经皮椎弓根螺钉固定联合椎体成形术的短期疗效：一种治疗伴有椎体内不稳定的Kümmell病的微创方法。
Short-term outcomes of percutaneous pedicle screw fixation combined with vertebroplasty: A minimally invasive treatment for Kümmell's disease with intravertebral instability.
作者信息
Lou Chao, Yu Weiyang, Chen Zhenzhong, Gao Jiawei, Liu Feijun, He Dengwei
机构信息
Department of Orthopaedic Surgery, Lishui Hospital of Zhejiang University, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Zhejiang, People's Republic of China.
出版信息
Acta Orthop Traumatol Turc. 2020 Nov;54(6):627-633. doi: 10.5152/j.aott.2020.19245.
OBJECTIVE
The aim of this study was to present early clinical and radiological outcomes of percutaneous pedicle screw fixation (PPSF) combined with vertebroplasty (VP) in the treatment of Kümmell's disease with intravertebral instability.
METHODS
In this study, 21 consecutive patients (4 male and 17 female; mean age = 75.6 years; age range=65-86 years) who suffered from stage II and III Kümmell's disease with intravertebral instability were prospectively recruited from 2012 to 2016 and treated with PPSF combined with VP. The Cobb angle (CA) or wedge angle (WA) in both flexion and extension positions was measured using lateral radiographs, computed tomography, or magnetic resonance imaging. In addition to these radiological parameters, clinical outcome measures, including the visual analog scale (VAS) and the Oswestry Disability Index (ODI) were collected preoperatively; 1 week and 1, 3, 6, and 12 months postoperatively; and then annually. Complications were also recorded.
RESULTS
The mean follow-up was 19.3 (range=12-36) months. The mean operating time was 135.4 (range, 110-175) min, and the mean estimated blood loss was 106.9 (range, 50-165) mL. The mean VAS score and ODI significantly decreased from 7.7±1.1 and 65.3%±7.7% preoperatively to 3.4±0.6 and 30.0%±7.6% postoperatively, respectively (p<0.05). At the final follow-up, the mean VAS score and ODI were 2.5±0.8 and 21.5%±8.8%, respectively (p>0.05). CA and WA significantly decreased from 26.9°±9.7° and 21.3°±6.0° preoperatively to 12.7°±7.2° to 8.6°±4.5° postoperatively, respectively (p<0.05). At the final follow-up, CA was 4.2°±2.0°, and WA was 4.7°±1.8° (p>0.05). No major complications were encountered during the follow-up period.
CONCLUSION
PPSF combined with VP seems to be an effective surgical option for the treatment of Kümmell's disease with intravertebral instability.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
目的
本研究旨在介绍经皮椎弓根螺钉固定术（PPSF）联合椎体成形术（VP）治疗伴有椎体内不稳的Kümmell病的早期临床和影像学结果。
方法
本研究前瞻性纳入了2012年至2016年期间连续收治的21例伴有椎体内不稳的II期和III期Kümmell病患者（4例男性，17例女性；平均年龄=75.6岁；年龄范围65 - 86岁），采用PPSF联合VP进行治疗。使用侧位X线片、计算机断层扫描或磁共振成像测量屈伸位的Cobb角（CA）或楔角（WA）。除了这些影像学参数外，还在术前、术后1周、1、3、6和12个月以及之后每年收集临床结果指标，包括视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）。同时记录并发症情况。
结果
平均随访时间为19.3（范围12 - 36）个月。平均手术时间为135.4（范围110 - 175）分钟，平均估计失血量为106.9（范围50 - 165）毫升。平均VAS评分和ODI分别从术前的7.7±1.1和65.3%±7.7%显著降至术后的3.4±0.6和30.0%±7.6%（p<0.05）。在末次随访时，平均VAS评分和ODI分别为2.5±0.8和21.5%±8.8%（p>0.05）。CA和WA分别从术前的26.9°±9.7°和21.3°±6.0°显著降至术后的12.7°±7.2°至8.6°±4.5°（p<0.05）。在末次随访时，CA为4.2°±2.0°，WA为4.7°±1.8°（p>0.05）。随访期间未发生重大并发症。
结论
PPSF联合VP似乎是治疗伴有椎体内不稳的Kümmell病的一种有效手术选择。
证据水平
IV级，治疗性研究。
Zotero 插件