摘要
[目的]比较经皮椎体成形术(PVP)和骨水泥强化椎弓根螺钉联合PVP术(PSPVP)治疗无神经症状Ⅲ期Kummell病的临床疗效。[方法]2015年6月~2018年9月,本院60例无神经症状Ⅲ期(Ⅲa期)Kummell病患者纳入本研究,其中30例采用PVP治疗,30例采用PSPVP治疗。比较两组围手术期、随访及影像学资料。[结果]60例患者均成功完成手术,术中均未发生严重并发症。PSPVP组在手术时间、骨水泥注入量、术中透视次数、术中出血量和术后住院时间方面显著大于PVP组(P<0.05)。60例患者均随访12个月以上,两组患者术后即刻及末次随访VAS及ODI评分均较术前显著降低(P<0.05),相应时间点两组VAS及ODI评分的差异均无统计学意义(P>0.05)。影像学方面,术后X线片示PVP组出现5例(16.67%)骨水泥渗漏,PSPVP组4例(13.34%),但均无相应的神经症状。两组患者术后1 d和末次随访时病椎前缘相对高度较术前均显著增加,而局部后凸Cobb角显著减少(P<0.05)。术前两组间病椎前缘相对高度和局部后凸Cobb角的差异均无统计学意义(P>0.05),但末次随访时PSPVP组病椎前缘相对高度显著大于PVP组,而局部后凸Cobb角显著小于PVP组(P<0.05)。[结论]PVP术与PSPVP术治疗Ⅲ期不伴神经症状的Kummell病均安全有效,但PVP术具有操作时间短、术中出血少、透视次数少和术后恢复时间快等优势;而PSPVP对畸形矫正的效果优于PVP。
[Objective]To compare the clinical outcomes of percutaneous vertebroplasty(PVP)versus cement-augmented pedicle screw combined with PVP(PSPVP)for stageⅢKummells disease without neurological symptoms.[Methods]From June 2015 to September 2018,a total of 60 patients who suffered from stageⅢKummells disease without neurological symptoms were included into this study in our hospital.Of them,30 patients had PVP,while the remaining 30 patients underwent PSPVP.The perioperative,follow-up and radiographic documentations were compared between the two groups.[Results]All the 60 patients had surgical procedures performed smoothly without serious complications.The PVP group proved significantly superior to the PSPVP group regarding operation time,volume of cement injected,frequency of intraoperative fluoroscopy,intraoperative blood loss and hospital stay postoperatively(P<0.05).The follow-up period lasted for more than 12 months.The VAS and ODI scores significantly decreased postoperatively with contrast to those before operation in both groups(P<0.05),nevertheless no statistically significant differences in these scores were found between the two groups at any matching time point(P>0.05).In term of radiographic assessment,cement leakage revealed by radiographs was of 5 cases(16.67%)in the PVP group,whereas 4 cases(13.34%)in the PSPVP group,with on corresponding neurological defect in anyone of the cement leakage.The relative anterior vertebral height significantly increased,whereas local kyphotic Cobbs angle of affected vertebra significantly decreased at 1 day and the latest follow up compared with those before operation in both groups(P<0.05).Regardless no statistically significant differences between the two groups before operation(P>0.05),the PSPVP group proved significantly superior to the PVP group in the relative anterior vertebral height and local kyphotic Cobbs angle of affected vertebra at the latest follow up(P<0.05).[Conclusion]Both PVP and PSPVP are safe and effective for treatment of stageⅢKummell’s disease without neurological symptoms.By comparison,PVP has advantages of shorter operation time,less blood loss and fewer postoperative hospital stay,while the PSPVP has benefit of better deformity correction.
作者
郝晨
关海山
HAO Chen;GUANG Haishan(Department of Spinal Surgery,The Second Hospital,Shanxi Medical University,Taiyuan 030000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第11期892-897,共6页
Orthopedic Journal of China
基金
卫生部医药卫生科技发展研究中心课题项目(编号:W2014ZT067)。
