Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Yuliang ,  XIONG Xiaoming , WAN Dun , DENG Xuangeng , SHI Huagang , SONG Simao , WU Xiao , ZHOU Jie , YANG Maoyi

Department of Spine Surgery, Sichuan Province Orthopedics Hospital, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

XIONG Xiaoming, Email: 2841710476@qq.com

Keywords：

Percutaneous kyphoplasty; Kümmell disease; osteoporosis; unilateral puncture; bilateral puncture

DOI：

10.7507/1002-1892.201704055

Video：

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Objective To compare the effectiveness between unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of Kümmell disease. Methods The clinical data of 45 patients with Kümmell disease that met the criteria between January 2014 and February 2016 were analyzed retrospectively. Among them, 26 cases were treated by unilateral PKP (unilateral group), 19 cases were treated by bilateral PKP (bilateral group). There was no significant difference in gender, age, disease duration, injured vertebral segment, bone mineral density (T value), and the preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior vertebral height, and kyphosis Cobb angle between 2 groups (P>0.05). The operation time, intraoperative fluoroscopy times, amount of injected bone cement, and hospitalization time were recorded, and the situation of bone cement leakage was observed. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle were evaluated before operation, at 1 day after operation, and at last follow-up. Results Bone cement leakage during the operation were found in 4 cases (15.38%) of unilateral group and 3 cases (15.79%) of bilateral group without obvious neurological symptoms; there was no significant difference in the incidence of bone cement leakage between 2 groups (χ²=0.000, P=1.000). The operation time, intraoperative fluoroscopy times, and amount of injected bone cement in the unilateral group were significantly lower than those in the bilateral group (P<0.05); but there was no significant difference in the hospitalization time between 2 groups (P>0.05). The X-ray film examination showed that there was no pulmonary embolism in all patients at 1 day after operation. All the patients were followed up 12-24 months, with an average of 16.4 months. There was no complication such as vertebral re-fracture or cement block displacement in the injured vertebra. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle at 1 day after operation and at last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05); the VAS score and ODI in 2 groups were further reduced at last follow-up when compared with the value at 1 day after operation (P<0.05), but the anterior vertebral height and kyphosis Cobb angle in 2 groups at last follow-up did not change significantly (P>0.05). There was no significant difference in above indexes at 1 day after operation and at last follow-up between 2 groups (P>0.05). Conclusion Both unilateral and bilateral PKP can achieve good effectiveness in treatment of Kümmell disease. But the unilateral puncture technique possesses advantages such as shorter operation time, less radiation dose, and less amount of injected bone cement.

Citation： SUN Yuliang, XIONG Xiaoming, WAN Dun, DENG Xuangeng, SHI Huagang, SONG Simao, WU Xiao, ZHOU Jie, YANG Maoyi. Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1086-1091. doi: 10.7507/1002-1892.201704055 Copy

1.	Freedman BA, Heller JG. Kummell disease: A not-so-rare complication of osteoporotic vertebral compression fractures. J Am Board Fam Med, 2009, 22(1): 75-78.
2.	Li KC, Kwon TU, Kung FC, et al. Staging of Kümmell’s disease. Musculoskeletal Res, 2004, 8(2): 43-55.
3.	王根林, 杨惠林, 孟斌, 等. 椎体后凸成形术治疗骨质疏松性 Kümmell’s 病. 中国脊柱脊髓杂志, 2011, 21(1): 46-49.
4.	杨根林, 杨惠林, 姜为民, 等. 球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折后骨坏死. 中华外科杂志, 2010, 48(8): 593-596.
5.	李厚坤, 王晓东, 杨小卫, 等. 单侧椎弓根入路与双侧椎弓根入路 PKP 治疗 Kummell’s 病的临床对比研究. 中国矫形外科杂志, 2016, 24(18): 1660-1665.
6.	Kim KT, Suk KS, Kim JM, et al. Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop, 2003, 27(2): 65-69.
7.	邱贵兴, 裴福兴, 胡侦明, 等. 中国骨质疏松性骨折诊疗指南 (骨质疏松性骨折诊断及治疗原则). 中华骨与关节外科杂志, 2015, 8(5): 371-374.
8.	刘洋, 李明辉, 梅红军. 经皮椎体后凸成形术后骨水泥渗漏的回顾性分析及预防策略. 中国骨质疏松杂志, 2013, 19(4): 375-380.
9.	Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
10.	Pflugmacher R, Kandziora F, Schroeder RJ, et al. Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up. Acta Radiol, 2006, 47(4): 369-376.
11.	Phillips FM, Ho E, Campbell Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vetebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
12.	Wang G, Yang H, Meng B, et al. Post-traumatic osteoporotic vertebral osteonecrosis treated using balloon kypboplasty. J Clinic Neuros, 2011, 18(5): 664-668.
13.	张磊磊, 李健, 贾惊宇, 等. Kummell 病的研究进展. 中国矫形外科杂志, 2015, 23(9): 816-819.
14.	Luo J, Daines L, Charalambous A, et al. Vertebroplasty only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine (Phila Pa 1976), 2009, 34(26): 2865-2873.
15.	Al-Ali F, Barrow T, Luke K. Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol, 2009, 30(10): 1835-1839.
16.	贺宝荣, 许正伟, 郝定均, 等. 骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系. 中华骨科杂志, 2012, 32(8): 768-773.
17.	Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa1976), 2005, 30(2): 201-205.
18.	印飞, 孙振中, 宋升, 等. 单双侧经皮椎体后凸成形术治疗中位胸椎骨质疏松性压缩骨折对比研究. 中国修复重建外科杂志, 2016, 30(1): 77-81.
19.	郭金库, 丁文元, 申勇, 等. 球囊扩张后凸椎体成形术治疗老年骨质疏松性胸腰椎爆裂骨折. 中国修复重建外科杂志, 2010, 24(11): 1341-1344.
20.	姚女兆, 夏曦, 唐绍锋. 序贯椎体成形术治疗 Kummell 病的疗效观察. 中国修复重建外科杂志, 2015, 29(10): 1265-1268.
21.	Wang C, Fan S, Liu J, et al. Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J, 2014, 14(8): 1551-1558.
22.	徐松, 纳强, 张雄文, 等. 分步筑墙 PKP 治疗胸腰椎骨质疏松性骨折骨不连. 中国骨与关节损伤杂志, 2016, 31(3): 231-234.

