经皮椎体成形术与经皮椎体后凸成形术治疗周壁硬化型Ⅲ期Kummell病的疗效比较

Percutaneous vertebroplasty versus percutaneous kyphoplasty in treating Kummell disease of peripheral sclerosis type in stage Ⅲ

  • 摘要:
      目的  比较经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗周壁硬化型Ⅲ期Kummell病的临床疗效。
      方法  回顾性分析77例周壁硬化型Ⅲ期Kummell病患者的临床资料,其中11例采用PVP治疗的患者设为PVP组, 66例采用PKP治疗的患者设为PKP组。比较2组手术时间,骨水泥注入量,术前、术后1 d及末次随访时的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI), 以及椎体前缘高度和病变椎体局部Cobb角。
      结果  2组均顺利完成手术,且均获得随访, PVP组随访16.00(14.50, 18.00)个月, PKP组随访16.00(14.00, 18.00)个月。PVP组术中骨水泥注入量为3.00(2.00, 3.00) mL, PKP组为4.00(4.00, 5.00) mL, 差异有统计学意义(Z=-4.63, P < 0.01); PVP组手术时间为30.00(27.00, 33.00) min, PKP组为50.00(45.00, 57.00) min, 差异有统计学意义(Z=-4.91, P < 0.01)。术后1 d及末次随访时, 2组患者VAS评分及ODI均较术前降低,差异有统计学意义(P < 0.01)。术后1 d及末次随访时, 2组椎体高度均高于同组术前, Cobb角均低于术前,且PKP组椎体高度大于PVP组, Cobb角小于PVP组,差异均有统计学意义(P < 0.05或P < 0.01)。
      结论  PVP与PKP均可有效缓解周壁硬化型Ⅲ期Kummell病患者腰背部顽固性疼痛,但PKP可更好地恢复椎体高度,改善局部后凸畸形。

     

    Abstract:
      Objective  To compare the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of patients with Kummell disease of peripheral sclerosis type in stage Ⅲ.
      Methods  The clinical materials of 77 patients with peripheral sclerosis type of Kummell disease in stage Ⅲ were retrospectively analyzed. Among them, 11 patients treated with PVP were selected as PVP group, and 66 patients treated with PKP were selected as PKP group. The operation time, the injected amount of bone cement, the Visual Analogue Scale (VAS) of pain and Oswestry dysfunction index (ODI) before operation, 1 day after operation and at the last follow-up, the height of the anterior edge of the vertebral body and the local Cobb angle of the diseased vertebral body were compared between the two groups.
      Results  Patients in both groups completed the operation successfully and were followed up. The PVP group was followed up for 16.00 (14.50, 18.00) months, and the PKP group was followed up for 16.00 (14.00, 18.00) months. The intraoperative injected volume of bone cement was 3.00 (2.00, 3.00) mL in the PVP group and 4.00 (4.00, 5.00) mL in the PKP group, and there was a significant difference between two groups (Z=-4.63, P < 0.01); the operation time was 30.00 (27.00, 33.00) min in the PVP group and 50.00 (45.00, 57.00) min in the PKP group, and there was also a significant difference between two groups (Z=-4.91, P < 0.01). One day after operation and at the last follow-up, the VAS score and ODI in both groups were significantly lower than those before operation in the same group (P < 0.01). One day after operation and at the last follow-up, the vertebral body height in both groups were higher than that before operation in the same group, and the Cobb angle was significantly lower than that before operation; meanwhile, the vertebral body height of the PKP group was higher than that of the PVP group, and the Cobb angle was smaller than that of the PVP group; the differences above were statistically significant (P < 0.05 or P < 0.01).
      Conclusion  Both PVP and PKP can effectively alleviate the intractable pain in the lower back of patients with peripheral sclerosis type of Kummell disease in stage Ⅲ, but PKP can better restore the height of vertebral body and improve local kyphosis.

     

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