Wu Heng, Dai Xiao, Liu Hao, Yang Xiang, Liu Shenao, Xu Shuang, Chi Hao, Chen Yuquan, Wang Song
Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Clinical Medical College, Southwest Medical University, Luzhou, China.
Front Endocrinol (Lausanne). 2025 Jun 11;16:1538337. doi: 10.3389/fendo.2025.1538337. eCollection 2025.
The present study introduced a novel technique called percutaneous kyphoplasty with multi-point cement anchoring technique (A-PKP) to prevent bone cement displacement in patients with stage I and II Kümmell's disease (KD).
A total of 82 patients with stage I and II KD were treated with PKP in our hospital from April 2020 to October 2022. The patients were divided into two groups: A-PKP group (N=39) where the Kirschner needle was used for the multi-point cement anchoring technique, and conventional transverse process-pedicle percutaneous kyphoplasty group (T-PKP group; N=43) where the Kirschner needle was not used. The operation time, volume of cement, VAS score, ODI score, cement distribution pattern and score, bone cement leakage, adjacent vertebra fracture, and bone cement displacement were compared between the two groups. A logistic regression model was used to evaluate the association between outcome variables and adjacent vertebral fractures, as well as to identify potential protective and risk factors following kyphoplasty.
All patients in both groups were operated successfully, with no serious complications reported. Compared with T-PKP patients, A-PKP patients had longer operation time (39.7 ± 4.86 min vs. 34.5 ± 3.18 min, P < 0.05), greater volume of cement (5.1 ± 0.41 ml vs. 4.3 ± 0.27 ml, P < 0.05), greater improvement in Visual Analog Scale (2.0 ± 0.48, 1.92 ± 0.72 vs. 3.0 ± 0.10, 3.1 ± 0.62, P < 0.05) and Oswestry Disability Index scores (17.9 ± 2.38, 14.8 ± 2.02 vs. 20.2 ± 3.31, 17.2 ± 2.55, P < 0.05) during follow-ups, more spongy cement configuration with higher distribution scores (10.0 ± 1.17 vs. 7.74 ± 1.08, P < 0.05), lower incidence of bone cement leakage (20.5% vs. 27.9%, P > 0.05), and lower rate of adjacent vertebra fractures (5.1% vs. 18.6%, P < 0.05) and bone cement displacement (2.5% vs. 20.9%, P < 0.05). The logistic regression results reveal that bone cement distribution score (OR= 0.355, 95% CI 0.171-0.734, P=0.005) acts as protective factor of adjacent vertebral fractures following kyphoplasty.
The A-PKP technique appears to be a safer and more effective alternative for patients with stage I and II KD. It effectively alleviates pain, enhances cement diffusion, and minimizes the risk of bone cement displacement compared with the T-PKP.
本研究引入了一种名为经皮椎体后凸成形术联合多点骨水泥锚固技术（A-PKP）的新技术，以预防I期和II期Kümmell病（KD）患者的骨水泥移位。
2020年4月至2022年10月，我院共82例I期和II期KD患者接受了椎体后凸成形术（PKP）治疗。患者分为两组：A-PKP组（N = 39），采用克氏针进行多点骨水泥锚固技术；传统横突-椎弓根经皮椎体后凸成形术组（T-PKP组；N = 43），未使用克氏针。比较两组的手术时间、骨水泥用量、视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分、骨水泥分布模式及评分、骨水泥渗漏、相邻椎体骨折和骨水泥移位情况。采用逻辑回归模型评估结局变量与相邻椎体骨折之间的关联，并确定椎体后凸成形术后潜在的保护因素和风险因素。
两组患者均手术成功，未报告严重并发症。与T-PKP组患者相比，A-PKP组患者手术时间更长（39.7±4.86分钟 vs. 34.5±3.18分钟，P < 0.05），骨水泥用量更大（5.1±0.41毫升 vs. 4.3±0.27毫升，P < 0.05），随访期间视觉模拟评分改善更明显（2.0±0.48，1.92±0.72 vs. 3.0±0.10，3.1±0.62，P < 0.05），Oswestry功能障碍指数评分改善更明显（17.9±2.38，14.8±2.02 vs. 20.2±3.31，17.2±2.55，P < 0.05），骨水泥呈海绵状结构且分布评分更高（10.0±1.17 vs. 7.74±1.08，P < 0.05），骨水泥渗漏发生率更低（20.5% vs. 27.9%，P > 0.05），相邻椎体骨折发生率更低（5.1% vs. 18.6%，P < 0.05），骨水泥移位率更低（2.5% vs. 20.9%，P < 0.05）。逻辑回归结果显示，骨水泥分布评分（OR = 0.355，95%CI 0.171 - 0.734，P = 0.005）是椎体后凸成形术后相邻椎体骨折的保护因素。
对于I期和II期KD患者，A-PKP技术似乎是一种更安全、更有效的选择。与T-PKP相比，它能有效缓解疼痛，增强骨水泥扩散，并将骨水泥移位风险降至最低。
