【摘要】 [目的]对比研究单侧入路和双侧入路PKP治疗Kummell’s病的临床疗效。[方法]回顾性分析本院2013年7月~2015年5月通过影像资料筛选出的63例行PKP手术治疗的Kummell’s病患者。男24人,女39例,年龄55~88岁,平均68.5岁。腰背痛时间1个月~3年,平均3.5个月。38例行单侧椎弓根入路球囊椎体后凸成形术,其中2例失随访,最后,纳入单侧入路手术组的患者36例;25例行双侧椎弓根入路球囊椎体后凸成形术,其中3例失随访,最后纳入双侧入路手术组的有22例。分别测量术前、术后1 d及末次随访时侧位X线片受累节段的矢状面Cobb角度评估后凸角度的恢复程度,使用视觉模拟量表(visual analog scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)和Roland-Morris功能障碍问卷表(roland-morris disability,RDQ)评估手术效果。[结果]随访12~36个月,平均15.8个月。单、双侧入路末次随访的VAS评分分别为(3.9±1.7)分和(3.7±0.7)分。单、双侧入路末次随访的ODI评分分别为(15.3±3.7)分和(13.8±2.7)分。单、双侧入路末次随访的RDQ评分分别为(10.2±1.7)分和(7.9±1.7)分。单侧入路组的手术时间为(47.6±7.8)分,双侧入路组的手术时间为(71.5±21.6)分。单侧骨水泥渗漏为2例,双侧骨水泥渗漏为7例。单侧入路手术组的手术时间明显较短,射线照射量、花费更少。围手术期的相关并发症组间比较差异无统计学意义。两组的年龄、性别、病程、随访持续时间差异均无统计学意义。[结论]单侧和双侧椎体成形术后临床表现和影像学表现在组内没有显著差异。双侧椎弓根入路的手术时间较长。骨水泥泄露的发生率组间比较差异无统计学意义(P>0.05)。单侧与双侧椎弓根入路球囊后凸成形术产生了相类似的临床表现和影像学结果,但单侧用时较少。因此,作者鼓励使用单侧椎弓根入路后凸椎体成形术治疗Kummell’s病。更多还原

【Abstract】 [Objective]To compare the clinical efficacy between unipedicular and bipedicular percutaneous kyphoplasty( PKP) for Kummell’s disease.[Method]A retrospective analysis was conducted in patients admitted to our hospital from July2013 to May 2015. A total of 63 patients with Kummell’s disease who underwent PKP were selected based on the radiographic and clinical data. These patients,consisting of 24 males and 39 females,were aged from 55 to 88 years( mean 68. 5 years). The duration of back pain ranged from 1 month to 3 years( mean 3. 5 month). In 38 patients undergoing unipedicular balloon PKP for Kummell’s disease,2 patients were lost during the followed-up,and the other 36 patients were enrolled into unipedicular PKP group. In 25 patients undergoing bipedicular balloon PKP for Kummell’s disease,3 patients were lost during the followed-up,and the other 22 patients were enrolled into bipedicular PKP group. Radiographic measurements of sagittal Cobb angles in diseased segments before surgery,at one day after surgery,and at the last follow-up were used to evaluate the recovery of the kyphosis angle. The outcomes of surgical treatment were evaluated by Visual Analog Scale( VAS) score,Oswestry Disability Index( ODI),and the Roland-Morris disability questionnaire( RDQ). [Result]All the patients were followed up for 12-36months( mean 15. 8 months). The VAS,ODI,and RDQ scores at the last follow-up were 3. 9 ± 1. 7,15. 3 ± 3. 7,and10. 2 ± 1. 7,respectively,in the unipedicular balloon PKP group,and 3. 7 ± 0. 7,13. 8 ± 2. 7,and 7. 9 ± 1. 7,respectively. in the bipedicular balloon PKP group. Two patients in theunipedicular balloon PKP group and seven patients in the bipedicular balloon PKP group had cement leakage. The unipedicular balloon PKP group had a significantly shorter operation time than the bipedicular balloon PKP group( 47. 6 ± 7. 8 vs 71. 5 ± 21.6 minutes,P < 0. 05). Moreover,the unipedicular balloon PKP group had lower radiation dose and cost than the bipedicular balloon PKP group. There were no significant differences in perioperative complications,age,sex,disease duration,or duration of follow-up between the two groups. [Conclusion]There were no significant differences in postoperative clinical and radiographic outcomes between patients within the two groups. The operation time of bipedicular balloon PKP is longer than that of unipedicular balloon PKP. There is no significant difference in the incidence of cement leakage between the groups( P > 0. 05). The unipedicular balloon PKP achieves similar clinical and radiographic outcomes but shorter operation time than the bipedicular balloon PKP. Therefore,the unipedicular balloon PKP is recommended for treating Kummell’s disease.更多还原