Kyphoplasty with polymethylmethacrylate bone cement treats Kummell disease in the elderly

doi:10.3969/j.issn.2095-4344.2017.30.001

Abstract

Abstract:

BACKGROUND: Percutaneous kyphoplasty is an effective method for the treatment of osteoporotic vertebral compression fracture, because it can relieve pain quickly, restore the vertebral height and correct kyphosis. However, little is reported on percutaneous kyphoplasty for the treatment of Kummell disease.

OBJECTIVE: To evaluate the efficacy and safety of kyphoplasty with polymethylmethacrylate bone cement in treating Kummell disease in the elderly.

METHODS: Thirty-one patients (6 males and 25 females) with Kummell disease, aged 58-72 years old, were included in this study. Affected segments involved T₁₁ in 5 cases, T₁₂ in 11 cases, L₁ in 8 cases, L₂ in 4 cases, L₃ in 2 cases, L₄ in 1 case. All the patients underwent percutaneous kyphoplasty with polymethylmethacrylate bone cement. The clinical effect was evaluated by pain, viability and imaging changes before and after therapy.

RESULTS AND CONCLUSION: (1) Pain relief: The visual analogue scale score for all the 31 patients at 3 days, 3 months and 12 months after the surgery were significantly lowered compared to the preoperative scores (P < 0.05). (2) Viability: The mean Oswestry disability index scores for 31 patients at 3 days, 3 months and 12 months after the surgery were significantly lowered compared to the preoperative scores (P < 0.05). (3) Imaging evaluation: The anterior vertebral height and vertebral height at middle line for 31 patients at 3 days, 3 months and 12 months after the surgery were higher compared to the preoperative data (P < 0.05), and Cobb angles were significantly lowered compared to the preoperative data (P < 0.05). (4) Adverse reaction: There was no leakage of bone cement in the vertebral canal and vein, and no adverse reaction occurred related to bone cement. In summary, the kyphoplasty with polymethylmethacrylate bone cement is safe and effective in treating Kummell disease in the elderly. It can fast relieve pain, improve patients quality of life, and reconstruct the spinal stability.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Key words: Kyphoplasty, Osteoporosis, Osteonecrosis, Tissue Engineering

CLC Number:

R318

Li Zhi-jun, Zheng Yu-peng, Jiang Tian-wei, Shi Yong-chen.

Kyphoplasty with polymethylmethacrylate bone cement treats Kummell disease in the elderly

[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(30): 4757-4762.

Figures/Tables 3

References

[1]Li H,LiangCZ,Chen QX.Kummells disease,an uncommon and complicated spinal disorder:a riview.J Int Med Res. 2012; 40(2):406-414.

[2]杨惠林,王根林,姜为民.分次灌注骨水泥技术治疗Kummell病[J].脊柱外科杂志,2012,10(1):22-24.

[3]陈锋,方文来,倪文飞.Kummell病的治疗进展[J].中国骨与关节损伤杂志,2013,28(1):95-96.

[4]贾崇哲,唐海,陈浩,等.聚甲基丙烯酸甲酯骨水泥的基础研究进展[J].临床和实验医学杂志,2017,16(5): 519-521.

[5]Ren HL,Jiang JM,Chen JT,et al.Risk factors of new symptomatic vertebral compression fracture in osteoporotic patients undergone percutaneous vertebroplasty.Eur spine J.2015;24(4):750-758.

[6]Ledlie JT,Renfro MB.Kyphoplasty treatment of vertebral fractures: 2-year outcomes show sustained benefits.Spine. 2006;31(1):57-64.

[7]印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.

[8]Matzaroglou C,Georgiou CS,Panagopoulos A,et al.Kummells disease:Clarifying the Mechanisms and Patients Inclusion Criteria.Open Orthop J.2014;15(8):288-297.

[9]胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012:1813.

[10]Kummell H.Die rarefizierende ostitis der Wirbelko.Deutsche Med.1895;21(1):180-181.

[11]Ma R,Chow R,Shen FH.Kummell’s disease:delayed post-traumatic osteonecrosis of the vertebral body .Eur Spine J.2010;19(7):1065-1070.

[12]谢胜荣,卢小刚,伍成东,等.Kummell病的发病机制研究进展[J].中华临床医师杂志(电子版),2014,8(20): 3675-3678.

[13]Matzaroglou C,Georgiou CS,Assimakopoulos K,et al. Kummell’s disease: pathophysiology, diagnosis,treatment and the role of nuclear medicine.Rationale according to our experience.Hell J Nucl Med.2011;14(3):291-299.

[14]Kong LD,Wang P,Wang LF,et al.Comparison of vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures with intravertebral cleft.Eur J Orthop Surg Traumatol.2014;24 Suppl 1:S201-208.

[15]Ranjan M,Mahadevan A,Prasal C,et al.Kummell’s disease uncommon or underreported disease: A clinicopathological account of a case and review of literature.J Neurosci Rural Pract.2013;4(4):439-442.

[16]李良辰,何登伟,黄文君,等.Kummell病椎体裂隙征发生机制的研究进展[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(4):363-366.

[17]Wu AM,Chi YL,Ni WF,et al.Vertebral compression fracture with intervertebral vacuum cleft sign: pathogenesis, image,and surgical intervention.Asian Spine J.2013;7:148-155.

[18]Feng SW,Chang MC,Wu HT,et al.Are intravertebral vacuum phenomena benignlesions?Eur Spine J.2011;20(8):1341-1348.

[19]Zhang GQ,Gao YZ,Zheng J,et al.Posterior decompression and short segmental pedicle screw fixation combined with vertebroplaty for Kummell’s disease with neurological deficits. Exp Ther Med.2013;5(2):517-522.

[20]Wang Q,Wang C,Fan S,et al.Pathomechanism of intravertebral clefts in osteoporotic compression fracture of the spine: basivertebral foramen collapse might cause intravertebral avascular necrosis.Spine J.2014;14(6):1090-1091.

[21]伍成东,谢胜荣,卢小刚,等.Kummell病的影像学研究进展[J].中华临床医师杂志(电子版),2014,8(24): 4489-4491.

[22]Kim YC,Kim YH,Ha KY,et al.Pathomechanism of intravertebral clefts in osteoporotic compression fracture of the spine.Spine J.2014;14(4):659-666.

[23]Nickell LT,Schucany WG,Opatowsky MJ.Kummell’s disease.Proc(Bayl Univ Med Cent).2013; 26(3):300-301.

[24]刘冬斌.经皮椎体成形术治疗Kummell病的临床效果分析[J].微创医学,2015,10(3):316-319.

[25]蔡俊,冯新民,王静成,等.椎体成形术治疗不愈合的胸腰椎陈旧性骨折疗效分析[J].创伤外科杂志,2015,17(5):426-429.

[26]周毅,海涌,苏庆军,等.椎体后凸成形术治疗骨质疏松椎体压缩性骨折疗效分析[J].中国骨质疏松杂志,2012,18(5):429-433.

[27]姚女兆,夏曦,唐绍峰.序贯椎体成形术治疗Kummell病的疗效观察[J].中国修复重建外科杂志,2015,29(10): 1265-1268.

[28]刘继军,刘志勇,郝阳泉,等.椎体后凸成形术治疗Kummell病的临床疗效分析[J].实用骨科杂志,2015, 21(7):585-588.