经皮椎体成形联合增强椎弓钉治疗III期Kummell病△（开放获取）

Percutaneous vertebroplasty combined with augmented pedicle screw for stage III Kummell disease

摘要:

[目的] 评价经皮椎体成形（percutaneous vertebroplasty, PVP） 联合增强椎弓钉（augmented pedicle screw, APS） 治疗III 期Kummell 病的临床疗效。[方法] 回顾性分析2019 年3 月—2021 年8 月本院手术治疗无神经症状III 期Kummell 病76 例患者的临床资料。根据医患沟通结果，32 例采用单纯PVP（PVP 组），21 例采用PVP-椎弓钉（pedicle screw, PS）（PVP-PS 组），23例采用PVP-增强椎弓钉（PVP-APS 组），比较三组患者围术期、随访和影像资料。[结果] PVP 组在手术时间、术中透视次数、穿刺调整次数、骨水泥注入量、术中出血量、下地行走时间、住院时间均显著少于PVP-PS 组和PVP-APS 组（P＜0.05）。随访时间均超过1 年，随时间推移，三组VAS、ODI 评分均显著减少（P＜0.05）；末次随访时，PVP-PS 组和PVP-APS 组的VAS [(2.7±0.6) vs(2.4±0.6) vs (3.3±0.4), P＜0.001] 以及ODI 评分[(22.6±4.3) vs (25.0±4.8) vs (30.1±5.8), P＜0.001] 均显著优于PVP 组。影像方面，末次随访时，PVP-PS 组和PVP-APS 组的矢状面指数（sagittal index, SI） [(88.4±3.6)% vs (93.2±3.7)% vs (46.2±3.6)%, P＜0.001]、局部后凸Cobb 角[(17.6±4.2)° vs (10.7±3.5)° vs (27.6±4.6)°, P＜0.001] 以及椎管狭窄率[(14.4±3.6)% vs (9.1±3.2)% vs (25.2±4.8)%, P＜0.001] 显著优于PVP 组，且PVP-APS 组显著优于PVP-PS 组（P＜0.05）。[结论] 采取经皮骨水泥螺钉短节段固定联合病椎PVP 术治疗无神经症状III 期Kummell 病，能有效恢复病椎高度、矫正后凸畸形、改善椎管狭窄，短期临床疗效满意，长期疗效仍待随访观察。

Abstract:

[Objective] To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) combined with augmented pedicle screw(APS) for stage III Kummell disease. [Methods] A retrospective analysis was performed on 76 patients who underwent surgical treatment forstage III Kummell disease without neurological symptoms during March 2019 to August 2021 in our hospital. According to doctor-patientcommunication, 32 cases were treated with simple PVP (the PVP group), 21 cases underwent PVP combined pedicle screw (the PVP-PSgroup), and 23 cases received PVP combined with augmented pedicle screw (the PVP-APS group). Perioperative, follow-up and imaging da-ta of the three groups were compared. [Results] The PVP group was significantly less than the PVP-PS and PVP-APS groups in terms of op-erative time, intraoperative fluoroscopy times, puncture adjustment times, bone cement injection amount, intraoperative blood loss, walkingtime and hospital stay (P＜0.05). As time went during the follow-up period lasted for more than 1 year, the VAS and ODI scores significantlydecreased in all the 3 groups (P＜0.05). At the last follow-up, PVP-PS and PVP-APS groups proved significantly superior to the PVP groupin terms of VAS [(2.7±0.6) vs (2.4±0.6) vs (3.3±0.4), P＜0.001] and ODI scores [(22.6±4.3) vs (25.0±4.8) vs (30.1±5.8), P＜0.001]. As for imag-ing, the PVP-PS and PVP-APS groups were significantly better than the PVP group in terms of sagittal index (SI) [(88.4±3.6)% vs (93.2±3.7)% vs (46.2±3.6)%, P＜0.001], local kyphotic Cobb angle [(17.6±4.2)° vs (10.7±3.5)° vs (27.6±4.6)°, P＜0.001], and spinal stenosis rate[(14.4±3.6)% vs (9.1±3.2)% vs (25.2±4.8)%, P＜0.001]. Moreover, the PVP-APS group was significantly better than PVP-PS group regardingabovesaid parameters (P＜0.05). [Conclusion] The PVP-APS do effectively restore the height of the diseased vertebra, correct kyphotic defor-mity and improve spinal stenosis, and achieve satisfactory short-term clinical outcome for stage III Kummell's disease without neurologicalsymptoms, while the long-term efficacy remains to be followed up further.