Cho Y
Department of Neurosurgery, Mok-Dong Hospital, Ewha Womans University College of Medicine, Mok-Dong, YangChun-Gu, Seoul, 158-710, Korea.
Musculoskelet Surg. 2017 Dec;101(3):269-274. doi: 10.1007/s12306-017-0480-1. Epub 2017 Jun 29.
The aim of this study was to investigate the surgical treatment of neurologically compromised advanced Kümmell's disease. The surgical treatment of Kümmell's disease has various options according to clinical and radiologic status. Far collapsed Kümmell's disease patients with neurological deficit need to be treated surgically.
We retrospectively analyzed 22 patients operated to our hospital with neurologically compromised Kümmell's disease between January 2011 and January 2014. Surgical approach was vertebrectomy, mesh cage insertion and segmental cement-augmented pedicle screw fixation. Corpectomy tissue was examined histopathologically. Anterior vertebral heights, kyphotic angle, the visual analog scale (VAS) and the Frankel classification were used to evaluate the effects of the surgery.
The mean time of follow-up was 26 months (range, 13-40 months). The VAS, anterior vertebral heights, kyphotic angle and neurological state were improved significantly immediate postoperatively and at the last follow-up compared with the preoperative examinations (P < 0.05). Most of the patients in this study exhibited intravertebral clefts, and postoperative pathology revealed bone necrosis.
Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective option for advanced Kümmell's disease with neurological deficits.
本研究旨在探讨神经功能受损的晚期Kümmell病的手术治疗方法。Kümmell病的手术治疗根据临床和影像学状况有多种选择。对于存在神经功能缺损的严重塌陷型Kümmell病患者需要进行手术治疗。
我们回顾性分析了2011年1月至2014年1月期间在我院接受手术治疗的22例神经功能受损的Kümmell病患者。手术方式为椎体切除术、网笼置入及节段性骨水泥增强椎弓根螺钉内固定。对椎体切除组织进行组织病理学检查。采用椎体前缘高度、后凸角、视觉模拟评分（VAS）及Frankel分级评估手术效果。
平均随访时间为26个月（范围13 - 40个月）。与术前检查相比，术后即刻及末次随访时VAS、椎体前缘高度、后凸角及神经功能状态均有显著改善（P < 0.05）。本研究中的大多数患者存在椎体内裂隙，术后病理显示骨坏死。
后路椎体切除术联合网笼置入及节段性骨水泥增强椎弓根螺钉内固定是治疗伴有神经功能缺损的晚期Kümmell病的有效方法。
