骨水泥强化椎弓根螺钉联合经皮椎体成形术治疗无神经症状Kummell病Ⅲ期患者疗效观察

Efficacy of bone cement reinforced pedicle screw combined with percutaneous vertebroplasty in the treatment of stageⅢKummell disease without neurological symptoms

目的观察骨水泥强化椎弓根螺钉联合经皮椎体成形术(PVP)治疗无神经症状Kummell病Ⅲ期患者的疗效。方法回顾性分析盘锦市中心医院骨科2015年3月至2019年4月期间收治的73例无神经症状Kummell病Ⅲ期患者的临床资料,根据手术方式的不同分为A组36例和B组37例,A组患者给予PVP术治疗,B组患者给予骨水泥强化椎弓根螺钉联合PVP治疗,比较两组患者围术期相关指标,评估并比较两组患者术前、术后3个月、术后6个月的视觉疼痛模拟评分量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、伤椎椎体前缘高度比、后凸Cobb角,统计两组患者术后并发症发生情况。结果B组患者的手术时间、住院时间、下床活动时间分别为(124.09±12.68)min、(8.36±0.75)d、(10.66±2.18)d,明显长于A组的(30.83±3.62)min、(3.39±0.32)d、(5.35±1.21)d,术中出血量、骨水泥注入量分别为(195.76±13.71)mL、(7.18±0.34)mL,明显多于A组的(11.81±2.64)mL、(3.97±0.25)mL,差异均有统计学意义(P<0.05);B组患者术后3个月、术后6个月的VAS评分分别为(2.66±0.83)分、(1.06±0.41)分,明显低于A组的(3.92±1.34)分、(1.85±0.52)分,ODI评分分别为(18.27±3.19)分、(11.67±2.54)分,明显低于A组的(25.31±5.02)分、(16.81±4.59)分,差异均有统计学意义(P<0.05);B组患者术后3个月、术后6个月的伤椎椎体前缘高度比分别为(69.65±5.93)%、(78.06±6.21)%,明显低于A组的(76.25±6.12)%、(90.52±5.23)%,凸Cobb角分别为(18.29±2.41)°、(18.04±2.18)°,明显低于A组的(22.27±2.35)°、(21.93±2.21)°,差异均有统计学意义(P<0.05);A组和B组患者随访期间的并发症发生率分别为8.33%、10.81%,差异无统计学意义(P>0.05)。结论与PVP治疗相比,骨水泥强化椎弓根螺钉联合PVP治疗无神经症状Kummell病Ⅲ期患者,虽在围术期相关指标方面无优势,但其对畸形矫正的效果优于PVP,可减轻疼痛,促进机体功能恢复,且不增加并发症发生率。

Objective To observe the efficacy of bone cement reinforced pedicle screw combined with percuta-neous vertebroplasty(PVP)in the treatment of stageⅢKummell disease without neurological symptoms.Methods The clinical data of 73 patients with stageⅢKummell disease without neurological symptoms who were admitted in Panjin Central Hospital from March 2015 to April 2019 were analyzed retrospectively,which were divided into group A(36 pa-tients)and group B(37 patients)according to the different surgical methods.Patients in group A were treated with PVP,and patients in group B were given bone cement reinforced pedicle screw combined with PVP.The perioperative related indexes of the two groups were compared,and the visual analogue scale(VAS),Oswestry disability index(ODI),anteri-or height ratio of injured vertebral body,kyphosis Cobb angle of the two groups were evaluated and compared before op-eration,3 months and 6 months after operation.The postoperative complications of the two groups were also compared.Results The operation time,hospitalization time,and activity time in group B were(124.09±12.68)min,(8.36±0.75)d,(10.66±2.18)d,which were significantly longer than(30.83±3.62)min,(3.39±0.32)d,(5.35±1.21)d in group A,and the intraoperative blood loss and bone cement injection volume in group B were(195.76±13.71)mL and(7.18±0.34)mL,which were significantly more than(11.81±2.64)mL and(3.97±0.25)mL in group A,with statistically significant differ-ences(P<0.05).The VAS scores of the patients in group B were(2.66±0.83)points,(1.06±0.41)points at 3 months and 6 months after operation,which were significantly lower than(3.92±1.34)points,(1.85±0.52)points in group A,and the ODI scores in group B were(18.27±3.19)points,(11.67±2.54)points at 3 months and 6 months after operation,which were significantly lower than(25.31±5.02)points,(16.81±4.59)points in group A,with statistically significant differences(P<0.05).The anterior height ratio of injured vertebral body in group B were(69.65±5.93)%,(78.06±6.21)%at 3 months and 6 months after operation,which were significantly lower than(76.25±6.12)%,(90.52±5.23)%in group A,and the kyphosis Cobb angle in group B were(18.29±2.41)°,(18.04±2.18)°at 3 months and 6 months after operation,which were significantly lower than(22.27±2.35)°,(21.93±2.21)°in group A,with statistically significant differences(P<0.05).The incidence of complications in group A and group B were 8.33%and 10.81%,with no statistically significant differences(P>0.05).Conclusion Compared with PVP,bone cement reinforced pedicle screw combined with PVP in the treatment of stageⅢKummell disease without neurological symptoms has no obvious advantages in the periopera-tive related indexes,but its effect on deformity correction is better than that of PVP,which can reduce pain,promote the recovery of body function,and does not increase the incidence of complications.