Kümmell病新分型系统评估及临床应用

Evaluation and clinical application of a new classification system for Kümmell disease

中文关键词:  Kümmell病  分型系统  治疗  临床应用

英文关键词:Kümmell disease  Classification system  Treatment  Clinical application

中文摘要:

  【摘要】目的：对Kümmell病提出一种新的分型方法，探讨其对临床治疗的指导意义。方法：回顾性分析我院有完整随访资料的168例Kümmell病患者，结合其临床表现及不同影像学改变，将其分为Ⅰ~Ⅴ型。其中影像学表现以骨不连为特点的定义为Ⅰ型（78例），治疗方式为经皮椎体成形术（percutaneous vertebroplasty，PVP）；影像学表现以不稳定为特点的为Ⅱ型（30例），手术方式为后路固定融合；影像学表现以继发椎管狭窄为特点的为Ⅲ型（27例），手术方式为后路减压固定融合；影像学表现以后凸为特点的为Ⅳ型（23例），治疗方式为后路截骨矫形固定融合；影像学表现为以上3种或4种类型混合存在为特点的为Ⅴ型（10例），治疗方式取决于引起患者最主要症状的类型。随访术后VAS评分及ODI评分，观察伤椎高度有无丢失或继发后凸畸形，以及神经功能改善情况。结果：所有患者均获得12~54个月随访，平均28.4±4.6个月。Ⅰ~Ⅴ型患者的VAS评分由术前8.0±1.7、8.2±1.6、8.4±1.4、7.9±1.2、8.5±1.3分改善为末次随访时的2.1±1.3、2.2±1.2、2.3±1.4、2.2±1.4、2.3±1.5分；ODI评分由术前69.5±2.8、68.5±2.6、69.7±2.2、65.6±2.7、68.6±2.7分改善为末次随访时的38.1±1.5、37.1±1.3、34.1±1.3、35.2±1.4、33.1±2.1分。所有患者VAS评分及ODI评分较术前均有改善，差异有统计学意义（P＜0.05）。19例（11.3％，19/168）患者伤椎高度有所丢失或继发局部后凸畸形。伴有神经功能损伤的15例患者末次随访时ASIA分级由术前12例C级改善为D级3例，E级9例；D级3例均改善为E级。结论：本研究表明Kümmell病的新Ⅰ~Ⅴ型分型方法客观、简单、易行，对临床治疗具有指导意义。

英文摘要:

  【Abstract】 Objectives: To propose a new system for classifying Kümmell disease, and to evaluate its feasibility for guiding clinical treatment. Methods: A retrospective study of 168 cases of Kümmell disease with complete follow-up data was conducted at our institute. Patients were divided into type Ⅰ-Ⅴ based on a combination of clinical manifestations and different morphological changes detected by imaging. Type Ⅰ was characterized by bone non-union imaging, percutaneous vertebroplasty(PVP) was the primary treatment option for this basic imaging morphological change in Kümmell disease. Type Ⅱ was characterized by instability imaging, posterior fixation and fusion was the primary treatment option. Type Ⅲ was characterized by spinal stenosis imaging, the primary treatment option was posterior decompression fixation and fusion. Type Ⅳ was characterized by kyphosis imaging, the primary treatment option was posterior osteotomy, fixation, and fusion. Type Ⅴ was characterized by a combination of 3 or 4 of the above imaging signs, the treatment provided was related to the specific responsible types. Treatment outcomes were evaluated based on postoperative visual analogue scale(VAS) and Oswestry disability index(ODI) scores. During the follow-up period, it was observed whether the damaged vertebra exhibited compression or local secondary kyphosis and whether neurological function improved in patients accompanying with neurological symptoms. Results: Each patient received between 12-54(mean, 28.4±4.6) months of follow-up. Patients of each type had statistically significant improvements in postoperative VAS and ODI scores compared with preoperative scores. The VAS scores of type Ⅰ-Ⅴ patients improved from preoperative 8.0±1.7, 8.2±1.6, 8.4±1.4, 7.9±1.2 and 8.5±1.3 points respectively, to the final follow-up of 2.1±1.3, 2.2±1.2, 2.3±1.4, 2.2±1.4, 2.3±1.5 points. And the ODI scores of type Ⅰ-Ⅴpatients improved from preoperative 69.5±2.8, 68.5±2.6, 69.7±2.2, 65.6±2.7 and 68.6±2.7 respectively, to the final follow-up of 38.1±1.5, 37.1±1.3, 34.1±1.3, 35.2±1.4, 33.1±2.1 points. The difference was statistically significant(P＜0.05). During the follow-up period, 19 patients(11.3%) exhibited compression of damaged vertebra or local secondary kyphotic deformity. At the final follow-up of patients with neurological deficits, the American Spinal Injury Association(ASIA) grade of C in 12 patients improved to grade D in 3 cases, grade E in 9 cases, and 3 patients of grade D all improved to grade E. Conclusions: This new classification of Kümmell disease in type Ⅰ-Ⅴ is objective, simple and easy to perform, and can effectively guide clinical treatment.