Kümmell病单侧骨水泥多点锚定经皮后凸成形术△

Unilateral bone cement multi-point anchoring percutaneous kyphoplasty for Kümmell's disease

摘要:

[目的]介绍单侧骨水泥多点锚定经皮后凸成形术的手术技术和初步临床疗效。[方法]对 31 例 I、II 期 Kümmell 病患者，行单侧骨水泥多点锚定经皮后凸成形术。采用单侧横突-椎弓根穿刺路径，球囊复位满意后，将两根克氏针头端预弯备用。裂隙靠近头或尾端终板时，采用“Out-In”穿刺方式，一根弯头克氏针由硬化带周围向裂隙内多次穿刺，另一根则向相反侧终板穿刺；裂隙位于椎体中央时，采用“In-Out”穿刺方式，则将一根弯头克氏针穿刺入裂隙内，弯头朝向上终板，由裂隙内向周围硬化带多次穿刺，另一根克氏针则朝向下终板，做相同穿刺，最终在硬化带上形成多个微型穿刺点。随后，序贯注入不同时期骨水泥。[结果]所有患者顺利完成手术，手术时间平均（40.6±3.6）min，骨水泥用量平均（5.2±0.3）mL。其中骨水泥椎旁渗漏 2 例，邻椎骨折 3 例，骨水泥移位 1 例。与术前相比，末次随访 VAS 评分 [(8.1±0.5), (1.7±0.7), P＜0.001]、ODI 指数 [(76.8±2.9), (14.6±2.0), P＜0.001]、椎体前缘高度 [(14.9±5.7) mm, (18.7±4.5) mm, P=0.006]、椎体后缘高度 [(22.4±4.8) mm, (25.0±4.1) mm, P=0.023] 及椎体楔形角 [(15.4±5.1)°, (12.4±3.9)°, P=0.011] 均显著改善。[结论]单侧骨水泥多点锚定经皮后凸成形术治疗 I、II 期 Kümmell 病简单可行，疗效满意，并发症少。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of unilateral bone cement multi-point anchoring percutaneous kyphoplasty (A-PKP) for stage I and II Kümmell's disease (KD). [Methods] A total of 31 patients received abovesaid A-PKA by transverse process-pedicle approach (TPA) for stage I and II KD. Following successful height restoration of the fractured vertebra by balloon expansion, two curved-tip Kirschner wires were prepared and introduced fractured vertebral body. If the intervertebral vacuum cleft (IVC) was close to cephalic or caudal endplate, the "Out-In" puncture was used, a curved Kirschner wire was controlled to puncture the surrounding hardening zone into IVC, while another wire was inserted opposite the endplate. If the IVC was located at the middle of the vertebral body, the "In-Out" puncture was used, a curved-tip Kirschner wire was placed towards upper endplate directly, followed by controlled puncturing from IVC to the surrounding hardened zone, and same procedure was performed with another wire towards the lower endplate from the IVC to the surrounding hardened zone. As results, multiple tiny puncture holes were created on the hardened zone surrounding the IVC. Subsequently, different periods of bone cement were injected sequentially. [Results] All patients had operation performed successfully with the average operation time of (40.6±3.6) min, and the average bone cement injected of (5.2±0.3) mL. Of them, 2 patients had bone cement paravertebral leakage, 3 patients got adjacent vertebral fracture and 1 had bone cement displacement. Compared with those before surgery, the VAS score [(8.1±0.5), (1.7±0.7), P＜0.001], the ODI score [(76.8±2.9), (14.6±2.0), P＜0.001], anterior vertebral height [(14.9±5.7) mm, (18.7±4.5) mm, P=0.006], posterior vertebral height [(22.4±4.8) mm, (25.0±4.1) mm, P=0.023) and vertebral wedge angle [(15.4±5.1)°, (12.4±3.9)°, P=0.011] were significantly improved at the last follow-up. [Conclusion] The A-PKP for the treatment of stage I and II KD is simple and feasible, with satisfactory clinical consequence and few complications.