Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Plastic and Cosmetic, Wuhan Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Orthop Surg. 2020 Feb;12(1):199-209. doi: 10.1111/os.12609.
This study aimed to present the different pattern of intravertebral vacuum cleft (IVC) related to high risk of cement complications in minimally invasive treatments for Kümmell's disease (KD) and relevant treatment strategies.
A retrospective study from January 2016 to January 2018 was conducted at Wuhan Fourth Hospital and comprised 35 patients with Kümmell's disease. There were seven males and 28 females, and the mean age of the patients was 70.4 years. The patterns of IVC in KD were analyzed. These patients were divided into three groups based on the treatment method used. The treatment methods included long-segment fixation (LSF), posterior short-segment fixation (SSF), and percutaneous kyphoplasty (PKP). We retrospectively reviewed outcomes, including the Oswestry Disability Index (ODI), visual analog scale (VAS) score, anterior height of affected vertebrae, kyphotic Cobb angle, and complications.
All patients were followed up for 12-38 months. According to their radiographic appearance we could observe two main patterns of clefts. Pattern I, clefts that were found to be near to the endplate and connected with intervertebral space, the endplate was incomplete. Pattern II, IVC traversed to anterior edge of the vertebral body affected. Both were related to high risk of cement complications in minimal invasive treatments for KD. Good results have been achieved in LSF and SSF groups, the VAS, ODI, anterior height of affected vertebrae and kyphotic Cobb angle showed statistically significant differences between pre- and post-operation and between pre- and final follow-up (P < 0.05). In PKP group, although the VSA and ODI showed statistically significant differences between pre- and post-operation and between pre- and final follow-up (P < 0.05), we could observe that the VSA and ODI rebounded a little at the final follow-up. Cement leakage into intervertebral space occurred in four (44.45%) patients of PKP group.
PKP should be chosen carefully if the IVC of the patient presents to be pattern I or II. LSF and SSF are safe and effective, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in patient's daily life, with few complications.
本研究旨在介绍与微创治疗 Kümmell 病（KD）中骨水泥并发症高风险相关的不同类型的椎体内真空裂隙（IVC）模式，并提出相关的治疗策略。
本回顾性研究于 2016 年 1 月至 2018 年 1 月在武汉市第四医院进行，共纳入 35 例 Kümmell 病患者。其中男 7 例，女 28 例，患者平均年龄 70.4 岁。分析 KD 中的 IVC 模式。根据使用的治疗方法将这些患者分为三组，治疗方法包括长节段固定（LSF）、后路短节段固定（SSF）和经皮椎体后凸成形术（PKP）。我们回顾性分析了包括 Oswestry 功能障碍指数（ODI）、视觉模拟评分（VAS）、受累椎体前缘高度、后凸 Cobb 角和并发症在内的结果。
所有患者均随访 12-38 个月。根据影像学表现，我们可以观察到两种主要的裂隙模式。模式 I，裂隙靠近终板，与椎间隙相连，终板不完整。模式 II，IVC 贯穿受累椎体前缘。这两种模式都与 KD 微创治疗中骨水泥并发症的高风险相关。LSF 和 SSF 组取得了良好的效果，VAS、ODI、受累椎体前缘高度和后凸 Cobb 角在术前与术后以及术前与最终随访之间均有统计学差异（P<0.05）。PKP 组虽然 VAS 和 ODI 在术前与术后以及术前与最终随访之间有统计学差异（P<0.05），但我们可以观察到 VAS 和 ODI 在最终随访时略有反弹。PKP 组中有 4 例（44.45%）患者出现骨水泥渗漏至椎间隙。
如果患者的 IVC 表现为模式 I 或 II，应谨慎选择 PKP。LSF 和 SSF 安全有效，可满意矫正后凸畸形和椎体高度，缓解疼痛，改善患者日常生活，并发症少。
