摘要
[目的]比较后路减压内固定联合椎体成形(DFVP)与后路减压内固定联合椎体次全切(DFVE)治疗Kümmell病合并脊髓损伤的临床疗效。[方法]本院2010年6月~2015年1月收治Kümmell病合并脊髓损伤患者共45例,其中,采用DFVP术21例,采用DFVE术24例,比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术,无神经系统损伤。DFVE组手术时间、术中出血量、术后引流量、下地行走时间和住院天数均显著大于DFVP组(P<0.05)。两组患者随访(31.91±8.18)个月。随时间推移,两组患者ASIA评级显著升级(P<0.05),VAS评分术后1个月时降至最低,而后又有增加(P<0.05)。相应时间点,两组间ASIA评级的差异无统计学意义(P>0.05);但是术后1年和末次随访时,DFVE组的VAS评分低于DFVP组(P<0.05)。影像方面,两组患者术后1周时LKA、AVH和PVH均较术前显著改善(P<0.05),而后有所衰退;末次随访时DFVE组的LKA、AVH和PVH矫正丢失差异无统计学意义(P>0.05);而DFVP组的LKA和AVH的矫正丢失差异有统计学意义(P<0.05);末次随访时DFVE组的LKA和AVH显著优于DFVP组(P<0.05)。[结论]两种术式均能获得满意的早期疗效,相比之下DFVE远期疗效优于DFVP。
[Objective]To compare the clinical outcomes of posterior decompression,instrumented fusion and vertebroplas⁃ty(DFVP)versus posterior decompression,instrumented fusion and subtotal vertebrectomy(DFVE)for Kümmell disease with neurological deficits.[Methods]From June 2010 to January 2015,45 consecutive patients who suffered from Kümmell disease accompanied with neurological deficits were surgically treated in our department.Of them,21 patients underwent DFVP,while the remaining 24 patients received DFVE.The two groups were compared regarding to documents of perioperative period,fol⁃low-up and radiographs.[Results]All the patients in both groups had operation conducted smoothly with no iatrogenic never in⁃juries.The DFVP groups was superior to the DFVE group in operation time,intraoperative blood loss and postoperative drainage volume,the time to return ambulationand hospital stay(P<0.05).The patients were followed up for(31.91±8.18)months.As time went,the ASIA grade for neurological function significantly improved(P<0.05),whereas the VAS score significantly de⁃creased at 1 month postoperatively(P<0.05)and slightly increased again after that in both groups.Although no a statistically sig⁃nificant difference in ASIA grade was found at any corresponding time point between the two group(P>0.05),the DFVE group proved significantly superior to the DFVP group in VAS score at 1 year and the latest follow-up(P<0.05).Regarding to imaging assessment,the local kyphotic angle(LKA),anterior vertebral height(AVH)and posterior vertebral height(PVH)significantly improved at 1 week postoperatively compared with those before operation in both groups(P<0.05),and deteriorated after that.The correction loss of LKA,AVH and PVH at the latest follow-up proved not statistically significant in the DFVE group(P>0.05),whereas the correction loss of LKA and AVH proved statistically significant in the DFVP group(P<0.05).The DFVE group was significantly superior to the DFVP group in LKA and AVH at the latest follow-up(P<0.05).[Conclu⁃sion]Both surgical procedures do achieve satisfactory clinical outcomes in the early stage,however,the DFVE is superior to the DFVP in long-term outcomes for Kümmell disease with neurological deficits.
作者
韦竑宇
董春科
王好
杨峰
谭明生
WEI Hong-yu;DONG Chun-ke;WANG Hao;YANG Feng;TAN Ming-sheng(Department of Orthopaedics,China-Japan Friendship Hospital,Beijing100029,China;Beijing University of Chinese Medicine,Beijing100029,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第22期2054-2059,共6页
Orthopedic Journal of China
关键词
Kümmell
病
脊髓损伤
固定融合
椎体成形
椎体次全切
Kümmell disease
neurological deficit
instrumented fusion
vertebroplasty
subtotal vertebrectomy
