Huang Yan-Sheng, Hao Ding-Jun, Wang Xiao-Dong, Sun Hong-Hui, Du Jin-Peng, Yang Jun-Song, Gao Jie, Xue Peng
Graduate School of Xi'an Medical University, Xi'an, China.
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
World Neurosurg. 2018 Aug;116:e1079-e1086. doi: 10.1016/j.wneu.2018.05.171. Epub 2018 Jun 2.
The standard treatment for Kummell disease with neurologic deficit remains controversial. Traditional posterior long-segment fixation (LSF) has been widely used, but the procedure results in significant trauma and carries the risk of multiple complications. Therefore, bone cement-augmented short-segment fixation (BCASSF) has been recommended for this condition.
The study included 36 patients treated with LSF or BCASSF between January 2012 and June 2015. The visual analog scale (VAS), Oswestry Disability Index (ODI) score, anterior height of fractured vertebrae, kyphotic Cobb angle, and neurologic function by the Frankel classification were evaluated and compared, and duration of operation, blood loss, length of hospital stay, and complications were recorded.
Significant differences were observed in the VAS, ODI, anterior height of affected vertebrae, and kyphotic Cobb angle between preoperatively and 7 days postoperatively and between preoperatively and at the final follow-up, whereas no significant differences were observed between 7 days postoperatively and at final follow-up. No significant differences in the aforementioned parameters were observed between the groups at 7 days postoperatively and at the final follow-up. Neurologic function was improved in both groups; however, no significant differences were observed between the 2 groups either preoperatively or postoperatively. Blood loss and length of hospital stay were significantly lower in the BCASSF group compared with the LSF group, but no significant between-group differences were observed in operation time and complications.
Lower blood loss and shorter hospital stay were associated with BCASSF compared with LSF; the 2 techniques had similar clinical outcomes and radiographic findings. Therefore, we recommend BCASSF for treating patients with Kummell disease with neurologic deficits.
伴有神经功能缺损的Kummell病的标准治疗方法仍存在争议。传统的后路长节段固定（LSF）已被广泛应用，但该手术会导致显著创伤并伴有多种并发症的风险。因此，骨水泥强化短节段固定（BCASSF）被推荐用于这种情况。
该研究纳入了2012年1月至2015年6月间接受LSF或BCASSF治疗的36例患者。评估并比较了视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）评分、骨折椎体的前缘高度、后凸Cobb角以及根据Frankel分级的神经功能，并记录了手术时间、失血量、住院时间和并发症情况。
术前与术后7天以及术前与末次随访之间，VAS、ODI、患椎前缘高度和后凸Cobb角存在显著差异，而术后7天与末次随访之间未观察到显著差异。术后7天和末次随访时，两组之间在上述参数上未观察到显著差异。两组的神经功能均有改善；然而，术前或术后两组之间均未观察到显著差异。与LSF组相比，BCASSF组的失血量和住院时间显著更低，但手术时间和并发症在组间未观察到显著差异。
与LSF相比，BCASSF与更低的失血量和更短的住院时间相关；这两种技术具有相似的临床结果和影像学表现。因此，我们推荐BCASSF用于治疗伴有神经功能缺损的Kummell病患者。
