伤椎强化与植骨椎弓钉固定IIIa期Kümmell病（开放获取）

Vertebral body augmentation versus vertebral body bone grafting with short-segment pedicle screw fixation for stage IIIaKümmell disease

摘要:

[目的] 比较伤椎强化椎弓钉固定与伤椎植骨联合短节段椎弓根强化螺钉内固定治疗Ⅲa 期Kümmell 病的临床效果。[方法] 回顾性分析2018 年12 月—2021 年12 月本院收治的Ⅲa 期Kümmell 病40 例患者的临床资料。依据医患沟通结果，18 例采用伤椎强化联合短节段椎弓根强化螺钉内固定术（强化组），22 例采用伤椎植骨联合短节段椎弓根强化螺钉内固定术（植骨组）。比较两组围手术期、随访以及影像学资料。[结果] 两组患者均顺利完成手术，术中无神经损伤等严重并发症。两组手术时间、切口长度、术中失血量、术中透视次数、下地行走时间、住院时间的差异均无统计学意义（P＞0.05）。随访时间平均（17.7±4.5） 个月，两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随时间推移，两组VAS 、ODI、JOA 评分均显著改善（P＜0.05），相应时间点两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，术后3 d 及末次随访时，两组伤椎前缘高度比值、局部后凸角及楔形角均显著改善（P＜0.05），术前两组间上述指标的差异均无统计学意义（P＞0.05），术后3 d、末次随访时，强化组的伤椎前缘高度比[(89.1±7.2)% vs (94.2±11.4)%, P=0.036; (85.5±7.8)% vs (91.3±12.2)%, P=0.019]、楔形角[(3.5±.3)° vs (1.8±2.7)°, P=0.042; (4.9±3.1)% vs (2.7±2.8)°, P=0.018] 均不及植骨组，两组局部后凸角的差异无统计学意义（P＞0.05）。[结论] 采用伤椎强化或伤椎植骨联合短节段椎弓根强化螺钉固定治疗Ⅲa 期Kümmell 病，均可获得满意的临床疗效，但后者可更好地纠正伤椎高度及伤椎楔形角。

Abstract:

[Objective] To compare the clinical consequence of vertebral body augmentation combined with augmented short-segmentpedicle screw fixation (VBA) versus vertebral body bone grafting with short-segment pedicle screw fixation (VBBG) for stage IIIa Kümmelldisease. [Methods] A retrospective study was conducted on patients who had stage IIIA Kümmell disease treated with minimally invasivesurgeries in our hospital from December 2018 to December 2021. According to doctor-patient communication, 18 patients underwent VBA,while other 22 patients underwent VBBG. The perioperative period, follow-up and imaging data of the two groups were compared. [Results]All patients in both groups had corresponding surgical procedures performed successfully, with no serious complications such as nerve inju-ry during the operation. There were no significant differences in operation time, incision length, intraoperative blood loss, intraoperative flu-oroscopy times, postoperative ambulation time and hospital stay between the two groups (P＞0.05). The average follow-up time lasted for(17.7±4.5) months, and there was no significant difference in time to resume full weight-bearing activities between the two groups (P＞0.05).The VAS, ODI and JOA scores in both groups were significantly improved over time (P＜0.05), which were not statistically significant be-tween the two groups at any time point accordingly (P＞0.05). Regarding to imaging, the ratio of anterior vertebra height, local kyphotic an-gle and intervertebral wedge angle in both groups were significantly improved 3 days postoperatively and at the last follow-up comparedwith those preoperatively (P＜0.05). Although there was no statistical significance in the abovesaid imaging measurements between the twogroups before surgery (P＞0.05), the VBA group proved significantly inferior to the VBBG group in terms of ratio of anterior vertebra heightof the injured vertebra [(89.1±7.2)% vs (94.2±11.4)%, P=0.036; (85.5±7.8)% vs (91.3±12.2)%, P=0.019], intervertebral wedge angle [(3.5±3.3)° vs (1.8±2.7)°, P=0.042; (4.9±3.1)° vs (2.7±2.8)°, P=0.018] 3 days postoperatively and at the latest follow-up, however, there was no asignificant difference in local kyphotic angle between the two groups at any matching time point (P＞0.05). [Conclusion] Both vertebral body augmentation combined with augmented short-segment pedicle screw fixation and vertebral body bone grafting with short-segmentpedicle screw fixation achieve satisfactory clinical outcome for stage IIIa Kümmell's disease. In comparison, the latter is superior to the for-mer regarding correction of the anterior height of injured vertebra and the intervertebral wedge angle.