfactory ratio of bone cement diffusion (56.7% vs 30.0%, P＜ 0.05). Compared with those preoperatively, the relative anterior vertebral height and local Cobb angle in both groups significantly improved immediately after surgery and at the latest follow-up (P＜0.05), whereas which proved not significantly different between the two groups at any time points accordingly (P＞0.05). [Conclusion] Intermittent perfusion of bone cement at low temperature does significantly increase the effective injection time of bone cement, improve the diffusion extent of bone cement in vertebral body, and reduce the risk of bone cement leakage