Objective: To compare the effectiveness between short segmental fixation combined with vertebroplasty (SSF+VP) and short segmental pedicle screw fixation combined with bone graft (SSF+BG) in the treatment of unstable type Kümmell's disease so as to provide a reference for the selection of the surgical method.
Methods: Between March 2013 and February 2015, 48 patients with unstable type Kümmell's disease who were in accordance with the inclusive criteria were included in the study. SSF+VP were used in 25 cases (SSF+VP group) and SSF+BG in 23 cases (SSF+BG 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), and kyphotic Cobb angle between 2 groups ( P>0.05). The operation time and complications related to operation were recorded; the effectiveness was evaluated by VAS, ODI, and kyphotic Cobb angle.
Results: The operation time was (107.7±18.8) minutes in SSF+VP group and was (113.7±22.4) minutes in SSF+BG group, showing no significant difference between 2 groups ( t=-1.045, P=0.302). Bone cement leakage occurred in 6 cases of SSF+VP group, and incision delayed healing occurred in 1 case of SSF+BG group. All patients achieved bone graft fusion on X-ray films. The bone graft fusion time was (15.1±1.3) weeks in SSF+VP group and (15.7±1.8) weeks in SSF+BG group, showing no significant difference between 2 groups ( t=-1.361, P=0.180). The VAS, ODI, and kyphotic Cobb angle at immediate after operation and at last follow-up were significantly lower than preoperative ones ( P<0.05). The VAS, ODI, and kyphotic Cobb angle had no significant difference between at immediate and at last follow-up in SSF+VP group ( P>0.05). In SSF+BG group, VAS at last follow-up was significantly lower than that at immediate after operation ( P<0.05), but no significant difference was found in kyphotic Cobb angle and ODI ( P>0.05). SSF+VP group was significantly better than SSF+BG group in VAS at immediate after operation ( P<0.05), but SSF+BG group was significantly better than SSF+VP group at last follow-up ( P<0.05). There was no significant difference in kyphotic Cobb angle and ODI between 2 groups at immediate after operation and at last follow-up ( P>0.05).
Conclusion: SSF+BG can achieve satisfactory effectiveness in the treatment of unstable type Kümmell's disease, and it has the advantages of good bony healing, obvious improvement of pain, and low complication incidence when compared with SSF+VP.
目的: 比较短节段钉棒固定联合伤椎椎体成形（short segmental pedicle screw fixation combined with vertebroplasty，SSF+VP）以及短节段钉棒固定联合伤椎植骨（short segmental pedicle screw fixation combined with bone graft，SSF+BG）治疗不稳定型 Kümmell 病的疗效，为临床选择治疗方法提供参考。.
方法: 将 2013 年 3 月—2015 年 2 月收治并符合选择标准的 48 例不稳定型 Kümmell 病患者纳入研究。其中 25 例采用 SSF+VP 治疗（SSF+VP 组），23 例采用 SSF+BG 治疗（SSF+BG组）。两组患者性别、年龄、病程、骨密度、骨折节段以及术前疼痛视觉模拟评分（VAS）、功能障碍指数（ODI）以及后凸 Cobb 角比较，差异均无统计学意义（ P>0.05），具有可比性。记录两组手术时间以及手术相关并发症发生情况；采用 VAS、ODI 评分以及后凸Cobb角评价手术疗效。.
结果: SSF+VP组手术时间为（107.7±18.8）min，SSF+BG组为（113.7±22.4）min，两组比较差异无统计学意义（ t=–1.045， P=0.302）。术中SSF+VP组 6 例出现骨水泥渗漏，术后 SSF+BG 组 1 例切口延迟愈合。X 线片复查示，两组植骨均融合，SSF+VP组植骨融合时间为（15.1±1.3）周，SSF+BG组为（15.7±1.8）周，比较差异无统计学意义（ t=–1.361， P=0.180）。两组术后即刻及末次随访时 VAS、ODI 评分以及 Cobb 角均显著低于术前（ P<0.05）。SSF+VP 组术后即刻及末次随访时以上指标比较，差异均无统计学意义（ P>0.05）；而 SSF+BG 组末次随访时 VAS 评分显著低于术后即刻（ P<0.05）；Cobb 角、ODI 评分与术后即刻比较，差异无统计学意义（ P>0.05）。术后即刻 SSF+VP 组 VAS 评分优于 SSF+BG 组（ P<0.05），但末次随访时 SSF+BG 组明显优于 SSF+VP 组（ P<0.05）；术后即刻及末次随访时两组间 Cobb 角、ODI 评分比较，差异均无统计学意义（ P>0.05）。.
结论: 与 SSF+VP 相比，SSF+BG 治疗不稳定型 Kümmell 病术后骨折椎体可达骨性愈合，疼痛改善明显，并发症较少，疗效更满意。.
Keywords: Kümmell’s disease; bone graft; short segmental fixation; vertebroplasty.