| [Objective] Evaluate and compare individual percutaneous kyphoplasty,cutaneous kyphoplasty,Percutaneous Vertebroplasty and short segmental fixation,percutaneous vertebroplasty and short segmental fixation,Clinical efficacy of PVP+SSF in the treatment of Kummell’s disease in stage Ⅱ and Ⅲa without nerve injury.[Methods] From January 2016 to October 2020,55 patients with osteoporotic Kummell’s disease at stage Ⅱ and Ⅲa without nerve injury were collected and screened from the Department of Orthopedics in some tertiary hospitals in Zhangjiakou City,Hebei Province.The patients in PKP group were divided into two groups according to different surgical methods.A total of 30 patients underwent kyphoplasty of the affected vertebra alone.A total of 25 patients in PVP+SSF group received short segmental fixation combined with cement reinforcement.Postoperative follow-up of more than 2 years,Perioperative time,intraoperative blood loss,intraoperative fluoroscopy times,length of hospital stay,total amount of bone cement injected into the affected vertebra,and Visual analogue scale scores of pain1 day before surgery,3 days after surgery,6 months and 2 years after surgery were collected,respectively.VAS),Oswestry disability index(ODI),Cobb Angle and anterior vertebral front height of affected vertebra measured and recorded before and after surgery using anteroposterior and lateral vertebral body radiographs and CT plain scan + 3D reconstruction.The incidence of complications such as bone cement leakage,spinal nerve injury,pedicle screw displacement and vertebral collapse after vertebral operation was observed,and then the relevant data were statistically analyzed by SPSS 26.0 statistical software,in order to evaluate the clinical efficacy of the two groups of operation methods in the treatment of stage Ⅱand Ⅲa Kummell’s disease.[Results] All patients successfully completed the operation,and relatively complete data were obtained through the review and follow-up 2to 2 and a half years after the operation.PKP group was smaller than PVP+SSF group in terms of operation time,intraoperative blood loss,length of hospital stay and bone cement injection amount in affected vertebrae(P < 0.05).But the intraoperative fluoroscopy times were significantly higher than those in PVP+SSF group(P < 0.05).1 day before surgery,VAS and ODI scores were not significantly different between the two groups.VAS and ODI scores of PKP group were lower than those of PVP+SSF group at 3 days after surgery(P < 0.05),but VAS and ODI scores were higher than those of PVP+SSF group at 6 months and 2 years after surgery(P < 0.05).The Cobb Angle of the spine and the anterior edge height of the affected vertebra were not significantly different between the two groups 1 day before surgery(P > 0.05).The Cobb Angle of the spine in the PVP+SSF group was lower than that in the PKP group,and the anterior edge height of the affected vertebra was significantly higher than that in the PKP group(P < 0.05).Complications: During 2 to 2 1/2 years of postoperative follow-up,10 cases of sagittal vertebral imbalance were reported in the PKP group,of which 5 cases had bone cement displacement and 1 case had secondary neurological symptoms.Bone cement leakage occurred in 7 cases.Bone cement leakage occurred in 3 cases in PVP+SSF group.The incidence of postoperative complications in PKP group(56.67%)was much higher than that in PVP+SSF group(12.00%).[Conclusion] For the treatment of osteoporotic Kummell’s disease in stage Ⅱ and Ⅲa without nerve injury,PKP has the advantages of quick postoperative pain improvement and functional recovery,less bleeding,short operation and hospital stay.PVP+SSF has greater advantages in postoperative recovery of the height of the affected vertebra,Cobb Angle of the spine,stable balance of the affected vertebra,long-term pain relief and functional recovery.PVP+SSF can inject more bone cement into the affected vertebra with lower postoperative complications. |
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