短节段椎弓根钉内固定＋骨水泥注入治疗合并Ktimmell病的胸腰段单椎体骨折  

Effectiveness of short segment pedicle screw fixation plus pecutaneous vertebroplasty for treatment of single thoracolumbar fracture with Kiimmell disease

作　　者：黄阳亮[1] 徐晶辉 王晓波[1] 谢超凡[1] 李泽民[1] 龙厚清[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510700

出　　处：《中华创伤杂志》2017年第11期1011-1015,共5页Chinese Journal of Trauma

摘　　要：目的探讨短节段椎弓根钉内固定＋骨水泥注入治疗合并Ktimmell病的胸腰段单椎体骨折的临床疗效。方法采用前瞻性病例系列研究分析2012年6月-2014年6月收治的15例合并Ktimmell病的胸腰段单椎体骨质疏松性椎体压缩骨折患者临床资料，其中男3例，女12例；年龄48～80岁，平均62．5岁。损伤节段：T11 3例，T12 4例，L1 5例，L2 3例。均采用短节段椎弓根钉内固定＋骨水泥1注入治疗。记录手术时间、手术相关并发症；随访期间有无相邻椎体骨折等并发症；术前、术后1周、末次随访时视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）及手术节段后凸Cobb角。结果手术时间0．8—2h，平均1．35h。未见伤口感染、神经损伤、骨水泥渗漏等手术相关并发症。15例患者获随访16～36个月，平均22．4个月。患者均可见椎体前方融合或明显骨桥形成，未见邻近节段再骨折。VAS由术前（5．93±0．62）分改善为术后1周的（1．80±0．64）分及末次随访的（2．60±0．53）分；ODI由术前61．53±4．30改善为术后1周的19．93±3．26及末次随访的23．07±4．06。手术节段后凸Cobb角由术前（17．40±6．73）°改善为术后1周的（9．53±3．12）°及末次随访的（11．00±3．20）°。与术前比较，术后1周、末次随访的VAS、ODI及手术节段后凸Cobb角差异均有统计学意义（P〈0．05或0．01）；而术后1周与末次随访的ODI及手术节段后凸Cobb角差异均无统计学意义（P〉0．05）。结论合并Ktimmell病的胸腰段单椎体骨质疏松性椎体压缩骨折，行短节段椎弓根钉内固定＋骨水泥注入治疗，可缩短手术时间，降低并发症发生率，明显缓解疼痛，促进功能恢复，防止手术节段后凸角度丢失，值得临床推广。Objective To study the surgical indications and effectiveness of short segment pedicle screw fixation plus peeutaneous vertebroplasty （PVP） for single thoracolumbar fracture combined with Ktimmell disease. Methods Between June 2012 and June 2014, a prospective case series analysis was made on the clinical data of 15 selected cases of single thoracolumbar fracture patients who were combined with Ktimmell disease. There were three males and 12 females, with an average age of 62.5 years （range, 48-80 years）. The injured vertebrae were located at Tljin 3 cases, at T12 in 4, at Ll in 5 and at L2 in 3. All the patients were treated by short segment fixation plus PVP. Operative time, surgery-related complications and adjacent vertebral fracture during follow-up were recorded. The effectiveness of the treatment was appraised by visual analogue scale （VAS）, Oswestry Disability Index （ODI） , Cobb angle of operative segment, which were recorded preoperatively, one week post-operatively and at final follow-up. One-way ANOVA （Analysis of Variance） was employed for statistical analysis. Results The operative time was 0. 8-2 hours （mean, 1.35 hour）. There was no observation of incision infection, nerve injury, cement leakage or other related operative complications. A total of 15 patients were followed up for 16- 36 months （mean, 22.4 months）, which showed solid fusion and bone bridges in all patients, with no fracture of adjacent vertebra observed. VAS was improved from preoperative （ 5.93 ±0.62） points to （1.80±0.64） points one week postoperatively and （2.60 ± 0.53 ）points at final follow-up. ODI was improved from preoperative 61.53 ±4.30 to 19.93 ± 3.26 one week postoperatively and 23.07 ±4.06 at final follow-up. Cobb angle of operative segment was improved from preoperative （ 17.40 ± 6.73 ）° to （9.53 ± 3.12）° one week postoperatively and （ 11.00 ± 3.20）° at final follow-up. There was significant difference of all the indexes namely, VAS, ODI and Cobb angle, bet

关 键 词：脊柱骨折 骨质疏松 内固定器 椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]