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目的探讨过伸位CT重建在经皮强化术治疗Ⅲ期可复型kümmell’s病中的价值。方法回顾性分析骨质疏松椎体压缩骨折患者中的Ⅲ期可复型kümmell’s病患者19例,男7例,女12例,年龄59~88岁,平均(74.6±9.2)岁。其中T_(10)1例,T_(11)3例,T_(12)8例,L_(1)5例,L_(2)1例,L_(4)1例。术前均行脊柱X线片、过伸位CT、MRI等影像学检查,所有患者均采用椎体强化术治疗。记录术前、术后第7天及末次随访时的疼痛视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)、伤椎前缘及中间高度、病椎局部矢状Cobb角,记录手术并发症。结果 19例患者均顺利完成手术,无严重手术并发症发生,4例患者出现少量骨水泥椎间隙渗漏,2例沿椎体前方骨壁裂隙渗漏,未出现临床症状。18例患者获随访,随访时间7~42个月,平均(22±13.5)个月。术后第7天及末次随访与术前相比,椎体高度得到恢复,后凸畸形角度显著改善,VAS及ODI评分明显下降(P<0.05);术后1周与末次随访差异无统计学意义(P>0.05)。随访期间3例患者出现邻近椎体骨折,再次行椎体强化术后痊愈。结论应用过伸位CT重建预判Ⅲ期可复型kümmell’s病,对指导经皮椎体强化术治疗Ⅲ期kümmell’s病有较高的临床价值。
Objective To investigate the value of hyperextension CT reconstruction in the treatment of stage Ⅲ refractory kümmell’s disease by percutaneous surgery. Methods A total of 19 patients with stage Ⅲ refractory kümmell’s disease, including 7 males and 12 females, aged 59-88 years (mean 74.6 ± 9.2 years), were retrospectively analyzed. There were 1 case of T_ (10), 3 cases of T_ (11), 8 cases of T_ (12), 5 cases of L_ (1), 1 case of L_ (2) and 1 case of L_ (4) Preoperative spinal X-ray, hyperextension CT, MRI and other imaging studies, all patients were treated with vertebroplasty. The visual analogue (VAS) score, Oswestry Disability Index (ODI), the anterior vertebral margin and mid-height of the vertebral column, and the sagittal Cobb angle of the vertebrae were recorded before operation, on the 7th day and at the final follow-up. The operative complications . Results All the 19 patients completed the operation successfully. No serious complications occurred. Four patients had a small amount of bone cement leakage and two patients had leakage along the anterior vertebral wall fracture. There were no clinical symptoms. Eighteen patients were followed up for 7 to 42 months with an average of (22 ± 13.5) months. The height of vertebral body was recovered, the angle of kyphosis was significantly improved, VAS and ODI scores were significantly decreased (P <0.05) at the 7th day and the last follow-up after operation. There was no significant difference between the last follow-up and the last follow-up Significance (P> 0.05). During the follow-up period, 3 patients had adjacent vertebral fractures and were cured again after vertebroplasty. Conclusions The application of hyperextension CT reconstruction in predicting stage Ⅲ kümmell’s disease is of great clinical value in the treatment of stage Ⅲ kümmell’s disease by percutaneous vertebroplasty.