| Objective To compare the efficacy of percutaneous vertebroplasty (PVP) with "noncoplanar bipedicular puncture method" and "coplanar bipedicular puncture method" in the treatment of stage I Kümmell disease.Methods From January 2014 to January 2021, 53 patients with stage I Kümmell disease who received PVP treatment in PLA Rocket Force Characteristic Medical Center were reviewed, including 25 cases treated with "noncoplanar bipedicular puncture method" (group A) and 28 cases treated with "coplanar bipedicular puncture method" (group B). The operative duration, the amount of bone cement injected, intraoperative cement leakage rate, bone cement distribution and complications of the two groups were compared, and the visual score scale (VAS) and Oswestry dysfunction index (ODI) were recorded before operation and 1 d, 1 month, 3 months and 6 months after operation. The anterior and midline height and Cobb angle of the injured vertebral body before and after operation were measured and recorded by X-ray or CT, and the loosening or displacement of bone cement and the occurrence of refracture of injured vertebra were observed. At the last follow-up, the improved MacNab standard was used to evaluate the excellent and good rate of the operation.Results The operation was successfully completed in both groups, all patients received regular follow-up. The operative duration in group A was similar to group B (P>0.05), and the amount of bone cement injection in group A was more than group B (P<0.05). In group A, bone cement leakage occurred in 2 cases, infiltration into intervertebral disc in 1 case and anterior vertebral body in 1 case, without neurological symptom. In group B, 9 cases had bone cement leakage, 6 cases penetrated into intervertebral disc and 3 cases in front of vertebral body, without neurological symptom. The intraoperative bone cement leakage rate in group A was smaller than that in group B, and the bone cement around the vertebral fracture line in group A was more widely distributed after operation (P<0.05). There were no spinal cord and prevertebral vascular injury, pulmonary embolism and other complications in both groups. Compared with preoperation, VAS and ODI in the two groups both decreased significantly 1 d, 1 month, 3 months and 6 months after operation (P<0.05); there was no significant difference in VAS and ODI between group A and group B (P>0.05). Compared with preoperation, the height of anterior and midline of injured vertebrae increased significantly 1 d, 1 month, 3 months and 6 months after operation (P<0.05), and the measured value of Cobb angle decreased significantly (P<0.05). Compared with group B, there were no significant changes in the height of anterior and midline of injured vertebra and Cobb angle of injured vertebra 1 d, 1 month, 3 months and 6 months after operation (P>0.05). At the last follow-up, there was no loosening or displacement of bone cement and refracture of injured vertebrae in both groups. The clinical efficacy was evaluated by the modified MacNab standard: 23 cases in group A were excellent and 2 cases were good, 19 cases in group B were excellent and 9 cases were good. The excellence rate of group A was higher than that of group B (P<0.05).Conclusion In the treatment of stage I Kümmell disease, percutaneous vertebroplasty with "noncoplanar bipedicular puncture method" has lower leakage rate and wider distribution of bone cement than percutaneous vertebroplasty with "coplanar bipedicular puncture method". The early treatment effect is equivalent and the later effect is more accurate. |
