A novel bone cement screw system combined with vertebroplasty for the treatment of Kummell disease with bone deficiency at the vertebral anterior border: A minimum 3-year follow-up study
A novel bone cement screw system combined with vertebroplasty for the treatment of Kummell disease with bone deficiency at the vertebral anterior border: A minimum 3-year follow-up study
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新型骨水泥螺钉系统联合椎体成形术治疗椎体前缘骨缺损的库梅尔病：至少 3 年的随访研究
DOI：
10.1016/j.clineuro.2020.106434
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发表时间：
2021-02-01
影响因子：
1.9
通讯作者：
Hao, Dingjun
中科院分区：
文献类型：
--
作者：
Wang, Biao;Wang, Yuhang;Hao, Dingjun
目的：当椎体成形术用于治疗椎体前缘骨缺损的Kummell病时，术中或术后经常发生骨水泥移位。我们设计并使用了一种新的骨水泥螺钉系统，以避免这种严重的并发症。本研究的目的是通过3年以上的随访来评估这种新型手术方法的安全性和有效性。患者和方法：从2014年1月至2016年8月，27例患有单节段Kummell病并伴有椎体前缘骨质缺损的患者接受了椎体成形术联合新型骨水泥螺钉的治疗。通过螺钉将骨水泥释放到患病椎骨中，以完全填充椎内真空裂隙。螺钉固定骨水泥可避免术中或术后移位。所有患者均接受单侧手术，每例患者仅植入一枚螺钉。采用Odom标准，对椎体指数（VBI）、椎体角（θ）、双节段Cobb角（BCA）、视觉模拟评分（VAS）、奥斯韦斯特里功能障碍指数（ODI）及健康状况调查表（SF-36）进行统计学分析。平均手术时间为49.63 ± 10.82 min，平均骨水泥注入量为4.70 ± 0.87 mL。患者的术前VBI、VAS、BCA、VAS和ODI评分分别为43.11 ± 5.94、21.04 ± 2.55、45.00 ± 6.26、7.59 ± 0.84和79.85 ± 7.58。术后测量值分别为78.70 ± 2.55、12.70 ± 2.11、26.11 ± 4.73、3.22 ± 0.93和50.04 ± 9.28。末次随访时，测量值分别为78.04 ± 2.30、13.15 ± 2.38、27.07 ± 4.87、2.04 ± 0.65和22.85 ± 5.06。术前与术后、术前与末次随访资料比较，差异均有统计学意义（P < 0.05）。SF-36评分术前与末次随访时比较，躯体功能、躯体角色、躯体疼痛、活力、社会功能差异有统计学意义（P < 0.05）。然而，在一般健康、情绪功能和心理健康方面没有显著差异。结论：3年的随访研究表明，新型骨水泥螺钉系统联合椎体成形术治疗椎体前缘骨质疏松的Kummell病患者具有良好的中、短期疗效，其长期疗效有待进一步研究。
Objectives: When vertebroplasty is used to treat Kummell disease with bone deficiency at the vertebral anterior border, bone cement displacement often occurs intraoperatively or postoperatively. We designed and used a new bone cement screw system to avoid this serious complication. The purpose of this study was to evaluate the safety and effectiveness of this novel operation method through more than 3 years of follow-up.Patients and methods: From January 2014 to August 2016, 27 patients suffering from single-segment Kummell disease with bone deficiency at the vertebral anterior border were treated by vertebroplasty combined with a novel bone cement screw. Bone cement was released into the diseased vertebrae through the screw to fully fill the intravertebral vacuum cleft. Screw fixation of bone cement can avoid intraoperatively or postoperatively displacement. All patients received surgery involving a unilateral technique, and only one screw was implanted in each patient. The clinical efficacy was evaluated using Odom's criteria and statistical analysis of the vertebral body index (VBI), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analogue scale (VAS), Oswestry disability index (ODI), and the results of the MOS 36-item short form health survey (SF-36).Results: The operation was completed successfully in 27 cases. The average operation time was 49.63 +/- 10.82 min, and the average volume of cement injected was 4.70 +/- 0.87 mL. The patients' preoperative VBI, VBA, BCA, VAS and ODI scores were 43.11 +/- 5.94, 21.04 +/- 2.55, 45.00 +/- 6.26, 7.59 +/- 0.84, and 79.85 +/- 7.58, respectively. The postoperative measurements were 78.70 +/- 2.55, 12.70 +/- 2.11, 26.11 +/- 4.73, 3.22 +/- 0.93 and 50.04 +/- 9.28, respectively. At the last follow-up, the measurements were 78.04 +/- 2.30, 13.15 +/- 2.38, 27.07 +/- 4.87, 2.04 +/- 0.65, and 22.85 +/- 5.06, respectively. There was a significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P < 0.05). Comparing the results of SF-36 before operation and at the last follow-up revealed significant differences in physical function, role-physical, body pain, vitality, and social function (P < 0.05). However, there were no significant differences in general health, emotional function and mental health. Finally, 26 patients (96.3 %) had good to excellent clinical outcomes according to Odom's criteria.Conclusions: This 3-year follow-up study shows that the novel bone cement screw system combined with vertebroplasty has a good short and medium-term therapeutic effect in patients with Kummell disease and bone deficiency at the vertebral anterior border, while its long-term efficacy is subject to further studies.