摘要
目的:比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗Kümmell病的临床疗效和安全性。方法:回顾性分析48例Kümmell病患者的病例资料,其中采用PKP治疗28例,采用PVP治疗20例。男5例,女43例;年龄60~75岁,中位数67岁;病变椎体位于T102例、T119例、T1215例、L114例、L24例、L31例、L41例、T12和L11例、T9和T121例。比较2组患者的手术时间、骨水泥注射量及并发症发生情况,以及术前、术后2 d、术后1个月及末次随访时2组患者的腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、伤椎前缘高度、伤椎与邻椎前缘高度比值、伤椎后凸Cobb角。结果:(1)手术时间和骨水泥注射量。PKP组手术时间长于PVP组[(68.35±11.63)min,(45.29±9.76)min,t=-7.454,P=0.000],骨水泥注射量少于PVP组[(2.95±0.56)m L,(3.29±0.66)m L,t=1.856,P=0.070]。(2)腰背部疼痛VAS评分。时间因素与分组因素不存在交互效应(F=0.076,P=0.785);2组患者腰背部疼痛VAS评分比较,组间差异无统计学意义,即不存在分组效应(F=0.132,P=0.895);手术前后不同时间点之间腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=710.533,P=0.000);2组患者腰背部疼痛VAS评分随时间均呈降低趋势,且2组的降低趋势完全一致[(8.00±0.82)分,(3.18±0.61)分,(2.25±1.04)分,(1.82±0.95)分,F=301.206,P=0.000;(7.85±0.93)分,(2.90±0.64)分,(2.30±0.98)分,(2.00±0.97)分,F=189.922,P=0.000]。(3)ODI。时间因素与分组因素不存在交互效应(F=0.785,P=0.380);2组患者ODI比较,组间差异无统计学意义,即不存在分组效应(F=-0.341,P=0.733);手术前后不同时间点之间ODI的差异有统计学意义,即存在时间效应(F=689.909,P=0.000);2组患者ODI随时间均呈降低趋势,且2组的降低趋势完全一致(69.79±10.84,38.39±5.65,25.50±4.14,21.61±3.75,F=296.004,P=0.000;71.55±9.57,40.50±4.38,27.05±3.71,20.25±3.39,F=304.494,P=0.000)。(4)伤椎前缘高度。时间因素与分组因素存在交互效应(F=11.128,P=0.002);2组患者伤椎前缘高度比较,组间差异有统计学意义,即存在分组效应(F=-5.030,P=0.000);手术前后不同时间点之间伤椎前缘高度的差异有统计学意义,即存在时间效应(F=182.068,P=0.000);术前和末次随访时,2组患者伤椎前缘高度比较,差异无统计学意义[(13.33±1.33)mm,(14.05±1.21)mm,t=-1.898,P=0.064;(17.09±1.52)mm,(17.75±1.63)mm,t=-1.441,P=0.156];术后2 d和术后1个月,PKP组伤椎前缘高度均小于PVP组[(19.02±1.51)mm,(20.55±0.72)mm,t=-4.207,P=0.000;(17.56±1.87)mm,(18.75±2.09)mm,t=-2.075,P=0.044]。(5)伤椎与邻椎前缘高度比值。时间因素与分组因素存在交互效应(F=13.048,P=0.001);2组患者伤椎与邻椎前缘高度比值比较,组间差异有统计学意义,即存在分组效应(F=-1.605,P=0.011);手术前后不同时间点之间伤椎与邻椎前缘高度比值的差异有统计学意义,即存在时间效应(F=501.461,P=0.000);术前和末次随访时,2组患者伤椎与邻椎前缘高度比值比较,差异无统计学意义[(49.07±2.17)%,(50.78±3.84)%,t=-1.959,P=0.056;(73.50±3.48)%,(74.65±4.19)%,t=-1.036,P=0.306];术后2 d和术后1个月,PKP组伤椎与邻椎前缘高度比值均小于PVP组[(74.81±3.65)%,(78.58±6.73)%,t=-2.497,P=0.016;(73.89±4.24)%,(76.85±3.73)%,t=-2.501,P=0.016]。(6)伤椎后凸Cobb角。时间因素与分组因素存在交互效应(F=10.777,P=0.002);2组患者伤椎后凸Cobb角比较,组间差异有统计学意义,即存在分组效应(F=-2.224,P=0.027);手术前后不同时间点之间伤椎后凸Cobb角的差异有统计学意义,即存在时间效应(F=89.178,P=0.000);术前和末次随访时,2组患者伤椎后凸Cobb角比较,差异无统计学意义(20.70°±1.71°,19.89°±1.19°,t=-1.930,P=0.060;13.59°±2.42°,13.39°±2.65°,t=-0.281,P=0.780);术后2 d和术后1个月,PKP组伤椎后凸Cobb角均大于PVP组(16.78°±2.27°,14.69°±3.33°,t=-2.417,P=0.020;14.50°±2.65°,12.89°±2.11°,t=0.140,P=0.024)。(7)安全性。PVP组1例出现骨水泥椎旁渗漏,PKP组2例出现骨水泥上椎间隙内渗漏,2组患者均未出现伤椎再骨折和邻椎骨折等并发症;2组并发症发生率比较,差异无统计学意义(P=1.000)。结论:采用PVP与PKP治疗Kümmell病,均能缓解腰背部疼痛,恢复椎体高度,纠正后凸畸形,改善脊柱功能,且并发症少。前者在缩短手术时间、恢复椎体高度、纠正后凸畸形方面优于后者,但后者较前者骨水泥注射量少。
Objective： To compare the clinical curative effects and safety of percutaneous vertebroplasty（ PVP） versus percutaneous kyphoplasty（ PKP） for treatment of Kümmell＇s diseases. Methods： The medical records of 48 patients with Kümmell＇s diseases were analyzed retrospectively. Twenty-eight patients were treated with PKP（ PKP group）,while the others were treated with PVP（ PVP group）. The patients consisted of 5 males and 43 females,and ranged in age from 60 to 75 years（ Median = 67 yrs）. The pathological changes located at T10（ 2）,T11（ 9）,T12（ 15）,L1（ 14）,L2（ 4）,L3（ 1）,L4（ 1）,T12 and L1（ 1） and