一种治疗伴有神经功能缺损的Kümmell病的有效治疗选择：改良经椎弓根截骨减压术联合椎间盘截骨术及长节段固定
An Effective Treatment Option for Kümmell Disease With Neurological Deficits: Modified Transpedicular Subtraction and Disc Osteotomy Combined With Long-Segment Fixation.
作者信息
Zhang Xuesong, Hu Wenhao, Yu Jiayi, Wang Zheng, Wang Yan
机构信息
Department of Orthopaedics, Chinese PLA General Hospital.
Department of Renal Cancer and Melanoma, Peking University Cancer Hospital, Beijing, China.
出版信息
Spine (Phila Pa 1976). 2016 Aug 1;41(15):E923-E930. doi: 10.1097/BRS.0000000000001467.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To illustrate the technique of modified transpedicular subtraction and disc osteotomy combined with long-segment fixation for the treatment of Kümmell disease with neurologic deficits and to evaluate clinical and radiographic results of patients treated with the technique.
SUMMARY OF BACKGROUND DATA
Kümmell disease is a clinical condition in which patients develop a kyphosis in the lower thoracolumbar spinal region months to years after sustaining an otherwise asymptomatic minor spinal. Currently, for patients with neurological deficits, anterior decompression with bone grafting fusion, posterior decompression with pedicle subtraction osteotomy, or a combined anterior and posterior approach operation were used; however, there is no standard treatment and no single effective treatment for Kümmell disease.
METHODS
Between May 2009 and May 2012, we reviewed 12 patients experiencing Kümmell disease with neurological deficits who underwent modified transpedicular subtraction and disc osteotomy combined with long-segment fixation. Preoperative and postoperative Cobb angle, visual analog scale, Asia Spinal Injury Association, and sagittal balance were documented. The patients were followed up for 33 months on average.
RESULTS
The Cobb angles decreased from 43.33 ± 7.44° to 1.92 ± 2.74° (P < 0.01), the mean visual analog scale reduced from 7.17 ± 1.27° to 1.17 ± 1.03° (P < 0.01), and the sagittal vertical angle improved from 14.82 ± 3.56 cm to 5.15 ± 2.10 cm (P < 0.01). Kyphotic deformity was successfully corrected and solid fusion was achieved in all cases. Neurologic function of nine cases was improved to various degrees.
CONCLUSION
Modified transpedicular subtraction and disc osteotomy combined with long-segment fixation is an effective treatment option for Kümmell disease with neurological deficits.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
阐述改良经椎弓根截骨减压与椎间盘截骨术联合长节段固定技术治疗伴有神经功能缺损的Kümmell病，并评估采用该技术治疗患者的临床及影像学结果。
背景资料总结
Kümmell病是一种临床病症，患者在经历一次原本无症状的轻微脊柱损伤数月至数年之后，在下胸腰段脊柱区域出现后凸畸形。目前，对于伴有神经功能缺损的患者，采用前路减压植骨融合术、经椎弓根截骨减压后路减压术或前后联合入路手术；然而，对于Kümmell病尚无标准治疗方法，也没有单一有效的治疗手段。
方法
2009年5月至2012年5月期间，我们回顾了12例伴有神经功能缺损的Kümmell病患者，他们接受了改良经椎弓根截骨减压与椎间盘截骨术联合长节段固定治疗。记录术前及术后的Cobb角、视觉模拟评分、亚洲脊髓损伤协会评分及矢状面平衡情况。患者平均随访33个月。
结果
Cobb角从43.33±7.44°降至1.92±2.74°（P<0.01），平均视觉模拟评分从7.17±1.27降至1.17±1.03（P<0.01），矢状垂直轴从14.82±3.56cm改善至5.15±2.10cm（P<0.01）。所有病例均成功矫正后凸畸形并实现牢固融合。9例患者的神经功能有不同程度改善。
结论
改良经椎弓根截骨减压与椎间盘截骨术联合长节段固定是治疗伴有神经功能缺损的Kümmell病的有效治疗选择。
证据级别
4级。
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