骨水泥增强椎弓根钉内固定治疗Kümmell病

Cement-enhanced pedicle screw internal fixation for Kümmell disease

目的研究应用骨水泥增强椎弓根钉固定治疗Kümmell病的有效性和安全性。方法对2017年1月至2019年6月北京大学人民医院25例应用骨水泥增强椎弓根钉固定治疗Kümmell病患者进行回顾性研究,记录患者的手术时间、术中出血量、骨水泥体积。随访过程中通过腰椎正侧位X线片和CT进一步评价病椎高度、Cobb角;采用腰痛视觉模拟评分(VAS)评定临床症状改善情况,采用Oswestry功能障碍指数(ODI)评分评定术后功能改善情况。结果VAS评分、ODI评分、病椎高度和后凸Cobb角度显示,术前和术后1周、术前和末次随访之间比较,差异有统计学意义(<0.05),术后1周和末次随访的随访值之间仅VAS评分比较差异无统计学意义(>0.05),而ODI评分、病椎前缘高度和Cobb角的差异具有统计学意义(<0.05)。结论骨水泥增强椎弓根钉内固定治疗Kümmell病可以减少脊柱后凸畸形、恢复椎体高度、缓解疼痛。尽管可能存在椎体高度丢失相关远期问题,但远期患者功能依旧恢复较好且并发症率较低,是一种安全有效的治疗方式。

Objective To study the effectiveness and safety of cement short segmental fixation for Kümmell disease.Methods The medical records of 25 patients in Peking University People’s Hospital who underwent cement short segmental fixation for Kümmell disease from January 2017 to June 2019 were retrospectively reviewed.We recorded the operation duration,intraoperative hemorrhage and cement use.Anterior height of affected vertebral body and Cobb angle were further evaluated by X-ray and CT during follow-up.The visual analog scale(VAS)pain score was used to evaluate the improvement of clinical symptoms,and Oswestry disability index(ODI)was used to assess postoperative functional improvement.Results The VAS grades,ODI scores,anterior heights of affected vertebrae,and Cobb angles showed statistically significant differences between pre-and postoperative and between preoperative and final follow-up values(P<0.05).While ODI scores,anterior heights of affected vertebrae,and Cobb angles showed their statistically significant differences(P<0.05)between postoperative and final follow-up,VAS grades did not(P>0.05).Conclusion Cementenhanced pedicle screw internal fixation for Kümmell disease can reduce kyphosis,restore vertebral height and relieve pain.Although there may be long-term problems such as vertebral height,the long-term functional recovery of patients is still good and the complication rate is low,hence it is a safe and effective treatment.