两种术式治疗无神经症状的Ⅲ期Kümmell病的疗效比较

Comparison of two surgical methods for the treatment of stage Ⅲ Kümmell's disease without neurological symptoms

目的比较经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)和后路经椎弓根椎体内植骨术治疗无神经症状的Ⅲ期Kümmell病的疗效。方法2017年12月~2022年4月对40例无神经症状的Ⅲ期Kümmell病患者行手术治疗,其中A组20例,行PKP术;B组20例,行后路经椎弓根椎体内植骨术。比较两组伤椎Cobb后凸角的改善情况、术后1 d伤椎高度、术后1年伤椎丢失高度、术后1年疼痛视觉模拟评分(visual analogue scale,VAS)改善率。结果两组患者术后1 d的VAS较术前均明显下降(P<0.05),伤椎椎体高度较术前明显增高(P<0.05),但组间比较无统计学意义(P>0.05)。术前伤椎Cobb后凸角组间比较无统计学意义(P>0.05);术后1 d、术后1年两组分别与术前比较,伤椎Cobb后凸角均明显变小(P<0.05);且B组的Cobb后凸角明显小于A组(P<0.05)。A、B两组患者术后1年伤椎丢失高度分别为(2.1±0.6)mm和(1.0±0.3)mm,术后1年VAS改善率分别为64%±7%和75%±6%,组间比较均有统计学意义,B组明显优于A组(P<0.05)。结论PKP与后路经椎弓根椎体内植骨术治疗没有神经症状的Ⅲ期Kümmell病均安全有效。PKP术具有耗时短、损伤小、出血少和康复快等微创优势;而后路经椎弓根椎体内植骨术对后凸畸形矫正的效果、伤椎高度的维持、远期疼痛的改善均优于PKP。

Objective To compare the efficacy of percutaneous kyphoplasty(PKP)and posterior transpedicular bone grafting for the treatment of asymptomatic stage Ⅲ Kümmell's disease.Methods From December 2017 to April 2022,40 asymptomatic stage Ⅲ Kümmell's disease patients underwent two different surgical treatment,were divided into two groups,including 20 patients in Group A underwent PKP surgery and 20 patients in Group B underwent posterior transpedicular bone grafting.The 1-day postoperative improvement of kyphosis Cobb angle,the height of injured vertebrae,and 1-year postoperative height loss of injured vertebrae,and the improvement rate of visual analog scale(VAS)were compared between the two groups.Results The 1-day postoperative VAS significantly reduced(P<0.05),and the height of the injured vertebral body significantly increased in both groups(P<0.05),but there was no statistically significant difference between the groups(P>0.05).There was no significant difference in the comparison of preoperative Cobb's angle between groups(P>0.05).After 1 day and 1 year of surgery,the two groups both showed significant reduction of the Cobb's angle(P<0.05);And the Cobb's angle in Group B was significantly smaller than that in Group A(P<0.05).The 1-year height loss of injured vertebrae in Group A and B was(2.1±0.6)mm and(1.0±0.3)mm respectively.The 1-year postoperative improvement rate of VAS was 64%±7% and 75%±6% respectively.There was statistical significance between the two groups,and Group B was significantly better than Group A(P<0.05).Conclusion Both PKP and posterior transpedicular bone grafting for the treatment of stage Ⅲ Kümmell's disease without neurological symptoms are safe and effective.PKP surgery has minimally invasive advantages such as short time consumption,minimal trauma,minimal bleeding,and fast recovery.The effectiveness of posterior kyphosis correction,maintenance of injured vertebral height,and long-term pain improvement of posterior transpedicular bone grafting are better than those of PKP.