短节段经皮椎弓根螺钉内固定联合单侧穿刺椎体成形治疗无神经症状型Ⅲ期Kümmell病

Treatment of posterior short-segmental percutaneous pedicle screw fixation combined with unilateral percutaneous vertebroplasty for Kümmell disease stageⅢwithout neurological symptoms

目的探讨短节段经皮椎弓根螺钉(PPS)内固定+单侧穿刺椎体成形术(PVP)联合治疗Ⅲ期无神经症状型Kümmell病患者的效果。方法回顾性分析2018年5月至2019年8月河南省洛阳正骨医院(河南省骨科医院)脊柱外科收治的11例Ⅲ期无神经症状型Kümmell病,并接受短节段PPS内固定+单侧PVP疗法的患者资料。其中男5例,女6例;年龄60~82岁,平均72.2岁。病程3~8个月,平均5.5个月。病变节段:T112例,T124例,L15例。术前骨密度(BMD)检查均提示患者脊柱存在不同程度骨质疏松。记录术前、术后7 d、末次随访时Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、病椎局部Cobb角与前缘相对高度,以及术中出血量、手术时间与术中骨水泥推注量,同时对术后植入物松动与周边椎体骨折与否展开观察。结果所有实验对象手术皆成功,随后对所有患者进行随访,最短时间12个月,最长15个月,平均(14.27±1.01)个月。ODI、病椎局部Cobb角、VAS和病椎前缘相对高度与未手术时相比,术后7 d与末次随访时显著改善(P<0.05)。1例术中发现无症状骨水泥渗漏至椎间盘,2例术后随访期间出现内固定轻度位移。结论短节段PPS联合单侧穿刺骨水泥强化治疗无神经症状型Ⅲ期Kümmell病安全、有效,临床症状得到显著改善。

Objective To study the clinical outcome of short segment percutaneous pedicle screw(PPS)combined with unilateral percutaneous vertebroplasty(PVP)for Kümmell disease stageⅢwithout neurological symptoms.Methods Retrospective analysis of 11 patients with Kümmell disease stageⅢhospitalized in the department of spine surgery of Luoyang Orthopedic-Traumatological Hospital of Henan Province from May 2018 to August 2019(5 males and 6 females),who were received posterior short-segment percutaneous pedicle screw fixation combined with unilateral percutaneous vertebroplasty.The mean age was 72.2 years old,withan average disease course of 5.5 months.All the patients had osteoporosis.The lesion segments included T11,T12 and L1.According to the follow up results,including the operation time,blood loss,the volume of injected bone cement,kyphosis Cobb angle,Oswesay disability index(ODI),height restoration of the vertebral,the incidence of adjacent vertebral fracture and stability of implant were assessed.Results The operations were successfully performed on the 11 patients,and all the patients were followed up for 12 to 15 months,average(14.27±1.01)months.Compared with preoperation,the observational targets(ODI,VAS score,Cobb angle and the height of anterior edge of injured vertebra)in last follow-up and a week after surgery were improved significantly(P<0.05).Two cases had slight displacement of internal fixation during the follow-up,and 1 case had cement leakage without symptom to the disc during operation.Conclusions Short segment percutaneous pedicle screw fixation combined with unilateral percutaneous vertebroplasty is safe and effective for treatment of Kümmell disease stageⅢwithout neurological symptoms,alleviate clinical symptoms and reduce the complication of long-term bed rest.