经皮椎体成形联合增强椎弓钉治疗Ⅲ期Kummell病  

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

作　　者：钟炯彪 孟旭东 许胤 李佳福 杨帆[1] 彭佳睿 袁野[1] 王佩珊 ZHONG Jiong-biao;MENG Xu-dong;XU Yin;LI Jia-fu;YANG Fan;PENG Jia-rui;YUAN Ye;WANG Pei-shan(Department of Spine Surgery,People's Hospitalof Yueyang City,Hunan Normal University,Yueyang 414000,China)

机构地区：[1]湖南师范大学岳阳市人民医院脊柱外科,湖南岳阳414000

出　　处：《中国矫形外科杂志》2024年第19期1740-1746,共7页Orthopedic Journal of China

基　　金：湖南省自然科学基金科药联合项目(编号:2020JJ9054);湖南省卫生健康委科研课题项目(编号:202104071123);岳阳市科技基础研究指导性计划项目(编号:202012)。

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。[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.

关 键 词：Kummell病 经皮椎体成形术 经皮椎弓根螺钉 骨水泥强化 

分 类 号：R687[医药卫生—骨科学]