对强直性脊柱炎后凸畸形患者行经腰椎椎弓根截骨术的临床价值分析

目的 分析对强直性脊柱炎后凸畸形患者行经腰椎椎弓根截骨术的临床价值.方法 选取2014年8月-2015年8月中南大学湘雅医院收治的90例强直性脊柱炎后凸畸形患者作为研究对象,将其分为观察组与对照组,每组45例,对照组采用椎弓根螺钉内固定治疗,观察组采用经腰椎椎弓根截骨术治疗,随后使用Bridwell-Dewald脊柱疾患疼痛与功能指标对两组的临床效果进行评价.结果 观察组总有效率明显高于对照组(P＜0.05);对照组手术时间明显长于观察组,术中出血量多于观察组,差异均有统计学意义(P＜0.05);治疗后1年观察组颌眉角、全脊柱后凸角、胸腰段后凸角较对照组明显减少(P＜0.05);观察组疼痛程度及性质评分、工作及社交限制评分、并发症发生率均明显低于对照组(P＜0.05).结论 对强直性脊柱炎后凸畸形患者采用经腰椎椎弓根截骨术治疗,临床疗效确切,不良反应较低,安全性较好,值得临床推广应用.     

Is percutaneous kyphoplasty safe and beneficial for patients aged 90 and over?

Background:At present, to a large extent, we do not know the safety and benefits of minimally invasive surgery for elderly patients, especially the focus population of patients aged 90 and over.Methods:We analyzed 189 consecutive patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty (PKP) between January 2018 and June 2021 at our institution. We divided them into the advanced age group aged 90 years or over (group A, n = 14) and the younger group under 90 years (group Y, n = 175). Clinical and complication indicators were evaluated and compared between the 2 groups.Results:A significant difference was observed in the procedure time, bleeding volume, and bone mineral density between the 2 groups during an average follow-up of 22 months. However, no significant difference was revealed in clinical and complication indicators between the 2 groups, and the pain and activity function of the 2 groups were significantly improved compared with those before PKP.Conclusions:Apparently, our results show that PKP is safe and beneficial for patients aged 90 years or older.     

Prevention of Bone Cement Displacement in Kümmell Disease without Neurological Deficits through Treatment with a Novel Hollow Pedicle Screw Combined with Kyphoplasty

Objective

Displacement of bone cement following percutaneous vertebral augmentation for Kümmell disease (KD) presents a significant concern, resulting in increasing back pain and compromising daily activities. Unfortunately, current literature does not yet establish a validated and minimally invasive surgical intervention for this issue. This study aims to investigate the effects of a novel hollow pedicle screw combined with kyphoplasty (HPS-KP) in preventing bone cement displacement following simply percutaneous kyphoplasty for the management of KD.

Methods

A total of 22 patients (six males, 16 females, averagely aged 77.18 ± 7.63 years) with KD without neurological deficits treated by HPS-KP at the hospital between March 2021 and June 2022 were hereby selected, among which, there were three stage I KD cases, 12 stage II KD cases, and seven stage III KD cases according to Li's classification. Bone mineral density (BMD), spinal X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) were examined before the operation. The operation time, intraoperative blood loss, and postoperative complications were all recorded. The follow-up focused on visual analog scale (VAS) score, Oswestry dysfunction index (ODI), anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), wedge-shape affected vertebral Cobb angle (WCA), and bisegmental Cobb angle (BCA). One-way analysis of variance (ANOVA) followed by Bonferroni post-hoc test was employed for performing multiple comparisons in the present study.

Results

All patients having received the operation successfully were followed up for more than 8 months (ranging from 8 to 18 months). The operation time, intraoperative blood loss, and BMD (T-score) were 39.09 ± 5.64 min, 14.09 ± 3.98 ml, and − 3.30 ± 0.90 g/cm³, respectively. Statistically significant differences were observed in the VAS score, ODI, AVH, MVH, and WCA (All p < 0.05), but there was no statistically significant difference in PVH and BCA at different time points (All p > 0.05). During follow-up, five patients suffered from bone cement leakage, and one presented an adjacent vertebral fracture and no bone cement displacement.

Conclusion

HPS-KP could be safe and effective in the treatment of KD without neurological deficits, effectively relieving the symptoms of patients, restoring partial vertebral height, and preventing the occurrence of bone cement displacement.