T9 and T12（ 1）. The operative time,consumption of bone cements,complications were compared between the 2 groups respectively. Moreover,low back pain visual analogue scale（ VAS） scores,Oswestry disability index（ ODI）,injured vertebrae anterior border height,ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height and kyphotic Cobb angle of injured vertebrae measured before the surgery,at 2 days and 1 month after the surgery and at last follow-up were compared between the 2 groups respectively. Results： The operative time was longer and the consumption of bone cements was less in PKP group compared to PVP group（ 68. 35 ＋/-11. 63 vs 45. 29 ＋/-9. 76 min,t =-7. 454,P = 0. 000; 2. 95 ＋/-0. 56 vs3. 29 ＋/-0. 66 m L,t = 1. 856,P = 0. 070）. There was no interaction between time factor and group factor in low back pain VAS scores（ F =0. 076,P = 0. 785）. There was no statistical difference in the low back pain VAS scores between the 2 groups,in other words,there was no group effect（ F = 0. 132,P = 0. 895）. There was statistical difference in the low back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect（ F = 710. 533,P = 0. 000）. The low back pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of low back pain VAS scores（ 8. 00 ＋/-0. 82,3. 18 ＋/-0. 61,2. 25 ＋/-1. 04,1. 82 ＋/-0. 95 points,F = 301. 206,P = 0. 000; 7. 85 ＋/-0. 93,2. 90 ＋/-0. 64,2. 30 ＋/-0. 98,2. 00 ＋/-0. 97 points,F = 189. 922,P = 0. 000）. There was no interaction between time factor and group factor in ODI（ F = 0. 785,P = 0. 380）. There was no statistical difference in ODI between the 2 groups,in other words,there was no group effect（ F =-0. 341,P = 0. 733）. There was statistical difference in ODI between different timepoints before and after the surgery,in other words,there was time effect（ F = 689. 909,P = 0. 000）. The ODI presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of ODI（ 69. 79 ＋/-10. 84,38. 39 ＋/-5. 65,25. 50 ＋/-4. 14,21. 61 ＋/-3. 75,F = 296. 004,P = 0. 000; 71. 55 ＋/-9. 57,40. 50 ＋/-4. 38,27. 05 ＋/-3. 71,20. 25 ＋/-3. 39,F = 304. 494,P = 0. 000）. There was interaction between time factor and group factor in injured vertebrae anterior border height（ F = 11. 128,P = 0. 002）. There was statistical difference in injured vertebrae anterior border height between the 2 groups,in other words,there was group effect（ F =-5. 030,P =0. 000）. There was statistical difference in injured vertebrae anterior border height between different timepoints before and after the surgery,in other words,there was time effect（ F = 182. 068,P = 0. 000）. There was no statistical difference in injured vertebrae anterior border height between the 2 groups before the surgery and at last follow-up（ 13. 33 ＋/-1. 33 vs 14. 05 ＋/-1. 21 mm,t =-1. 898,P = 0. 064;17. 09 ＋/-1. 52 vs 17. 75 ＋/-1. 63 mm,t =-1. 441,P = 0. 156）. The injured vertebrae anterior border heights were lower in PKP group compared to PVP group at 2 days and 1 month after the surgery（ 19. 02 ＋/-1. 51 vs 20. 55 ＋/-0. 72 mm,t =-4. 207,P = 0. 000;17. 56 ＋/-1. 87 vs 18. 75 ＋/-2. 09 mm,t =-2. 075,P = 0. 044）. There was interaction between time factor and group factor in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height（ F = 13. 