【摘要】 目的：探讨手法复位联合经皮椎体成形术(PVP)治疗老年Kümmell病的临床疗效和安全性。方法：对64例单节段Kümmell病的患者进行回顾性分析，根据手术方式分为A、B两组。A组30例，采用手法复位联合PVP治疗；B组34例，采用椎体后凸成形术（PKP）治疗。记录两组的手术时间、术中出血量、术中透视时间、骨水泥注射剂量及渗漏情况、手术费用及并发症；分析两组术后第1天、6个月及末次随访时的VAS评分、ODI评分；影像学比较两组上述3个随访时间点的伤椎前缘高度和Cobb角。结果：所有患者均手术顺利，未发生严重的并发症。A组手术时间、术中透视时间、手术费用低于B组(P <0.05)。两组骨水泥注射剂量、术中出血量、骨水泥渗漏率方面差异无统计学意义(P> 0.05)。超过2年的随访发现，两组的VAS评分、ODI评分均较术前明显改善，各随访时间点，两组间差异无统计学意义(P> 0.05)。影像学方面，两组患者的伤椎前缘高度、Cobb角均较术前有显著改善(P <0.05)；随时间推移，伤椎椎体高度及Cobb角的矫正程度逐渐降低，但末次随访时，两组间差异无统计学意义(P> 0.05)。结论：相较于PKP技术，手法复位联合PVP技术治疗老年Kümmell病手术时间更短，接受放射量更少，医疗费用更低。更多还原

【Abstract】 Objective To explore the effectiveness and safety of manual reduction combined with percutaneous vertebroplasty(PVP) in treating Kümmell’s disease(KD). Methods The relevant data that 64patients of neurologically intact osteoporotic KD receiving manual reduction combined with PVP(30 patients) or percutaneous kyphoplasty(PKP)(34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage,transient fever and re-fracture were recorded. Universal indicators of visual analogue scale(VAS) and Oswestry disability index(ODI) were evaluated separately before surgery and at 1 day, 6 months and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection,intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the manual reduction combined with PVP group. The post-operative VAS,ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation.Conclusion Both manual reduction combined with PVP and PKP technologies can significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, manual reduction combined with PVP has the advantages of shorter operation time, less radiation volume and operation cost.更多还原