手法复位经皮骨水泥椎弓根钉治疗Ⅲa期Kümmell's病

Manual reduction and percutaneous cement-augmented pedicle screw fixation for stage Ⅲa Kümmell's disease

[目的]探究全麻下手法复位经皮骨水泥增强椎弓根钉治疗Ⅲa期Kümmell's病的疗效。[方法]回顾性分析2019年1月—2023年2月本院采取手法复位经皮骨水泥螺钉治疗Ⅲa期Kümmell's病16例患者的临床资料。评价临床和影像结果。[结果]16例患者均顺利完成手术,术中无骨水泥渗漏、神经及血管损伤等严重并发症;手术时间平均(96.6±11.1)min,术中出血量平均(93.4±13.6)ml。随访12个月以上,随访过程中16例患者均无严重腰痛复发,无翻修手术者。与术前相比,出院前和末次随访时患者VAS评分[(7.4±0.7),(2.7±0.6),(2.3±0.7),P<0.001]和ODI评分[(74.5±3.1),(33.4±3.9),(29.9±2.8),P<0.001]均显著改善。影像方面,与术前相比,出院前和末次随访时,16例患者的椎体前缘高度(anterior height,AH)均显著增加[(12.2±1.1)mm,(20.4±0.9)mm,(20.2±0.9)mm,P<0.001],而局部后凸角(local kyphotic angle,LKA)显著减少[(22.4±1.6)°,(14.6±1.6)°,(14.8±1.6)°,P<0.001]。[结论]手法复位经皮骨水泥增强椎弓根钉治疗Ⅲa期Kümmell's病具有创伤小、恢复快的优点,并取得满意的临床疗效。

[Objective]To investigate the clinical outcomes of manual reduction under general anesthesia and percutaneous cementaugmented pedicle screw fixation in the treatment of stage Ⅲa Kümmell's disease.[Methods]A retrospective study was done on 16 patients who received manual reduction and percutaneous cement-augmented pedicle screw fixation for stage Ⅲa Kümmell's disease in our hospital from January 2019 to February 2023.Clinical and imaging data were evaluated.[Results]All the 16 patients were successfully operated on without any serious complications such as bone cement leakage,nerve and vascular injury,with the mean operation time of(96.6±11.1)min and the mean intraoperative bleeding of(93.4±13.6)ml.During the follow-up period lasted for more than 12 months,none of the 16 patients had any recurrence of severe low back pain or revision surgery.Compared with those preoperatively,the VAS score[(7.4±0.7),(2.7±0.6),(2.3±0.7),P<0.001]and ODI scores[(74.5±3.1),(33.4±3.9),(29.9±2.8),P<0.001]were significantly improved before discharge and at the latest follow-up.As for imaging,compared with those preoperatively,the vertebral anterior height(AH)was significantly increased[(12.2±1.1)mm,(20.4±0.9)mm,(20.2±0.9)mm,P<0.001],while the local kyphotic angle(LKA)was significantly decreased before discharge and at the latest follow-up in the 16 patients.[Conclusion]Manual reduction and percutaneous bone cement augmented pedicle screw fixation in the treatment of stage Ⅲa Kümmell's disease trauma has the advantages of less trauma,rapid recovery,and does achieve satisfactory clinical consequence.