微创医学

目的探讨局麻下经皮椎体后凸成形术配合中医手法及体位复位治疗高龄Kümmell’s病的疗效。方法局麻下行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)配合中医手法及使用俯卧后伸体位治疗42例高龄Kümmell’s病患者。患者年龄75~94岁,平均82.4岁。均无明显脊髓神经受损症状,单节段27例,双节段15例,随访时间2个月~47个月,平均29.4个月。记录术前与术后第3天、末次随访时病椎前柱高度、矢状面Cobb角及手术并发症,并分别使用Oswestry功能障碍指数(oswestry disability index,ODi)和视觉模拟评分法(visual analogue score,VAS)、日本骨科协会评分(Japanese Orthopedic As-sociation,JOA)行手术疗效的综合评估。结果手术时间为20~45 min(平均29 min),术中累计X线透视时间平均32 s,术中出血量为5~10 m L(平均7.5 m L),平均住院4 d,均在术后1~5 d佩戴腰围下床。患者术后3 d及末次随访时的病椎前柱高度、矢状面Cobb角、VAS评分、ODI、JOA与术前比较均有有显著性差异(P<0.05)。而术后第3天对比末次随访在以上指标中无明显差异。结论局麻下经皮椎体后凸成形术配合中医手法及体位复位是一种相对安全、创伤小、疗效肯定、高效治疗高龄Kümmell’s病的临床方法。

Objective To study the therapeutic effect of percutaneous kyphoplasty under local anesthesia combied with Chinese practices and postural restoration in treatment of elderly patients with K ü mmell′s disease. Methods From 2009 December - 2014 year in February,42 elderly cases of K ü mmell′s disease received percutaneous kyphoplasty under local anesthesia combied with Chinese practices and postural restoration. Of them,23 were male,19 were female,with the average age of 82. 4 years old (ranging from 75 to 94 years old). There were no significant spinal nerve damage symptoms. Single segment was involved in 27 cases,15 cases involved double segments. The followup time ranged from 2 months to 47 months,averaging 29. 4 months. The vertebral anterior column height,the sagittal Cobb′s angle,the operation complications,the Oswestry disability index (Oswestry disability index,ODi)and visual analogue scale (visual analogue score,VAS),Japan (Japanese Orthopedic Association Department of orthopedics association score,JOA the comprehensive evaluation for the efficacy of operation)were recorded before and after surgery. Results The operation time was 20 -45 min (average 29min),the mean time of intraoperative cumulative fluoroscopy was 32S,the amount of bleeding was 5 -10 mL (average 7. 5 mL). The mean hospital stay was 4 days. All patients got out of bed after wearing waist circumference within 1 - 5 days postoperatively. There were significant differences in vertebral anterior column height,the sagittal Cobb′s angle,VAS score,ODI,JOA before and after treatment (P <0. 05). Conclusion Percutaneous kyphoplasty under local anesthesia combied with Chinese practices and postural restoration has the advantages of relative safety,small trauma,high curative effect in the treatment of Kummell′s disease.