经皮椎体成形联合增强椎弓钉治疗Ⅲ期Kummell病
Percutaneous vertebroplasty combined with augmented pedicle screw for stage Ⅲ Kummell disease
钟炯彪 1孟旭东 1许胤 1李佳福 1杨帆 1彭佳睿 1袁野 1王佩珊1
作者信息
- 1. 湖南师范大学岳阳市人民医院脊柱外科,湖南岳阳 414000
- 折叠
摘要
[目的]评价经皮椎体成形(percutaneous vertebroplasty,PVP)联合增强椎弓钉(augmented pedicle screw,APS)治疗Ⅲ期Kummell病的临床疗效.[方法]回顾性分析2019年3月-2021年8月本院手术治疗无神经症状Ⅲ期Kummell病76例患者的临床资料.根据医患沟通结果,32例采用单纯PVP(PVP组),21例采用PVP-椎弓钉(pedicle screw,PS)(PVP-PS组),23例采用PVP-增强椎弓钉(PVP-APS组),比较三组患者围术期、随访和影像资料.[结果]PVP组在手术时间、术中透视次数、穿刺调整次数、骨水泥注入量、术中出血量、下地行走时间、住院时间均显著少于PVP-PS组和PVP-APS组(P＜0.05).随访时间均超过1年,随时间推移,三组VAS、ODI评分均显著减少(P＜0.05);末次随访时,PVP-PS组和PVP-APS组的VAS[(2.7±0.6)vs(2.4±0.6)vs(3.3±0.4),P＜0.001]以及 ODI 评分[(22.6±4.3)vs(25.0±4.8)vs(30.1±5.8),P＜0.001]均显著优于 PVP 组.影像方面,末次随访时,PVP-PS 组和 PVP-APS 组的矢状面指数(sagittal index,SI)[(88.4±3.6)％vs(93.2±3.7)％vs(46.2±3.6)％,P＜0.001]、局部后凸Cobb 角[(17.6±4.2)° vs(10.7±3.5)° vs(27.6±4.6)°,P＜0.001]以及椎管狭窄率[(14.4±3.6)％vs(9.1±3.2)％vs(25.2±4.8)％,P＜0.001]显著优于PVP组,且PVP-APS组显著优于PVP-PS组(P＜0.05).[结论]采取经皮骨水泥螺钉短节段固定联合病椎PVP术治疗无神经症状Ⅲ期Kummell病,能有效恢复病椎高度、矫正后凸畸形、改善椎管狭窄,短期临床疗效满意,长期疗效仍待随访观察.
Abstract
[Objective]To evaluate the clinical efficacy of percutaneous vertebroplasty(PVP)combined with augmented pedicle screw(APS)for stage Ⅲ Kummell disease.[Methods]A retrospective analysis was performed on 76 patients who underwent surgical treatment for stage Ⅲ Kummell disease without neurological symptoms during March 2019 to August 2021 in our hospital.According to doctor-patient communication,32 cases were treated with simple PVP(the PVP group),21 cases underwent PVP combined pedicle screw(the PVP-PS group),and 23 cases received PVP combined with augmented pedicle screw(the PVP-APS group).Perioperative,follow-up and imaging da-ta of the three groups were compared.[Results]The PVP group was significantly less than the PVP-PS and PVP-APS groups in terms of op-erative time,intraoperative fluoroscopy times,puncture adjustment times,bone cement injection amount,intraoperative blood loss,walking time and hospital stay(P＜0.05).As time went during the follow-up period lasted for more than 1 year,the VAS and ODI scores significantly decreased in all the 3 groups(P＜0.05).At the last follow-up,PVP-PS and PVP-APS groups proved significantly superior to the PVP group in terms of VAS[(2.7±0.6)vs(2.4±0.6)vs(3.3±0.4),P＜0.001]and ODI scores[(22.6±4.3)vs(25.0±4.8)vs(30.1±5.8),P＜0.001].As for imag-ing,the PVP-PS and PVP-APS groups were significantly better than the PVP group in terms of sagittal index(SI)[(88.4±3.6)％ vs(93.2±3.7)％ vs(46.2±3.6)％ ,P＜0.001],local kyphotic Cobb angle[(17.6±4.2)° vs(10.7±3.5)° vs(27.6±4.6)°,P＜0.001],and spinal stenosis rate[(14.4±3.6)％ vs(9.1±3.2)％ vs(25.2±4.8)％ ,P＜0.001].Moreover,the PVP-APS group was significantly better than PVP-PS group regarding abovesaid parameters(P＜0.05).[Conclusion]The PVP-APS do effectively restore the height of the diseased vertebra,correct kyphotic defor-mity and improve spinal stenosis,and achieve satisfactory short-term clinical outcome for stage Ⅲ Kummell's disease without neurological symptoms,while the long-term efficacy remains to be followed up further.
关键词
Kummell病/经皮椎体成形术/经皮椎弓根螺钉/骨水泥强化Key words
Kummell's disease/percutaneous vertebroplasty/percutaneous pedicle screws/bone cement augmentation引用本文复制引用
基金项目
湖南省自然科学基金科药联合项目(2020JJ9054)
湖南省卫生健康委科研课题项目(202104071123)
岳阳市科技基础研究指导性计划项目(202012)
出版年
2024
NETL
NSTL
万方数据