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Title: [Clinical application of an improved classification system of Kümmell's disease].
Author: Zhang Y, Gao G, Wang L, Li Z, Dong J, Xue J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Apr 15; 35(4):464-470. PubMed ID: 33855831.
Abstract:
OBJECTIVE: To report an improved classification system of Kümmell's disease and its clinical application. METHODS: Based on CT and MRI, an improved classification system of Kümmell's disease was proposed in terms of the integrity of sagittal endplate, the integrity of posterior wall of vertebral body, and the degree of vertebral compression. Between January 2011 and March 2018, the improved classification system was used to evaluate and guide the treatment of 78 patients with Kümmell's disease. There were 13 males and 65 females. The mean age was 69.1 years (range, 54-85 years). The mean disease duration was 4.0 months (range, 1-8 months). The mean T value of bone mineral density was -3.66 (range, -3.86- -3.34).The fractures located at thoracic vertebrae in 47 cases and lumbar vertebrae in 31 cases. According to the modified classification system of Kümmell's disease, there were 11 cases of type A1, 13 cases of type A2, 2 cases of type A3, 10 cases of type B1, 18 cases of type B2, 4 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 11 cases of type C3. According to the classification results, the patients of types A and B were treated with percutaneous kyphoplasty (PKP), while the patients of type C were treated with PKP or intra- vertebral fixation according to the degree of vertebral reduction. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate clinical efficacy. The heights of the anterior, middle, and posterior edges of the vertebrae and the Cobb angle were measured to evaluate the reduction of the injured vertebrae and the improvement of kyphosis deformity. The complications were recorded. RESULTS: The statistical analysis showed that the improved classification system has good consistency. All patients were followed up 12-36 months (mean, 24.3 months). The heights of anterior, middle, and posterior edges of the vertebrae, Cobb angle, VAS score, and ODI of all types of patients at last follow-up showed significant differences when compared with those before operation ( P<0.05). After operation, 4 patients of type A2 had different degree of vertebral height loss; 2 patients of type B2, 3 patients of type C1, and 2 patients of type C2 developed asymptomatic bone cement leakage during PKP; 2 patients of type B3 and 3 patients of type C2 underwent percutaneous internal fixation and vertebral augmentation due to bone cement loosening. CONCLUSION: The modified classification system of Kümmell's disease can be used to guide treatment of Kümmell's disease, but the number of clinical application cases is limited, and further application and observation are needed. 目的: 报告一种 Kümmell 病改良分型系统及其临床应用效果。. 方法: 基于 CT 及 MRI 图像，根据矢状面终板完整性及椎体后壁完整性、椎体压缩程度，提出一种 Kümmell 病改良分型系统。2011 年 1 月—2018 年 3 月，将该改良分型系统用于评估并指导 78 例 Kümmell 病患者的治疗。男 13 例，女 65 例；年龄 54～85 岁，平均 69.1 岁。病程 1～8 个月，平均 4.0 个月。骨密度 T 值−3.86～−3.34，平均−3.66。骨折节段：胸椎 47 例，腰椎 31 例。根据 Kümmell 病改良分型系统，A1 型 11 例、A2 型 13 例、A3 型 2 例、B1 型 10 例、B2 型 18 例、B3 型 4 例、C1 型 4 例、C2 型 5 例、C3 型 11 例。参照分型结果进行针对性治疗，A、B 型患者均选择经皮椎体后凸成形术（percutaneous kyphoplasty，PKP），C 型患者选择 PKP 或后路椎体内固定术。采用疼痛视觉模拟评分（VAS）及 Oswestry 功能障碍指数（ODI）评估临床疗效；影像学图像上测量椎体前缘、中间及后缘高度以及后凸 Cobb 角，记录相关并发症发生情况。. 结果: 经统计分析，该改良分型系统具有良好一致性。患者术后均获随访，随访时间 12～36 个月，平均 24.3 个月。各型患者末次随访时伤椎前缘、中间、后缘高度以及 Cobb 角、VAS 评分和 ODI 与术前比较，差异均有统计学意义 ( P<0.05)。术后 4 例 A2 型患者出现不同程度椎体高度丢失；2 例 B2 型、3 例 C1 型及 2 例 C2 型患者 PKP 术中出现无症状骨水泥渗漏；2 例 B3 型、3 例 C2 型患者因骨水泥松动行经皮内固定联合伤椎强化处理。. 结论: Kümmell 病改良分型系统可用于指导 Kümmell 病的治疗，但目前临床应用例数有限，其应用价值有待进一步观察明确。.

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