1. Freedman BA, Heller JG. Kummell disease: A not-so-rare complication of osteoporotic vertebral compression fractures. J Am Board Fam Med, 2009, 22(1): 75-78.
2. Li KC, Kwon TU, Kung FC, et al. Staging of Kümmell’s disease. Musculoskeletal Res, 2004, 8(2): 43-55.
3. 王根林, 杨惠林, 孟斌, 等. 椎体后凸成形术治疗骨质疏松性 Kümmell’s 病. 中国脊柱脊髓杂志, 2011, 21(1): 46-49.
4. 杨根林, 杨惠林, 姜为民, 等. 球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折后骨坏死. 中华外科杂志, 2010, 48(8): 593-596.
5. 李厚坤, 王晓东, 杨小卫, 等. 单侧椎弓根入路与双侧椎弓根入路 PKP 治疗 Kummell’s 病的临床对比研究. 中国矫形外科杂志, 2016, 24(18): 1660-1665.
6. Kim KT, Suk KS, Kim JM, et al. Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop, 2003, 27(2): 65-69.
7. 邱贵兴, 裴福兴, 胡侦明, 等. 中国骨质疏松性骨折诊疗指南 (骨质疏松性骨折诊断及治疗原则). 中华骨与关节外科杂志, 2015, 8(5): 371-374.
8. 刘洋, 李明辉, 梅红军. 经皮椎体后凸成形术后骨水泥渗漏的回顾性分析及预防策略. 中国骨质疏松杂志, 2013, 19(4): 375-380.
9. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
10. Pflugmacher R, Kandziora F, Schroeder RJ, et al. Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up. Acta Radiol, 2006, 47(4): 369-376.
11. Phillips FM, Ho E, Campbell Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vetebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
12. Wang G, Yang H, Meng B, et al. Post-traumatic osteoporotic vertebral osteonecrosis treated using balloon kypboplasty. J Clinic Neuros, 2011, 18(5): 664-668.
13. 张磊磊, 李健, 贾惊宇, 等. Kummell 病的研究进展. 中国矫形外科杂志, 2015, 23(9): 816-819.
14. Luo J, Daines L, Charalambous A, et al. Vertebroplasty only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine (Phila Pa 1976), 2009, 34(26): 2865-2873.
15. Al-Ali F, Barrow T, Luke K. Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol, 2009, 30(10): 1835-1839.
16. 贺宝荣, 许正伟, 郝定均, 等. 骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系. 中华骨科杂志, 2012, 32(8): 768-773.
17. Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa1976), 2005, 30(2): 201-205.
18. 印飞, 孙振中, 宋升, 等. 单双侧经皮椎体后凸成形术治疗中位胸椎骨质疏松性压缩骨折对比研究. 中国修复重建外科杂志, 2016, 30(1): 77-81.
19. 郭金库, 丁文元, 申勇, 等. 球囊扩张后凸椎体成形术治疗老年骨质疏松性胸腰椎爆裂骨折. 中国修复重建外科杂志, 2010, 24(11): 1341-1344.
20. 姚女兆, 夏曦, 唐绍锋. 序贯椎体成形术治疗 Kummell 病的疗效观察. 中国修复重建外科杂志, 2015, 29(10): 1265-1268.
21. Wang C, Fan S, Liu J, et al. Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J, 2014, 14(8): 1551-1558.
22. 徐松, 纳强, 张雄文, 等. 分步筑墙 PKP 治疗胸腰椎骨质疏松性骨折骨不连. 中国骨与关节损伤杂志, 2016, 31(3): 231-234.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease

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