3种术式治疗无神经症状Ⅲ期Kümmell病的临床疗效比较

Comparison of clinical efficacies among three surgical methods in treating stageⅢKümmell disease without neurological symptoms

目的比较3种术式治疗无神经症状Ⅲ期Kümmell病的临床疗效。方法选取2019年9月至2022年4月湖南师范大学附属岳阳医院骨科收治的69例无神经症状Ⅲ期Kümmell病患者。按手术方式分为3组:椎体成形术(PVP)组(A组)29例,经皮椎弓根螺钉联合病椎PVP组(B组)19例,经皮骨水泥强化椎弓根螺钉联合病椎PVP组(C组)21例,比较3组患者影像学、围手术期和随访指标。结果所有患者均顺利完成手术,术后未发生严重并发症,随访时间>1年。A组患者术后各时间点(术后1个月、3个月、1年)病椎矢状位指数(SI值)、视觉模拟评分法(VAS)评分、Oswestry功能障碍指数问卷表(ODI)评分较术前有改善(P<0.05);B、C组患者术后各时间点病椎SI值、后凸Cobb角、椎管狭窄率、VAS评分、ODI评分较术前均有改善(P<0.05);B、C组患者术后各时间点病椎SI值、后凸Cobb角、椎管狭窄率、VAS评分、ODI评分及均优于A组(P<0.05),而C组患者术后1年病椎SI值、后凸Cobb角及椎管狭窄率优于B组(P<0.05);A组患者在手术时间、术中出血量、术后住院时间及病椎骨水泥注入量方面均明显少于B、C组(P<0.05);B组患者手术时间短于C组(P<0.05)。结论3种术式治疗无神经症状Ⅲ期Kümmell病均能缓解症状及恢复功能,经椎弓根螺钉复位的两种术式相对于单纯PVP能更加有效恢复病椎高度、矫正后凸畸形及改善椎管狭窄,而椎弓根螺钉经骨水泥强化后在维持力学支撑及稳定性方面更有优势。

Objective To compare the clinical efficacies among three surgical methods in the treatment of stageⅢKümmell’s disease without neurological symptoms.Methods A total of 71 patients with stageⅢKümmell’s disease without neurological symptoms admitted and treated in the orthopedics department of Affiliated Yueyang Hospital of Hunan Normal University from September 2019 to April 2022 were selected and divided into three groups:29 cases in the percutaneous vertebroplasty(PVP)group(group A),19 cases in the percutaneous pedicle screw+lesioned vertebral PVP group(group B)and 21 cases in the percutaneous bone cement screw combined with lesioned vertebral PVP group(group C)according to the operation methods.The imaging,perioperative and follow-up indexes were compared among the three groups.Results All patients successfully completed the operation,no serious complications occurred after operation,and the follow-up time was more than 1 year.The sagittal position index(SI value)in the affected vertebra,visual analogue scale(VAS)score and Oswestry Disability Index(ODI)score at each time point(postoperative 1,3 months,1 year)after surgery in the group A were improved compared with before operation(P<0.05).The affected vertebra SI value,kyphosis Cobb angle,spinal canal stenosis rate,VAS score and ODI score at postoperative time points in the group B and C were improved compared with before operation(P<0.05).The affected vertebra SI value,kyphosis Cobb angle,spinal canal stenosis rate and ODI score at postoperative time points in the group B and C all were superior to those in the group A(P<0.05),while the affected vertebra SI value,kyphosis Cobb angle and spinal canal stenosis rate in postoperative 1 year in the group C were superior to those in the group B(P<0.05).The operative time,intraoperative bleeding volume,postoperative hospitalization duration and affected vertebral cement injection volume in the group A were significantly less than those in the group B and C(P<0.05).The operation time in the group B was less than that in the group C(P<0.05).Conclusion The three surgical methods for the treatment of stageⅢKümmell’s disease without neurological symptoms all could relieve the symptoms and restore the function.The two surgical methods of pedicle screw reduction could more effectively restore the height of the affected vertebra,correct kyphosis malformation and improve spinal stenosis than PVP alone.The pedicle screw has more advantages in maintaining mechanical support and stability after bone cement reinforcement.