背景:椎体后凸成形术对Kummell病的短期治疗效果明显。然而,术后再骨折和相邻椎体骨折偶尔发生,难以治疗。帕金森病(PD)是一种与异位骨化相关的病理障碍。在一个PD患者中,椎间桥在术后再骨折和相邻椎体骨折后的短时间内形成,提供新的稳定性。
方法:一名78岁的妇女患有PD超过10年。手术前三个月,她出现了下背部疼痛和不适。视觉模拟量表(VAS)评分为9分。术前磁共振显示L2椎骨塌陷。进行了椎体后凸成形术,可显着降低顽固性疼痛的严重程度。患者的疼痛VAS评分从9提高到2。术后50天,病人突然出现严重的背痛,VAS评分为9分。X线显示L2椎体塌陷,轻微的向前骨水泥位移,L1椎体压缩性骨折,和严重的L1崩溃。患者给予醋酸钙胶囊0.6gpoqd和阿法骨化醇0.5ugpoqd,并订购了卧床休息和支撑保护。保守治疗2个月后,病人的背痛得到缓解,VAS评分从9分提高到2分。在7个月的随访中,计算机断层扫描显示T12-L2椎骨周围形成广泛的愈伤组织和椎间桥接骨化,提供新的稳定性。
结论:椎体后凸成形术是目前Kummell病的常规治疗方法,具有明确的短期影响。然而,长期仍有并发症,这些并发症很难解决;因此,治疗需要仔细选择。为了避免再骨折,在注射骨水泥的过程中,应最大程度地形成骨水泥与小梁的交错结构。当患有PD的患者经历再骨折和相邻椎骨骨折时,可能不需要紧急进行手术干预。因为坚固的桥梁可能有助于稳定椎骨和缓解疼痛。
BACKGROUND: The short-term therapeutic efficacy of kyphoplasty on Kummell\'s disease is obvious. However, postoperative
refracture and adjacent vertebral fracture occur occasionally and are difficult to treat. Parkinson\'s disease (PD) is a pathological disorder associated with heterotopic ossification. In a patient with PD, an intervertebral bridge was formed in a short period of time after postoperative
refracture and adjacent vertebral fracture, providing new stability.
METHODS: A 78-year-old woman had been suffering from PD for more than 10 years. Three months before operation, she developed lower back pain and discomfort. The visual analog scale (VAS) score was 9 points. Preoperative magnetic resonance imaging indicated collapse of the L2 vertebra. Kyphoplasty was performed and significantly decreased the severity of intractable pain. The patient\'s VAS score for pain improved from 9 to 2. Fifty days postoperatively, the patient suddenly developed severe back pain, and the VAS score was 9 points. X-ray showed L2 vertebral body collapse, slight forward bone cement displacement, L1 vertebral compression fracture, and severe L1 collapse. The patient was given calcium acetate capsules 0.6 g po qd and alfacalcidol 0.5ug po qd, and bed rest and brace protection were ordered. After conservative treatment for 2 mo, the patient\'s back pain was alleviated, and the VAS score improved from 9 to 2. Computed tomography at the 7-mo follow-up indicated extensive callus formation around the T12-L2 vertebrae and intervertebral bridging ossification, providing new stability.
CONCLUSIONS: Kyphoplasty is currently a conventional treatment for Kummell\'s disease, with definite short-term effects. However, complications still occur in the long term, and these complications are difficult to address; thus, the treatment needs to be selected carefully. To avoid
refracture, an interlaced structure of bone cement with trabeculae should be created to the greatest extent possible during the injection of bone cement. Surgical intervention may not be urgently needed when a patient with PD experiences
refracture and adjacent vertebral fracture, as a strong bridge may help stabilize the vertebrae and relieve pain.