Two kinds of posterior approach for Kümmell's disease after osteoporotic thoracolumbar fracture

LONG Hou-qing; WAN Yong; ZHANG Xin; LIU Shao-yu; LI Fo-bao

摘要

To compare the surgical results of two kinds of posterior approach for osteoporotic thoracolum-bar Kummell's disease.Methods: Clinical and radiographic results of 1-seg-mental pedicle screw fixation combined with vertebroplasty (Group A, n=12) or posterior shortening osteotomy (Group B, n=16) for osteoporotic thoracolumbar Kummell's disease were analyzed retrospectively. Japanese orthopedic asso-ciation (JOA) and visual analogue scale (VAS) scores were used for clinical evaluation. Neurological status was judged by Frankel grades. X-ray was used to evaluate the radio-graphic results. Complications related to operation and de-vices were also considered. Results: The follow-up period was 12-54 months (average 29 months). Pre- and post-operative VAS were 9.3 and 3.2 in Group A, 8.9 and 2.5 in Group B, respectively. The mean JOA score at the final follow-up was significantly higher than that of pre-operation (t=5.306, P<0.001). There was no sig-nificant difference between Groups A and B (t=0.618, P>0.05). The kyphosis were corrected from preoperative 33.9°(A)/37.3°(B) to postoperative 10.3°(A)/6.5°(B), and 15.3°(A)/13.7°(B) at the final follow-up. There was a significant difference between the two groups at the final follow-up. Frankel grade was improved from grade C preoperatively to postopera-tively grade D or E in 7 cases of Group A and 5 cases of Group B, from grade D to E in 5 cases of Group A and 11 cases of Group B. The mean improvement was 1.6 and 1.7 grades for Groups A and B, respectively. There were no serious complications related to internal fixation. Conclusions: The similar clinical results can be ob-tained by the two kinds of posterior surgical methods for osteoporotic Ktimmell's disease. Posterior spinal shorten-ing is a better choice for patients with serious kyphosis combined with neurological deficit than the other.

机译：比较两种后路手术治疗骨质疏松性胸腰椎Kummell病的方法。方法：1段椎弓根椎弓根螺钉固定加椎体成形术（A组，n = 12）或后缩短截骨术（回顾性分析骨质疏松性胸腰段Kummell病的B组（n = 16）。日本骨科协会（JOA）和视觉模拟量表（VAS）得分用于临床评估。神经系统状态由Frankel等级判断。 X射线用于评估射线照相结果。还考虑了与手术和装置有关的并发症。结果：随访时间为12-54个月（平均29个月）。 A组的术前和术后VAS分别为9.3和3.2，B组为8.9和2.5。最后一次随访的平均JOA评分明显高于术前（t = 5.306，P <0.001）。 A组和B组之间无显着差异（t = 0.618，P> 0.05）。最后一次随访将驼背从术前的33.9°（A）/37.3°（B）矫正为术后的10.3°（A）/6.5°（B）和15.3°（A）/13.7°（B）。在最后的随访中，两组之间存在显着差异。 A组7例和B组5例从Frankel级从术前C级提高到术后D或E级，A组5例和B组11例从D级提高到E级。 A组和B组分别为1.6和1.7级。没有内固定相关的严重并发症。结论：两种后路手术治疗骨质疏松性克提梅尔氏病均可获得相似的临床效果。对于患有严重后凸畸形并伴有神经功能缺损的患者，后路脊髓缩短术是更好的选择。

Two kinds of posterior approach for Kümmell's disease after osteoporotic thoracolumbar fracture

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