Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
BMC Surg. 2022 Aug 20;22(1):319. doi: 10.1186/s12893-022-01770-1.
To compare the clinical and radiological outcomes of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) in the treatment of stage III Kummell disease without neurological deficit.
This retrospective study involved 41 patients with stage III Kummell disease without neurological deficit who underwent PKP or PVP from January 2018 to December 2019. Demographic data and clinical characteristics were comparable between these two groups before surgery. Operation time, volume of injected bone cement, intraoperative blood loss and time of hospital stay were analyzed. Visual analog scale (VAS) scoring and Oswestry disability index (ODI) scoring were assessed for each patient before and after operation. Radiographic follow-up was assessed by the height of anterior (Ha), the height of middle (Hm), Cobb's angle, and Vertebral wedge ratio (VWR). The preoperative and postoperative recovery values of these data were used for comparison.
The two groups showed no significant difference in demographic features (p > 0.05). What's more, the operation time, intraoperative blood loss, and time of hospital stay revealed no sharp statistical distinctions either (p > 0.05), except PKP used more bone cement than PVP (7.4 ± 1.7 mL vs 4.7 ± 1.4 mL, p < 0.05). Radiographic data, such as the Ha improvement ratio (35.1 ± 10.2% vs 16.2 ± 9.4%), the Hm improvement ratio (41.8 ± 11.3% vs 22.4 ± 9.0%), the Cobb's angle improvement (10.0 ± 4.3° vs 3.5 ± 2.1°) and the VWR improvement ratio (30.0 ± 10.6% vs 12.7 ± 12.0%), were all better in PKP group than that in PVP group (p < 0.05). There were no statistical differences in the improvement of VAS and ODI 1-day after the surgery between these two groups (p > 0.05). However, at the final follow-up, VAS and ODI in PKP group were better than that in PVP (p < 0.05). Cement leakage, one of the most common complications, was less common in the PKP group than that in the PVP group (14.3% vs 45.0%, p < 0.05). And there was 1 case of adjacent vertebral fractures in both PKP and PVP (4.8% vs 5.0%, p > 0.05), which showed no statistical difference, and there were no severe complications recorded.
For stage III Kummell disease, both PKP and PVP can relieve pain effectively. Moreover, PKP can obtain more satisfactory reduction effects and less cement leakage than PVP. We suggested that PKP was more suitable for stage III Kummell disease without neurological deficit compared to PVP from a vertebral reduction point of view.
比较经皮椎体后凸成形术（PKP）和经皮椎体成形术（PVP）治疗无神经功能缺损的 III 期 Kummell 病的临床和影像学结果。
本回顾性研究纳入了 2018 年 1 月至 2019 年 12 月期间接受 PKP 或 PVP 治疗的无神经功能缺损的 III 期 Kummell 病患者 41 例。两组患者术前的一般资料和临床特征均具有可比性。分析手术时间、注入骨水泥量、术中出血量和住院时间。对每位患者术前和术后均采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分进行评估。通过测量术前和术后的椎体前缘高度（Ha）、椎体中部高度（Hm）、Cobb 角和椎体楔变率（VWR）来评估影像学随访结果。比较这些数据的术前和术后恢复值。
两组患者的一般特征无显著差异（p>0.05）。此外，手术时间、术中出血量和住院时间也无明显统计学差异（p>0.05），但 PKP 组使用的骨水泥量多于 PVP 组（7.4±1.7ml vs 4.7±1.4ml，p<0.05）。影像学数据显示，PKP 组的 Ha 改善率（35.1±10.2%比 16.2±9.4%）、Hm 改善率（41.8±11.3%比 22.4±9.0%）、Cobb 角改善（10.0±4.3°比 3.5±2.1°）和 VWR 改善率（30.0±10.6%比 12.7±12.0%）均优于 PVP 组（p<0.05）。两组患者术后 1 天 VAS 和 ODI 的改善程度无统计学差异（p>0.05）。然而，在最终随访时，PKP 组的 VAS 和 ODI 优于 PVP 组（p<0.05）。骨水泥渗漏是最常见的并发症之一，PKP 组的发生率低于 PVP 组（14.3%比 45.0%，p<0.05）。PKP 和 PVP 组各有 1 例相邻椎体骨折（4.8%比 5.0%，p>0.05），无统计学差异，且均无严重并发症发生。
对于 III 期 Kummell 病，PKP 和 PVP 均可有效缓解疼痛。此外，PKP 可获得比 PVP 更满意的复位效果，且骨水泥渗漏发生率更低。从椎体复位的角度来看，我们认为与 PVP 相比，PKP 更适合治疗无神经功能缺损的 III 期 Kummell 病。
