Kümmell病经空心椎弓钉增强椎体成形术

Enhanced percutaneous vertebroplasty via cannulated pedicle screw for Kümmellʼs disease

摘要:

[目的]介绍 Kümmell 病经空心椎弓钉增强椎体成形术（percutaneous vertebroplasty, PVP）的手术技术和初步临床效果。[方法]2021 年 5 月—2022 年 12 月，采用经空心椎弓钉增强椎体成形术治疗 Kümmell 病患者 23 例。患者取俯卧位，局部浸润麻醉后于病变椎体内插入穿刺针，拔出针芯后沿穿刺针通道插入导丝，将空心螺钉沿导丝钻入椎体内。用 2.5 ml 注射器， 在透视下将骨水泥用沿空心钉尾部注射入椎体内，至椎体内空隙被骨水泥填充并弥散到椎体，且骨水泥与螺钉前方螺纹锚定在一起后，停止注射。[结果]所有患者均顺利手术，术中无严重并发症，随访 3 个月以上。随时间推移（术前，术后 2 d，术后 3 个月）VAS 评分 [(5.6±0.2), (1.1±0.2), (1.2±0.2), P＜0.05] 和 ODI 评分 [(37.8±0.6), (15.1±0.5), (14.0±0.7), P＜0.05] 均显著改善。影像方面，所有患者均无椎管内骨水泥渗漏，术后椎体中心高度显著增加 [(12.3±0.4), (17.3±0.4), (16.9±0.3), P＜0.05]，椎体前后缘距离无显著变化（P＞0.05）。[结论]经椎弓根空心螺钉锚定增强 PVP 治疗 Kümmell 病手术技术简单，可增加前后柱间的锚合力，改善远期临床效果。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of enhanced percutaneous vertebroplasty (PVP) via cannulated pedicle screw for Kümmell?s disease. [Methods] From May 2021 to December 2022, 23 patients received abovemen- tioned surgical treatment for Kümmell?s disease. As the patient was placed in prone position for fracture reduction, the puncture needle was inserted into the diseased vertebra after local infiltration anesthesia. After pulling out the needle core, the guide wire was inserted along the needle channel, and then the cannulated pedicle screw was inserted into the vertebral body over the guide wire. Using a 2.5 ml syringe at- tached with the tail of the cannulated screw, the bone cement was injected into the vertebral body under fluoroscopy. The injection was stopped as the void in the vertebral body was filled with bone cement, which was anchored together with the thread in front of the screw. [Results] All patients were successfully operated without serious complications, and followed up for more than 3 months. As time elapsed preop- eratively, 2 days postoperatively and 3 months postoperatively, the VAS score [(5.6±0.2), (1.1±0.2), (1.2±0.2), P＜0.05] and ODI scores [(37.8±0.6), (15.1±0.5), (14.0±0.7), P＜0.05] improved significantly. Regarding imaging, no intravertebral cement leakage was observed in all patients, and the center height of the vertebral body significantly increased after surgery [(12.3± 0.4), (17.3±0.4), (16.9±0.3), P＜0.05], where- as the distance between the anterior and posterior edges of the vertebral body was not significantly changed (P＞0.05). [Conclusion] This en- hanced PVP via cannulated pedicle screw for Kümmell?s disease is a simple surgical technique, which might increase the anchoring force between the anterior and posterior columns and improve the long-term clinical outcomes.