Comparison Of Short Segment Fixation Combined With PVP And PVP In The Treatment Of Stage Ⅲ Kummell’s Disease

Objective:To compare the early clinical efficacy of bone cement reinforced nail short segment fixation combined with PVP and PVP alone in the treatment of stage Ⅲ Kummell’s disease,so as to evaluate the clinical value of bone cement reinforced nail short segment fixation combined with PVP.Methods:80 patients with stage Ⅲ Kummell’s disease diagnosed by * * * *spine surgery from July 1,2019 to December 30,2021 were analyzed retrospectively,including 17 males and 63 females;The patients were divided into short segment fixation with bone cemen t reinforced nail combined with PVP(combined group) and patients treated with PVP alone(single group).The amount of intraoperative bleeding,operation time,Cobb angle before and after operation,postoperative bed time,length of hospital stay and posto perative complications(bone cement displacement and incision exudation)were recorded in detail,Visual Analog Scale(VAS),Oswety Disability Index(ODI).Results:(1)The age(P = 0.259),sex(P = 0.263)and preoperative bone mineral density(P = 0.273)of the two groups;The operation time of short segment fixation combined with PVP was(101.50 ± 13.27)min and that of simple PVP was(39.00 ± 5.82)min.compared with the two groups(P = 0.000),the operation time of simple PVP was significantly shorter than that of short segment fixation combined with PVP,and the difference was statistically significant;The bleeding volume of short segment fixation combined with PVP was(98.17 ± 19.57)ml,and that of PVP alone was(5.95 ± 3.29)ml.the bleeding volume of PVP alone was less than that of short segment fixation combined with PVP.The difference was statistically significant(P= 0.000).(2)Imaging parameters: The Cobb angle improvement rate(%) of the two groups was compared,the Cobb angle improvement rate(%) of the first day after short segment fixation combined with PVP was 77.23 ± 8.97,and the Cobb angle improvement rate(%) of the first day after PVP alone was15.61 ± 3.51.There was significant difference between the two groups(P =0.000).The Cobb angle improvement rate(%)1 month after short segment fixation combined with pvpf was 75.68 ± 5.53,and the Cobb angle improvement rate(%)1 month after PVP alone was 13.29 ± 1.32.There was significant difference between the two groups(P = 0.000).T he improvement rate of Cobb angle(%)(70.17 ± 5.39),the recovery rate of vertebral body height(67.35 ± 6.29),the improvement rate of Cobb angle(%)(10.56 ± 1.39) and the recovery rate of vertebral body height(19.18 ±8.16)half a year after short segment fixation combined with PVP were statistically significant(P < 0.05).(3)Clinical outcome measures: the preoperative and postoperative pain visual analogue score(VAS) and Oswestry dysfunction index score(ODI)were compared between the two groups.The results of preoperative and last follow-up showed that there was no significant difference in VAS score and ODI between the two groups(P > 0.05).One month after operation,the VAS score and ODI was significantly lower than that of PVP alone(P >0.05).Half a year after operation,VAS score and ODI of low back pain in short segment fixation combined with PVP group were still significantly lower than those before operation,while VAS score and ODI in PVP group alone increased compared with that one month before operation(P < 0.05).(4)Complications: Incision exudation: short segment fixation combined with PVP in 1 case,PVP alone in 0 cases;Bone cement leakage: short segment fixation combined with PVP in 3 cases and PvP alone in 2 cases;Bone cement displacement: short segment fixation combined with PVP in 0cases and PvP alone in 8 cases;Spinal cord and nerve root injury: there were no cases of spinal cord and nerve root injury in both groups;Pedicle screw disorder: short segment fixation combined w ith PVP in 0 cases and PvP alone in 0 cases.Conclusion:1.Short segment fixation with bone cement reinforced nail combined with PVP and PvP alone can quickly alleviate the clinical symptoms in the early stage of stage Ⅲ kummells disease.2.Short segment fixation with bone cement reinforced nail combined with PVP is a safe and effective choice for the treatment of stage Ⅲ kummells disease;3.Compared with PVP alone,short segment fixation with bone cement reinforced nail combined with PVP in the treatment of stage Ⅲ kummells disease has the advantages of less bone cement displacement and symptom recurrence,and the correction of Cobb angle of the diseased vertebral segment is more satisfactory.