Comparison Of Clinical Efficacy Of Two Surgical Treatments For Kümmell Disease

Objective To compare the clinical efficacy between percutaneous kyphoplasty(PKP)and bone cement-augmented short segmental pedicle screw fixation(BCASSF)in the treatment of Kümmell's disease so as to provide a reference for the selection of the surgical method.Methods From Jan 2014 to Dec 2016,60 patients with Kümmell's disease who were in accordance with the inclusive criteria were studied retrospectively.PKP were used in 32 cases(PKP group)and BCASSF in 28 cases(BCASSF group).There was no significant difference in gender,age,disease duration,bone mineral density,fracture segment,and preoperative visual analogue scale(VAS),Oswestry disability index(ODI),anterior vertebral height(AVH)and kyphotic Cobb angle between 2 groups(P>0.05).The operation time,blood loss,hospital stay and complications related to operation were recorded;the effectiveness was evaluated by VAS,ODI,AVH and kyphotic Cobb angle.Results All patients successfully completed the operation.The follow-up period ranged from 12 to 36 months,with a mean of 24.5 months.The operation time(43.1±7.1)minutes in PKP group was significantly lower than(115.9±10.0)minutes in BCASSF group(P<0.05).Intraoperative blood loss in PKP group(9.9±2.7)m L was significantly lower than that in BCASSF group(214.3±17.5)m L(P<0.05).The hospital stay in PKP group(3.4 + 1.2)days was significantly lower than that in BCASSF group(7.6 + 1.3)days(P<0.05).Bone cement leakage occurred in 3 cases of PKP group.In BCASSF group,bone cement leakage occurred in 3 cases,incision delayed healing in 1 cases,pneumonia in 1 cases,urinary tract infection in1 cases.There was no difference in the incidence of complications between 2 groups.The VAS,ODI,AVH and kyphotic Cobb angle at 3 days after operation and at last follow-up were significantly lower than preoperative ones in two groups(P<0.05).The VAS,ODI,AVH and kyphotic Cobb angle had no significant difference between 3 days after operation and last follow-up in PKP group(P>0.05).In BCASSF group,VAS and ODI at last follow-up was significantly lower than that 3 days after operation(P<0.05),but no significant difference was found in AVH and kyphotic Cobb angle(P>0.05).PKP group was significantly better than SSF+BCA group in VAS and ODI 3 days after operation(P<0.05),but no significant difference was found in VAS and ODI between 2 groups last follow-up(P>0.05).There was no significant difference in AVH and kyphotic Cobb angle between 2 groups at 3 days after operation and at last follow-up(P>0.05).Conclusion Both surgical procedures can achieve the purpose of stabilizing the vertebral body,relieving pain,and improving function.Both are safe and effective methods for the treatment of Kümmell's disease.Compared with short segmental fixation combined with bone cement augmentation(BCASSF),percutaneous kyphoplasty(PKP)had a better early result in clinical outcome with simpler procedure,shorter operation time and hospital stay,and less blood loss,but they had similar long-term clinical outcomes and complications.