河南省洛阳正骨医院（河南省骨科医院）
河南省中医药科学研究专项项目（20-21ZY1058），河南省中医药科学研究专项项目（20-21ZY2243）；洛阳市公益性行业医疗卫生专项项目（2022008A）
Luoyang Orthopedic Hospital of Henan Province（Orthopedic Hospital of Henan Province）
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[目的] 比较经皮单侧囊内穿刺椎体成形术与经皮单侧经囊壁穿刺椎体成形术治疗Ⅰ、Ⅱ期Kummell病患者的临床疗效。[方法] 回顾性分析2017年3月-2021年2月行经皮单侧椎弓根穿刺椎体成形术（percutaneous vertebro plasty，PVP）治疗的Ⅰ、Ⅱ期Kummell病患者56例，将患者分为两组：采用经囊壁穿刺治疗者为囊壁组（n=30）；采用囊内穿刺治疗者为囊内组（n=26）。比较两组围手术期、随访和影像资料。[结果] 所有患者均顺利完成手术，随访12-24个月，平均17.4个月。囊壁组与囊内组患者的手术时间、首次穿刺成功率、骨水泥渗漏率的差异无统计学意义（P＞0.05），囊壁组在术中透视次数和骨水泥注入量方面显著大于囊内组（P＜0.05）。两组患者术后3d及末次随访时腰背痛VAS评分和ODI评分均较术前明显改善（P＜0.05），并且随着时间的推移无加重趋势。两组患者术后3d及末次随访时VAS评分、ODI评分的差异均无统计学意义（P＞0.05），术后3d及末次随访时Cobb角、伤椎前缘高度和中线高度均较术前明显改善（P＜0.05）。囊壁组远期椎体无再次骨折，囊内组有2例出现再次骨折。[结论] 经皮单侧椎弓根经囊壁穿刺椎体成形术治疗Ⅰ、Ⅱ期Kummell病患者的临床疗效显著、安全性高、远期效果稳定，并可有效减少椎体再骨折的发生风险。
Objective: To compare the clinical efficacy of percutaneous vertebroplasty (PVP) by puncturing in the cyst and PVP by puncturing through the cyst wall in the treatment of stage Ⅰ and Ⅱ Kummell's disease. Method: The clinical data of 56 patients with stage Ⅰ and Ⅱ Kummell's disease who underwent PVP in our department from March 2017 to February 2021 were retrospectively analyzed. The patients were divided into two groups according to the surgical puncture method: The patients treated with PVP by puncturing through the cyst wall was group A (n=30); Patients treated with PVP by puncturing in the cyst wall was group B (n=26). Perioperative, follow-up and imaging data were compared between the two groups. Results: All patients successfully completed the operation and were followed up for 12-24 months (mean 17.4 months). There was no statistically significant difference in the operation time, the success rate of first and leakage rate of bone cement between two groups (P>0.05), but there was statistically significant difference in the number of fluoroscopy, puncture and amount of bone cement injection (P < 0.05). VAS score and ODI score of two groups were significantly improved at 3 days after surgery and the last follow-up compared with preoperative results (P < 0.05), and there was no increasing trend over time. Compared with the two groups, there were no significant differences in VAS score and ODI score at 3 days after surgery and the last follow-up (P > 0.05). Cobb angle, anterior edge height and midline height of injured vertebra were significantly improved at 3 days after surgery and the last follow-up (P < 0.05). There was no long-term vertebral refracture in the group B, and there were 2 cases in the group A. Conclusions: The clinical efficacy of PVP by puncturing through the cyst wall in the treatment of stage Ⅰ and Ⅱ Kummell's disease is significant. The long-term effect of this method is stable and can effectively reduce the risk of vertebral refracture.
