经皮椎体成形术少量骨水泥治疗Kümmell病术后伤椎再骨折的疗效

Effect of percutaneous vertebroplasty with a small amount of bone cement on refracture of injured vertebroplasty after Kümmell disease

摘要:

目的 探讨经皮椎体成形术（PVP）少量骨水泥治疗Kümmell病术后伤椎再骨折的疗效。方法 回顾性分析2018年3月—2023年3月嘉峪关市第一人民医院收治的81例Kümmell病术后伤椎再骨折患者的病历资料。根据Kümmell病术后伤椎再骨折患者PVP骨水泥填充剂量分为对照组（常规剂量骨水泥）40例和研究组（少量骨水泥）41例。比较两组患者手术及骨折愈合情况，两组患者骨水泥分布类型；采用视觉模拟评分法（VAS）评估术后疼痛情况；术前、术后6个月采用日本骨科协会（JOA）评分及Oswestry功能障碍指数（ODI）评估患者伤椎功能；比较两组患者伤椎影像学参数及并发症情况。结果 两组患者手术时间、术中透视次数、骨折愈合时间比较，差异无统计学意义（P >0.05）。两组骨水泥分布比较，差异无统计学意义（P >0.05）。两组术前、术后3 d、术后1个月、术后3个月的静息状态下VAS评分比较，结果 ①不同时间点的VAS评分比较，差异有统计学意义（P <0.05）；②两组VAS评分比较，差异无统计学意义（P >0.05）；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。两组术前、术后6个月的JOA评分、ODI指数差值比较，差异均无统计学意义（P >0.05）。两组术前、术后6个月的伤椎前后缘高度比差值、后凸Cobb角差值比较，差异均无统计学意义（P >0.05）。研究组总并发症发生率低于对照组（P <0.05）。结论 PVP术中小剂量骨水泥、常规量骨水泥填充治疗Kümmell病术后伤椎再骨折均效果显著，可促进患者伤椎功能恢复，减轻疼痛，但小剂量骨水泥填充安全性更高。

Abstract:

Objective To explore the efficacy of small amounts of bone cement in percutaneous vertebroplasty (PVP) for treating refractures of the affected vertebra in patients with Kümmell’s disease.Methods A retrospective analysis was conducted on the medical records of 81 patients who experienced refractures of the affected vertebra following PVP treatment for Kümmell’s disease at Jiuquan City First People's Hospital between March 2018 and March 2023. The patients were divided into two groups based on the amount of bone cement used during PVP: the control group (40 cases, conventional bone cement dose) and the study group (41 cases, small amount of bone cement). Surgical and fracture healing outcomes, cement distribution types, postoperative pain (measured using the Visual Analog Scale, VAS), and vertebral function (evaluated using the Japanese Orthopaedic Association, JOA, score and the Oswestry Disability Index, ODI) at pre-operation and six months post-operation were compared between the two groups. Radiographic parameters of the affected vertebra and complications were also analyzed.Results There were no significant differences between the two groups in terms of surgical time, intraoperative fluoroscopy frequency, or fracture healing time (P >0.05). The distribution of bone cement also showed no significant differences between the groups (P >0.05). VAS scores at pre-operation, 3 days post-operation, 1 month post-operation, and 3 months post-operation showed significant improvements over time in both groups (P <0.05), but there were no significant differences between the groups at any given time point (P >0.05). Both groups showed significant improvements in JOA scores and ODI indices six months post-operation compared to pre-operation, with no significant differences between the groups (P >0.05). The changes in anterior and posterior vertebral height ratios and kyphotic Cobb angle at six months post-operation also showed no significant differences between the groups (P >0.05). However, the overall complication rate was lower in the study group compared to the control group (P <0.05).Conclusion Both small and conventional amounts of bone cement during PVP are effective in treating refractures of the affected vertebra in Kümmell’s disease, leading to significant pain relief and functional recovery. However, using a small amount of bone cement may offer higher safety, making it a preferable option.