椎弓根螺钉强化技术联合PVP治疗kummell病的疗效及对患者脊柱稳定性和肢体功能的影响

摘要 目的：探究椎弓根螺钉强化技术联合经皮椎体成形术（PVP）治疗kummell病的疗效及对患者脊柱稳定性和肢体功能的影响。方法：选择2017年1月-2020年12月期间新疆医科大学第六附属医院和海军医科大学第二附属医院收治的64例kummell病患者，按照治疗方法分为PVP组（使用PVP治疗，32例）和强化组（使用椎弓根螺钉强化技术联合PVP治疗，32例），比较两组围术期指标、脊柱稳定性、肢体功能及并发症。结果：强化组手术时长、术后住院时间长于PVP组，伤椎骨水泥注入量、透视次数、术中出血量多于PVP组，差异有统计学意义（P＜0.05）。末次随访时，两组伤椎局部Cobb角较术前降低，强化组低于PVP组，伤椎椎体前缘高度比较术前升高，强化组高于PVP组，差异有统计学意义（P＜0.05）。末次随访时，两组Roland-Morris功能障碍中文调查表（CRMDQ）、改良版Oswestry功能障碍指数量表（ODI）评分较术前降低，强化组低于PVP组，差异有统计学意义（P＜0.05）。两组随访期间腰背部疼痛、骨水泥渗漏、相邻椎体骨折等并发症差异无统计学意义（P＜0.05）。结论：PVP术治疗kummell病具有时间短、出血少、恢复快、透视次数少等明显优势，但椎弓根螺钉强化技术联合PVP治疗kummell病可以更好的保证脊柱稳定性，促进肢体功能恢复，且不增加并发症发生率。

Effect of Pedicle Screw Augmentation Techniques Combined with PVP in the Treatment of Kummell's Disease and the Influence on Spinal Stability and Limb Function

ABSTRACT Objective: To investigate the effect of pedicle screw augmentation techniques combined with percutaneous vertebroplasty (PVP) in the treatment of Kummell''s disease and the influence on spinal stability and limb function. Methods: A total of 64 patients with Kummell''s disease who were admitted to the Department of Spinal Surgery at the Sixth Affiliated Hospital of Xinjiang Medical University and the Second Affiliated Hospital of Naval Medical University from January 2017 to December 2020 were divided into the PVP group (32 patients treated with PVP) and the augmentation group (32 patients treated with pedicle screw augmentation techniques and PVP) according to the treatment method. Perioperative indicators, spinal stability, limb function and complications were compared between the groups. Results: The operation time and postoperative hospital stay of the augmentation group were longer than those of the PVP group. The volume of bone cement injected into the injured vertebra, fluoroscopy times and intraoperative blood loss were more than those in the PVP group (P<0.05). At the last follow-up, local Cobb angles of injured vertebral bodies in the two groups decreased, and Cobb angle in the augmentation group was smaller than that in the PVP group. The anterior vertebral height increased, and anterior vertebral height in the augmentation group was larger than that in the PVP group (P<0.05). At the last follow-up, the Roland-Morris Disability Questionnaire (RMDQ) scores and the modified Oswestry Disability Index (ODI) scores in the two groups decreased. The augmentation group had lower scores than the PVP group (P<0.05). Up to the last follow-up, there was no statistically significant difference in the incidence rates of complications such as low back pain, bone cement leakage and adjacent vertebral fracture (P<0.05). Conclusion: PVP has obvious advantages in the treatment of Kummell''s disease, such as short duration, less blood loss, fast recovery and less fluoroscopy times. However, pedicle screw augmentation techniques combined with PVP can better ensure spinal stability and promote the recovery of limb function, without increasing the incidence of complications.