经皮椎弓根螺钉锚定式椎体强化术治疗无神经症状Kümmell病

目的：探讨经皮椎弓根螺钉锚定式椎体强化术(percutaneous pedicle screw anchored vertebral augmentation,PPSAVA)治疗无神经症状Kümmell病的临床疗效。方法：回顾性分析2019年1月至2021年12月于采用PPSAVA治疗的20例无神经症状Kümmell病患者的临床资料,其中男5例,女15例,年龄56~88(74.95±9.93)岁,病程7~60(21.35±14.46) d。记录手术时间、骨水泥注入量、骨水泥渗漏情况;比较术前、术后3 d和末次随访时患者疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎体角(vertebral body angle,VBA)、椎体前缘高度及椎体中线高度,末次随访时观察骨水泥松动、移位情况。结果：20例患者均顺利完成手术,手术时间30~56(41.15±7.65) min,骨水泥注入量6.0~12.0(9.30±1.49) ml。术中6例发生骨水泥渗漏,未出现明显临床症状。随访时间为6~12(8.43±2.82)个月。术后3 d及末次随访时的VBA、伤椎椎体前缘高度及伤椎椎体中线高度较术前明显改善(P＜0.05);与术后3 d比较,末次随访时的VBA、伤椎椎体前缘高度及伤椎椎体中线高度均有不同程度丢失(P＜0.05)。术后3 d及末次随访时的VAS和ODI较术前显著下降(P＜0.05);末次随访与术后3 d的VAS、ODI比较,差异无统计学意义(P＞0.05)。末次随访时未出现骨水泥松动、移位的情况。结论：PPSAVA治疗无神经症状Kümmell病可以有效改善患者的疼痛和功能障碍,降低术后骨水泥松动、移位风险。

Percutaneous pedicle screw anchored vertebral augmentation for the treatment of Kümmell disease without neurological symptoms

Objective To explore the clinical effect of percutaneous pedicle screw anchored vertebral augmentation(PPSAVA) in the treatment of asymptomatic Kümmell disease without neurological symptoms.

Methods The clinical data of 20 patients with Kümmell disease without neurological symptoms treated with PPSAVA in our hospital from January 2019 to December 2021 were analyzed retrospectively,including 5 males and 15 females,aged 56 to 88 (74.95±9.93) years old. and the course of disease was 7 to 60 days with an average of (21.35±14.46) days. All patients were treated with PPSAVA. The time of operation,the amount of bone cement injected and the leakage of bone cement were recorded. The visual analogue scale(VAS),Oswestry disability index(ODI),vertebral body angle(VBA),anterior edge height and midline height of vertebral body were compared among the before operation,3 days after operation and during the final follow-up. The loosening and displacement of bone cement were observed during the final follow-up.

Results All the 20 patients completed the operation successfully. The operation time was 30 to 56 min with an average of (41.15±7.65) min,and the amount of bone cement injection was 6.0 to 12.0 ml with an average of (9.30±1.49) ml. Bone cement leakage occurred in 6 cases and there were no obvious clinical symptoms. The follow-up time was 6 to 12 months with an average of (8.43±2.82) months. The VBA,anterior edge height and midline height of of injured vertebral body were significantly improved 3 days after operation and the final follow-up(P＜0.05),and the VBA,anterior edge height and midline height of of injured vertebral body were lost in different degrees at the final follow-up (P＜0.05). The VAS and ODI at 3 days after operation and at the final follow-up were significantly lower than those at preoperatively(P＜0.05),but the VAS score and ODI at the final follow-up were not significantly different from those at 3 d after operation(P＞0.05). At the last follow-up,no patients showed loosening or displacement of bone cement.

Conclusion PPSAVA is highly effective in treating Kümmell disease without neurological symptoms,improving patients'' pain and functional impairment,and reducing the risk of cement loosening and displacement postoperatively.