Zhong Shixiao, Zhong Hui, Huang Kun, Zhao Yayu, Lei Wen, Li Weichao
Faculty of Medical Science Kunming University of Science and Technology Kunming China.
Department of Orthopaedics, The First People's Hospital of Yunnan Province Affiliated Hospital of Kunming University of Science and Technology Kunming China.
JOR Spine. 2024 Dec 6;7(4):e70017. doi: 10.1002/jsp2.70017. eCollection 2024 Dec.
Vertebral augmentation is the preferred treatment for Kümmell disease (KD), but there exists a risk of cement displacement resulting in severe back pain and exacerbation of kyphosis. The study aimed to investigate the efficacy and safety of a novel hollow pedicle screw combined with kyphoplasty (HPS-KP) for treating KD, effectively preventing postoperative bone cement displacement.
The prospective study included 50 KD patients with no neurological deficit detected during clinical and radiological evaluation who underwent HPS-KP ( = 25) and PKP ( = 25) surgeries. The visual analogue scale (VAS) score, Oswestry dysfunction index (ODI), anterior vertebral height (AVH), wedge-shape affected vertebral Cobb angle (WCA), bisegmental Cobb angle (BCA), and complications were evaluated and compared in both groups. Besides, a finite element (FE) model of T11-L2 was constructed. The stress distributions, maximum von Mises stresses of vertebrae and bone cement, and maximum displacement of bone cement were compared and analyzed.
The VAS and ODI scores at 3 days, 3 and 6 months, and 1 year after surgery significantly improved in both groups ( < 0.05). The AVH, BCA, and WCA significantly improved initially after the surgery in both groups ( < 0.05). The displacement of M2 was larger than other models, especially in flexion, right bending, and left and right rotation, while that of M6 was the lowest under all conditions.
HPS-KP was a safe and effective treatment for KD, effectively relieving pain, restoring vertebral height, and correcting local kyphosis, and it had better biomechanical stability and safety than ordinary single PKP and PKP combined with pediculoplasty in avoiding cement loosening and displacement.
椎体强化术是治疗Kümmell病（KD）的首选方法，但存在骨水泥移位的风险，可导致严重背痛和后凸畸形加重。本研究旨在探讨新型空心椎弓根螺钉联合后凸成形术（HPS-KP）治疗KD的疗效和安全性，有效预防术后骨水泥移位。
本前瞻性研究纳入50例KD患者，这些患者在临床和影像学评估中未发现神经功能缺损，分别接受了HPS-KP手术（n = 25）和经皮椎体后凸成形术（PKP）手术（n = 25）。对两组患者的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、椎体前缘高度（AVH）、楔形受累椎体Cobb角（WCA）、双节段Cobb角（BCA）及并发症进行评估和比较。此外，构建了T11-L2的有限元（FE）模型。比较并分析椎体和骨水泥的应力分布、最大von Mises应力以及骨水泥的最大位移。
两组患者术后3天、3个月、6个月及1年时的VAS和ODI评分均显著改善（P < 0.05）。两组患者术后初期AVH、BCA和WCA均显著改善（P < 0.05）。M2模型的位移大于其他模型，尤其是在屈曲、右侧弯曲以及左右旋转时，而M6模型在所有情况下位移最低。
HPS-KP是治疗KD的一种安全有效的方法，能有效缓解疼痛、恢复椎体高度并矫正局部后凸畸形，在避免骨水泥松动和移位方面，其生物力学稳定性和安全性优于普通单节段PKP以及PKP联合椎弓根成形术。
