ABSTRACT
Objective:To investigate the short-term clinical outcomes of posterior percutaneous pedicle screw fixation combined with percutaneous vertebroplasty (PVP) for treating Kümmell's disease with intravertebral instability.Methods:A retrospective case series study was made on 18 patients with Kümmell's disease with intravertebral instability treated at Lishui Hospital of Zhejiang University from January 2012 to February 2016. There were 4 males and 14 females, aged 65-86 years [(76.0±5.5)years]. Segment of injury was T 7 in 1 patient, T 10 in 2, T 11 in 3, T 12 in 4, L 1 in 6, and L 2 in 2. All patients underwent posterior percutaneous pedicle screw fixation combined with PVP. The operation time, intraoperative blood loss, amount of cement injected into the vertebra, and length of postoperative hospital stay were recorded. The visual analogue scale (VAS), Oswestry disability index (ODI), Cobb angle, and wedge angle of the operative segment were recorded and compared preoperatively, postoperatively, and at the latest follow-up. Meanwhile, the complications were recorded. Results:All patients were followed up for 12-28 months [(17.7±4.4)months]. The operation time was 110-175 minutes [(137.9±21.9)minutes] and the blood loss was 50-165 ml [(110.7±35.6)ml]. The amount of cement injected into the vertebra was 2.5-6.0 ml [(4.7±0.9)ml]. The length of hospital stay was 7-14 days [(9.4±2.3)days]. The VAS was (7.8±1.2) points preoperatively, (3.3±0.7) points at 1 week postoperatively and (2.4±0.7)points at the latest follow-up. The ODI was (67.3±7.3)% preoperatively, (30.5±7.5)% at 1 week postoperatively and (21.8±8.3)% at the latest follow-up. The Cobb angle was (26.2±9.5)° preoperatively, (12.6±7.2)° at 1 week postoperatively and (16.7±6.2)°at the latest follow-up. The wedge angle was (21.1±6.1)° preoperatively, (8.4±4.6)° at 1 week postoperatively, and (13.2±4.1)° at the latest follow-up. The above clinical and radiological parameters were significantly improved after operation ( P<0.05), and showed no significant differences at the latest follow-up when compared to that at 1 week postoperatively ( P>0.05). Five patients showed slight screw loosening, but there was no obvious dislocation of internal fixation. One case developed distal vertebral compression fracture at 6 months postoperatively and cured after a second PVP. Conclusion:For Kümmell's disease with intravertebral instability, posterior percutaneous pedicle screw fixation combined with PVP can effectively restore and maintain the spinal sequence, rapidly relieve the pain and improve clinical function. However, the long-term efficacy needs further study.
ABSTRACT
Objective:After the propensity score matching method was used to balance the covariates between groups, the effects of pancreaticoduodenectomy (PD) and total pancreatectomy (TP) on the survival of patients with pancreatic head cancer and related prognostic factors were compared.Methods:The National Cancer Institute Surveillance, Epidemiology and Results (SEER) database were searched and 3 676 patients with pancreatic head cancer from 2010 to 2016 were selected, of whom 3 559 patients underwent PD (PD group) and 117 patients underwent TP (TP group) . Using propensity score matching to balance confounding factors, 117 pairs of cases from PD group and TP group were matched successfully. The Kaplan-Meier curve was used to observe the overall survival rate and cancer-specific survival rate of patients before and after matching. Log-rank test and Cox proportional hazard model were used to analyze and evaluate the impact of different clinicopathological characteristics on the prognosis of patients with pancreatic head cancer.Results:Before matching, the 1, 3, and 5-year cancer-specific survival rates of 3 559 patients in the PD group were 72.8%, 35.1% and 24.9%, and the median survival time was 23.89 months; the 1, 3, and 5-year cancer-specific survival rates of 117 patients in the TP group were 67.9%, 29.4% and 26.1%, and the median survival time was 21.51 months, and all the differences were not statistically significant (all P>0.05). After matching, the 1, 3, and 5-year cancer-specific survival rates of 117 patients in the PD group were 77.8%, 44.5% and 31.8%, and the median survival time was 31.50 months, which was significantly better than that of the TP group, and the differences were statistically significant (all P values <0.05). Cox regression analysis showed that surgical methods, tumor differentiation degree, N staging and pathological types were independent risk factors for overall survival and cancer-specific survival. Conclusions:Surgical methods, tumor differentiation degree, N stage and pathological type were independent risk factors affecting the overall survival rate and cancer-related survival rate. The survival benefit of PD was significantly better than that of TP, and the clinical choice of TP treatment for patients with pancreatic head cancer should be cautious.