Yang Da-Long, Yang Si-Dong, Chen Qian, Shen Yong, Ding Wen-Yuan
Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).
Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland).
Med Sci Monit. 2017 Feb 2;23:606-612. doi: 10.12659/msm.902669.
BACKGROUND The aim of this study was to evaluate the clinical efficacy of modified posterior vertebral column resection (MPVCR) in treating osteoporotic Kummell disease. MATERIAL AND METHODS Between January 2013 and January 2015, 10 patients who were diagnosed with Kummell disease underwent MPVCR treatment, and their medical records were retrospectively collected. Every patient had follow-up for at least one year, with an average of 15 months. Clinical efficacy of MPVCR treatment was evaluated by kyphotic Cobb's angle, Oswestry disability index (ODI) and visual analogue scale (VAS) score. RESULTS Data analyses showed that operation time was 188.39±30.8 minutes, and blood loss was 860±130 mL with 600±200 mL of blood transfusions. VAS score decreased significantly after MPVCR surgery (p<0.001, Mann-Whitney U test). In addition, data analyses showed that postoperative ODI was less than preoperative ODI, which was a statistically significant difference (p<0.001, Mann-Whitney U test). X-ray radiograph showed that kyphotic Cobb's angle was 45°±12° preoperatively, 10°±4° two weeks after surgery, and 15°±6° at last follow-up, indicating that Cobb's angle after MPVCR surgery was significantly improved, compared to the preoperative scores (p<0.05, SNK-q test). CONCLUSIONS MPVCR surgery was an effective and safe surgical method to treat Kummell disease, especially for patients with kyphotic deformity and obvious nerve-oppressed symptoms. However, the long-term clinical effect still needs further studies.
背景 本研究旨在评估改良后路脊柱全椎体切除术(MPVCR)治疗骨质疏松性Kummell病的临床疗效。
材料与方法 2013年1月至2015年1月期间,10例诊断为Kummell病的患者接受了MPVCR治疗,并对其病历进行回顾性收集。每位患者至少随访1年,平均随访15个月。通过后凸Cobb角、Oswestry功能障碍指数(ODI)和视觉模拟量表(VAS)评分评估MPVCR治疗的临床疗效。
结果 数据分析显示,手术时间为188.39±30.8分钟,失血量为860±130毫升,输血量为600±200毫升。MPVCR手术后VAS评分显著降低(p<0.001,Mann-Whitney U检验)。此外,数据分析显示术后ODI低于术前ODI,差异具有统计学意义(p<0.001,Mann-Whitney U检验)。X线片显示术前Cobb角为45°±12°,术后2周为10°±4°,末次随访时为15°±6°,表明MPVCR手术后Cobb角较术前评分有显著改善(p<0.05,SNK-q检验)。
结论 MPVCR手术是治疗Kummell病的一种有效且安全的手术方法,尤其适用于有后凸畸形和明显神经受压症状的患者。然而,长期临床效果仍需进一步研究。