048,P = 0. 001）. There was statistical difference in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height between the 2 groups,in other words,there was group effect（ F =-1. 605,P = 0. 011）. There was statistical difference in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height between different timepoints before and after the surgery,in other words,there was time effect（ F =501. 461,P = 0. 000）. There was no statistical difference in ratio of injured vertebrae anterior border height to adjacent vertebrae anterior border height between the 2 groups before the surgery and at last follow-up（ 49. 07 ＋/-2. 17 vs 50. 78 ＋/-3. 84%,t =-1. 959,P =0. 056; 73. 50 ＋/-3. 48 vs 74. 65 ＋/-4. 19%,t =-1. 036,P = 0. 306）. The ratios of injured vertebrae anterior border height to adjacent vertebrae anterior border height were smaller in PKP group compared to PVP group at 2 days and 1 month after the surgery（ 74. 81 ＋/-3. 65 vs 78. 58 ＋/-6. 73%,t =-2. 497,P = 0. 016; 73. 89 ＋/-4. 24 vs 76. 85 ＋/-3. 73%,t =-2. 501,P = 0. 016）. There was interaction between time factor and group factor in kyphotic Cobb angle of injured vertebrae（ F = 10. 777,P = 0. 002）. There was statistical difference in kyphotic Cobb angle of injured vertebrae between the 2 groups,in other words,there was group effect（ F =-2. 224,P = 0. 027）. There was statistical difference in kyphotic Cobb angle of injured vertebrae between different timepoints before and after the surgery,in other words,there was time effect（ F = 89. 178,P = 0. 000）. There was no statistical difference in kyphotic Cobb angle of injured vertebrae between the 2 groups before the surgery and at last follow-up（ 20. 70 ＋/-1. 71 vs 19. 89 ＋/-1. 19 degrees,t =-1. 930,P = 0. 060; 13. 59 ＋/-2. 42 vs13. 39 ＋/-2. 65 degrees,t =-0. 281,P = 0. 780）. The kyphotic Cobb angles of injured vertebraes were larger in PKP group compared to PVP group at 2 days and 1 month after the surgery（ 16. 78 ＋/-2. 27 vs 14. 69 ＋/-3. 33 degrees,t =-2. 417,P = 0. 020; 14. 50 ＋/-2. 65 vs 12. 89 ＋/-2. 11 degrees,t = 0. 140,P = 0. 024）. The bone cements leaked out of vertebral body（ 1） in PVP group and leaked into superior intervertebral space（ 2） in PKP group,and no complications such as injured vertebrae refractures and adjacent vertebrae fractures were found in the 2 groups. There was no statistical difference in complication incidences between the 2 groups（ P = 1. 000）. Conclusion： Both PVP and PKP can alleviate low back pain,restore vertebral height,correct kyphotic deformity and improve spinal function in treatment of Kümmell＇s diseases,and both of them have less postoperative complications. However,the former surpasses the latter in shortening operation time,restoring vertebral height and correcting kyphotic deformity,while the latter needs less bone cements compared to the former.
作者
俞兴
王婷
杨济洲
毕连涌
杨永栋
王逢贤
曲弋
赵子义
赵丁岩
YU Xing;WANG Ting;YANG Jizhou;BI Lianyong;YANG Yongdong;WANG Fengxian;QU Yi;ZHAO Ziyi;ZHAO Dingyan(Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100700,China)
出处
《中医正骨》
2018年第6期23-29,33,共8页
The Journal of Traditional Chinese Orthopedics and Traumatology
