两种术式对无神经症状Kummell病的疗效比较

Comparison of curative effects of two surgical methods in treatment of Kummell disease without neurological symptoms

目的比较经皮椎体成形术(percutaneous vertebroplasty,PVP)与短节段固定联合椎体成形术(short segment fixation combined with vertebroplasty,SSF+VP)治疗无神经症状Kummell病的临床疗效。方法回顾性分析2013年10月至2018年10月收治的42例无神经症状Kummell病患者的临床资料,其中PVP组23例,SSF+VP组19例,比较2组术中出血量、手术时间、骨水泥注射量。采用VAS评分、ODI评分、椎体前缘相对高度、后凸Cobb角评价临床疗效。结果全部患者均顺利完成手术。术后均获得随访,随访时间24~55个月。PVP组的手术时间、术中出血量明显少于SSF+VP组(P<0.01)。2组骨水泥注射量差异无统计学意义(P>0.05)。2组术后3 d和末次随访时的VAS评分、ODI评分均较术前明显改善(P<0.05),2组术后3 d及末次随访时VAS评分、ODI评分差异无统计学意义(P>0.05)。SSF+VP组末次随访时椎体前缘相对高度明显大于PVP组(P<0.05),SSF+VP组术后3 d及末次随访时的后凸Cobb角明显小于PVP组(P<0.05)。结论PVP和SSF+VP均是治疗无神经症状Kummell病的安全有效方法,PVP具有手术时间短、出血量少的优势,SSF+VP具有保持椎体前缘高度和矫正后凸畸形的优势。

Objective To compare the curative effects of percutaneous vertebroplasty(PVP)and short segment fixation combined with vertebroplasty(SSF+VP)in treatment of Kummell disease without neurological symptoms.Methods The clinical dates about 42 patients with Kummell disease without neurological symptoms who were treated in our hospital from October 2013 to October 2018 were retrospectively analyzed,in which,23 cases in PVP group and 19 cases in SSF+VP group.The intraoperative blood loss,operation time,bone cement injection amount,VAS score,ODI score,anterior vertebral height and kyphosis Cobb Angle were observed and compared between the two groups to evaluate the clinical efficacy.Results The operation was successfully completed for all the patients,who were followed up for 24~55 months after operation.The operation time and intraoperative blood loss in PVP group were significantly shorter than those in SSF+VP group(P<0.01).However there was no significant difference in bone cement injection amount between the two groups(P>0.05).The VAS scores and ODI scores at 3d after surgery and at the last follow up in both groups were significantly improved,there were no significant differences in VAS scores and ODI scores between the two groups(P>0.05).In addition the relative height of anterior vertebral body at the last follow up in SSF+VP group was significantly higher than that in PVP group(P<0.05),but,the kyphotic Cobb angle at 3d after surgery and at last follow-up in SSF+VP group was significantly lower than that in PVP group(P<0.05).Conclusion Both PVP and SSF+VP are safe and effective in treating Kummell disease without neurological symptoms.PVP has the advantages of shorter operation time and less blood loss,however,SSF+VP has the advantages of maintaining the height of the anterior vertebral edge and deformity correction.