比较椎体后凸成形术与短节段固定联合患椎骨水泥强化术治疗Ⅱ、Ⅲa期Kümmell病疗效对比研究

作者	单位	邮编
金鸽^*	河北北方学院附属第一医院骨外科，河北张家口，075001	075001
孟宪勇	河北北方学院附属第一医院骨外科，河北张家口，075001	075001

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中文摘要:

目的比较椎体后凸成形术（percutaneous kyphoplasty, PKP）与短节段固定联合患椎骨水泥强化术（short segment fixation combined with vertebroplasty, SSF+VP）治疗Ⅱ、Ⅲa期Kümmell病的临床疗效。方法回顾性分析2016年1月至2020年10月期间在河北北方学院附属第一医院进行手术治疗的Ⅱ、Ⅲa期Kümmell病的患者55例。其中，30例行PKP，25例行SSF+VP。比较两组患者的手术时间、术中出血量、住院时间、患椎骨水泥注入量、术中透视次数及术前1 d、术后3 d、6个月、24个月的疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、椎体Cobb角、侧位患椎前缘高度及术后并发症的发生情况。结果 55例患者术后随访24个月以上，PKP组在手术时间、术中出血量、住院时间及患椎骨水泥注入量方面小于SSF+VP组，但术中透视次数明显多于SSF+VP组，两组间比较差异有统计学意义（P＜0.05）。PKP组术后3 d的VAS、ODI评分小于SSF+VP组（P＜0.05），术后6、24个月的VAS、ODI评分大于SSF+VP组（P＜0.05）。影像学方面，SSF+VP组术后椎体Cobb角较PKP组明显减小（P＜0.05）；术后患椎前缘高度值显著大于PKP组（P＜0.05）。并发症情况：PKP组出现了10例椎体矢状位失衡病例，其中5例出现了骨水泥移位、1例继发神经症状、10例均出现了患椎内骨水泥失效；7例术中出现骨水泥渗漏。SSF+VP组有3例骨水泥渗漏。PKP组术后并发症发生率显著高于SSF+VP组（P＜0.05）。结论对于治疗Ⅱ、Ⅲa期Kümmell病，PKP具有术后疼痛改善及功能恢复快、出血少、手术时间及住院时间短的优点，SSF+VP在术后恢复患椎高度、椎体Cobb角、患椎平衡稳定、远期的疼痛缓解及功能恢复方面有更大的优势。SSF+VP在患椎内可注入更多的骨水泥，且术后并发症较低。

英文摘要:

Objective To compare the clinical efficacy of PKP and SSF+VP in the treatment of stage Ⅱ and Ⅲa Kümmell disease.Methods A retrospective analysis was performed on 55 patients with stage Ⅱ and Ⅲa Kümmell disease who underwent surgical treatment in the First Affiliated Hospital of Hebei North University from January 2016 to October 2020. Among them, 30 cases underwent PKP and 25 cases underwent SSF+VP. The operation time, intraoperative blood loss, length of hospital stay, cement injection amount of the affected vertebrae, intraoperative fluoroscopy times, visual analogue scale (VAS) and Oswestry disability index(ODI), vertebral Cobb angle, lateral frontal height of the affected vertebra, and incidence of postoperative complications at 1 day before surgery, 3 days after surgery, 6 months and 24 months after surgery were compared between the two groups.Results The 55 patients were followed up for more than 2 years after surgery. PKP group was less than SSF+VP group in terms of operation time, intraoperative blood loss, hospital stay and cement injection amount of the affected vertebrae, but the intraoperative fluoroscopy times were significantly more than SSF+VP group, and the difference between the two groups was statistically significant (P<0.05). The VAS and ODI scores in the PKP group were lower than those in the SSF+VP group at 3 days after surgery (P<0.05), and the VAS and ODI scores at 6 months and 24 months after surgery were higher than those in the SSF+VP group (P<0.05). In terms of imaging, the postoperative Cobb angle of spine in the SSF+VP group was significantly decreased compared with that in the PKP group (P<0.05). The height of the anterior edge of the affected vertebra was significantly higher than that of the PKP group (P<0.05). Complications: There were 10 cases of sagittal vertebral imbalance in the PKP group, among which 5 cases had bone cement displacement, 1 case had secondary neurological symptoms, and 10 cases all had bone cement failure in the affected vertebra. There were 7 cases of bone cement leakage. There were 3 cases of bone cement leakage in the SSF+VP group. The incidence of postoperative complications in the PKP group was significantly higher than that in the SSF+VP group (P<0.05).Conclusion For the treatment of Kümmell disease at stage Ⅱ and Ⅲa, PKP has the advantages of quick postoperative pain improvement and functional recovery, less bleeding, shorter operation and hospital stay. SSF+VP has greater advantages in postoperative recovery of the affected vertebral height, Cobb angle of the spine, stability of the affected vertebral balance, long-term pain relief and functional recovery. SSF+VP can inject more bone cement into the affected vertebra with fewer postoperative complications.

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