Kümmell病囊壁与囊内穿刺椎体成形术比较△

Cyst-wall versus intracystic puncture in percutaneous vertebroplasty for Kümmell's disease

摘要:

[目的] 比较单侧囊壁穿刺与囊内穿刺经皮椎体成形术 （percutaneous vertebroplasty, PVP） 治疗 I、II 期 Kümmell 病患者的临床疗效。[方法]回顾性分析 2017 年 3 月—2021 年 2 月行 PVP 治疗的 56 例 I、II 期 Kümmell 病患者的临床资料，根据医患沟通结果，30 例采用经囊壁穿刺治疗（囊壁组），26 例采用囊内穿刺治疗（囊内组）。比较两组围手术期、随访和影像资料。[结果]所有患者均顺利完成手术，两组患者手术时间、首次穿刺成功率、骨水泥渗漏率、下地行走时间、住院时间的差异均无统计学意义（P＞0.05）。囊壁组术中透视次数 [(12.4±1.6) 次 vs (9.2±1.7) 次, P＜0.05] 和骨水泥注入量 [(4.7±0.2) ml vs (4.3±0.2) ml, P＜0.05] 均显著多于囊内组。随访时间平均（17.4±2.4）个月。术后随时间推移，两组 VAS、ODI 评分均显著减少（P＜0.05）， 相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，术后 3 d 及末次随访时，两组患者 Cobb 角、伤椎前缘高度和中线高度均较术前显著改善（P＜0.05）。术前两组患者上述影像指标的差异均无统计学意义（P＞0.05），囊壁组伤椎前缘高度 [术后 3 d (20.5±1.9) mm vs (19.5±1.7) mm, P＜0.05；末次随访时 (20.1±1.9) mm vs (18.0±2.0) mm, P＜0.05]、伤椎中线高度 [术后 3 d (18.0±1.4) mm vs (17.2±1.2) mm, P＜0.05；末次随访时 (17.5±1.4) mm vs (16.6±1.2) mm, P＜0.05] 和局部后凸角 [术后 3 d (13.9±4.2) ° vs (16.5±5.4) °, P＜0.05；末次随访时 (14.4±4.6) ° vs (17.9±5.7) °, P＜0.05] 均显著优于囊内组。[结论] 对于 I 期和 II 期 Kümmell 病， 单侧囊壁穿刺经皮椎体成形术在恢复和维持病变椎体形态方面的效果明显好于囊内穿刺成形术。

Abstract:

[Objective] To compare the clinical outcomes of unilateral cyst-wall puncture (CWP) versus intracystic puncture (ICP) in percutaneous vertebroplasty (PVP) for stage I and II Kümmell's disease. [Methods] A retrospective study was conducted on 56 patients who underwent PVP for stage I and II Kümmell's disease from March 2017 to February 2021. According to doctor-patient communication, 30 pa- tients received CWP-PVP, while the remaining 26 patients received ICP-PVP. The perioperative, follow-up and imaging data were com- pared between the two groups. [Results] All patients in both groups had corresponding procedure performed successfully without serious in- traoperative complications. Although there were no significant differences in the operation time, first puncture success rate, bone cement leakage rate, walking time and hospital stay between the two groups (P＞0.05), the CWP group had significantly more intraoperative fluorosco- py times [(12.4±1.6) times vs (9.2±1.7) times, P＜0.05] and significantly more bone cement injected [(4.7±0.2) ml vs (4.3±0.2) ml, P＜0.05] than the ICP group. With time of follow-up lasted for (17.4±2.4) months on an average, the VAS and ODI scores significantly decreased in both groups (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiographi- cally, the Cobb angle, anterior and midline vertebral heights of injured vertebra were significantly improved in both groups at 3 days postoper- atively and the last follow-up (P＜0.05). There was no significant difference in the above imaging indexes between the two groups before sur- gery (P＞0.05), however, the CWP group proved significantly superior to the ICP group in terms of anterior vertebral height [3 days postopera- tively (20.5±1.9) mm vs (19.5±1.7) mm, P＜0.05; the last follow-up (20.1±1.9) mm vs (18.0±2.0) mm, P＜0.05], the middle vertebral height [3 days postoperatively (18.0±1.4) mm vs (17.2±1.2) mm, P＜0.05; the last follow-up (17.5±1.4) mm vs (16.6±1.2) mm, P＜0.05], and the local kyphotic angle [3 days postoperatively (13.9± 4.2) ° vs (16.5±5.4) °, P＜0.05; the latest follow-up (14.4±4.6) ° vs (17.9±5.7) °, P＜0.05]. [Con- clusion] The unilateral cyst-wall-puncture percutaneous vertebroplasty does achieve considerably better consequences to recover and main- tain morphology of the affected vertebrae than the intracystic counterpart for stage I and II Kümmell's disease.