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Title: [Effectiveness of posterior short-segmental fixation with bone cement augmentation for stage Ⅲ Kümmell's disease with spinal canal stenosis].
Author: Chen H, Yang J, Hao D.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2019 Jun 15; 33(6):707-711. PubMed ID: 31197997.
Abstract:
OBJECTIVE: To investigate the effectiveness of posterior short-segmental fixation with bone cement augmentation in treatment of stage Ⅲ Kümmell's disease with spinal canal stenosis. METHODS: Between June 2012 and January 2017, 36 patients with stage Ⅲ Kümmell's disease and spinal canal stenosis were treated by posterior short-segmental fixation and bone cement augmentation. There were 12 males and 24 females, aged 55-83 years (mean, 73.5 years). The disease duration ranged from 2 to 8 months, with an average of 4.6 months. Preoperative bone mineral density examination showed that all patients had different degrees of osteoporosis in the spines. The lesion segments included T ₁₀ in 4 cases, T ₁₁ in 7 cases, T ₁₂ in 8 cases, L ₁ in 9 cases, and L ₂ in 8 cases. The preoperative neural function was classified as grade B in 4 cases, grade C in 12 cases, grade D in 13 cases, and grade E in 7 cases according to Frankle classification. The operation time, intraoperative blood loss, and the volume of injected bone cement, and hospital stay were recorded. The visual analogue scale (VAS) score, Oswestry Disability Index (ODI), kyphotic Cobb angle, and the height of anterior edge of injured vertebra were recorded before operation, at 1 week after operation, and at last follow-up; and the leakage of bone cement was observed. RESULTS: All operations were completed successfully. The operation time was 90-145 minutes (mean, 110.6 minutes); the intraoperative blood loss was 198-302 mL (mean, 242.5 mL); the volume of injected bone cement was 8.3-10.5 mL (mean, 9.2 mL); the hospital stays were 7-12 days (mean, 8.3 days). All patients were followed up 12-26 months (mean, 24.5 months). At 1 week after operation, the neural function was classified as grade B in 2 cases, grade C in 8 cases, grade D in 12 cases, and grade E in 14 cases, which was significantly improved when compared with that before operation ( Z=2.000, P=0.047). The VAS score, ODI, the height of anterior edge of injured vertebra, and Cobb angle were significantly improved at 1 week and last follow-up when compared with preoperative values ( P<0.05); but there was no significant difference between 1 week and last follow-up ( P>0.05). Two cases had asymptomatic cement leakage to the intervertebral disc at 1 week after operation; and 1 case had adjacent vertebral fracture at 8 months after operation. No complication such as loosening or breaking of internal fixator occurred during the follow-up. CONCLUSION: Posterior short-segmental fixation with bone cement augmentation is a safe and effective surgical scheme for stage Ⅲ Kümmell's disease combined with spinal canal stenosis, which can avoid the aggravation of nerve injury and complications related to staying in bed. 目的: 探讨后路短节段固定骨水泥增强治疗Ⅲ期 Kümmell 病伴椎管狭窄患者的疗效。. 方法: 2012 年 6 月—2017 年 1 月，采用后路短节段固定骨水泥增强治疗 36 例Ⅲ期 Kümmell 病伴椎管狭窄患者。其中男 12 例，女 24 例；年龄 55～83 岁，平均 73.5 岁。病程 2～8 个月，平均 4.6 个月。术前骨密度检查示患者脊柱均存在不同程度骨质疏松。病变节段：T ₁₀ 4 例，T ₁₁ 7 例，T ₁₂ 8 例，L ₁ 9 例，L ₂ 8 例。神经功能采用 Frankle 分级：B 级 4 例，C 级 12 例，D 级 13 例，E 级 7 例。记录手术时间、术中出血量、骨水泥注射量、住院时间，以及术前、术后 1 周、末次随访时疼痛视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、后凸 Cobb 角、伤椎前缘高度，并观察术后骨水泥渗漏情况。. 结果: 36 例患者均顺利完成手术。手术时间 90～145 min，平均 110.6 min；术中出血量 198～302 mL，平均 242.5 mL；骨水泥注射量 8.3～10.5 mL，平均 9.2 mL；住院时间 7～12 d，平均 8.3 d。术后患者均获随访，随访时间 12～26 个月，平均 24.5 个月。术后 1 周神经功能 Frankle 分级：B 级 2 例，C 级 8 例，D 级 12 例，E 级 14 例，较术前显著改善（ Z=2.000， P=0.047）。术后 1 周及末次随访时 VAS 评分、ODI、伤椎前缘高度、后凸 Cobb 角均较术前显著改善（ P<0.05），术后 1 周与末次随访时比较差异无统计学意义（ P>0.05）。2 例术后 1 周发现无症状骨水泥渗漏至椎间盘，1 例术后 8 个月发生邻近椎体骨折。随访期间均无内固定物松动、断裂等并发症发生。. 结论: 后路短节段固定骨水泥增强治疗Ⅲ期 Kümmell 病伴椎管狭窄安全、有效，可避免神经损伤加重和长期卧床并发症。.

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