Clinical Study Of Pathogenesis,diagnosis And Treatment Of Kummell's Disease

Objective: To explore the pathogenesis of Kummell's disease,clinical and imaging characteristics,clinical diagnostic criteria and view of treatment.Methods: To retrospectively analysis 33 cases of 27 patients of vertebral Kummell's disease diagnosis and follow-up data.Access to relevant literature at home and abroad.Summarize the pathogenesis of Kummell's disease,clinical and imaging characteristics,diagnostic criteria and treatment principles.To statistic the distribution of its vertebral,and the distribution characteristics of intravertebral vacuum cleft in vertebral body.To compare the sensitivity of various imaging methods to the imaging characteristics of Kummell's disease.Using VAS score(visual analog scale method),kyphotic cobb angle and the vertebral anterior compression rate and other evaluation indicators to analysis and evaluation of surgical treatment of the disease.Results: 1.The average age of Kummell's patients in this group was 74.5 years(range: 58-97 years).A history of low back pain on average 4.2 months.The vertebrae mainly concentrated in the thoracolumbar segment(T11,T12,L1,L2).2.IVC distribution in the vertebral body,25 cases distributed over the vertebral endplates and vertebral body forward(75.8%),5 cases were located in the middle of the vertebral body(15.1%),3 cases were located in the middle of the vertebral body(9.1%);3.A variety of imaging methods for the diagnosis of IVC,X-ray is 60.6%,CT is 90.9%,MRI is 87.9%;4.Changes in evaluation indexes before and after operation,VAS score decreased from preoperative 7.593 ± 0.89 to 1.074 ± 0.871 after operation,the postoperative cobb angle decreased from 17.707 ± 4.096 ° to 11.837 ± 2.072 ° after surgery,Statistically significant(t = 9.867,P <0.05);The compression rate of the anterior vertebrae decreased from 41.459% ± 8.498% to 32.033% ± 7.549% after operation,which was statistically significant(t = 18.787,P <0.05).There were no significant changes in the three indicators during follow-up.Conclusion: 1.Combining domestic and foreign literature,the pathogenesis of Kummell's disease is the result of a combination of various factors such as reduced osteogenic ability,ischemic osteonecrosis,intervertebral disc degeneration,and biomechanics.2.The disease occurs in the stress concentration of the thoracolumbar segment(T11,T12,L1,L2).The characteristic manifestations of Kummell's disease are more common in the upper end of the vessel and the front of the vertebral body.3.Imaging examination can show the vertebral vacuum cracks and vertebral collapse,Clinical X-ray film is often used as a screening method of the initial method,CT diagnosis of IVC most sensitive,accurate,direct,MRI can further determine the shape of IVC and the distribution of gas or liquid;4.The diagnosis of the disease should be combined with the patient's history,clinical and imaging performance comprehensive judgments.Can grasp the following:(1)The presence of old minor spinal trauma,More than 3 months repeated persistent low back pain;(2)The pain can relief when the patient rest on bed.Postural changes and increased after walking,Often lower back tenderness,percussion tenderness,even thoracolumbar kyphosis;(3)Imaging findings IVC and vertebral collapse,with or without symptoms of spinal cord injury;(4)Highly suspected of the disease when patients with osteoporosis or long-term use of hormone drugs;5.Clinical treatment should grasp the early,minimally invasive,rapid and stable treatment principles,Vertebroplasty clinical efficacy.Vertebroplasty clinical efficacy of the exact treatment of the disease is the preferred method of treatment.However,patients with spinal cord compression symptoms,recommended vertebroplasty combined with open surgery.