经伤椎椎弓根钉棒固定联合高粘度骨水泥灌注强化治疗Ⅲ期Kümmell病的临床疗效分析  

Analysis on the clinical efficacy of the combined intensive treatment of transpedicular pedicle screw fixation and priming of high-viscosity bone cement for Kümmell disease in stageⅢ

作　　者：李海涛[1] 孙丽静 胡成栋[1] 王瑞[1] 霍喜卫[1] LI Hai-tao;SUN Li-jing;HU Cheng-dong(Department of Orthopedics,Handan Central Hospital,Handan 056001,China.)

机构地区：[1]邯郸市中心医院骨科,河北邯郸056001 [2]邯郸市第七医院手术室,河北邯郸056001

出　　处：《中国医学装备》2020年第7期96-100,共5页China Medical Equipment

基　　金：河北省医学科学研究重点课题计划(20150451)“经皮椎体成形术治疗骨质疏松性锥体骨折的疗效及近远期并发症”。

摘　　要：目的:观察分析经伤椎椎弓根钉棒固定联合高粘度骨水泥椎体强化与经皮椎体成形术(PVP)治疗Ⅲ期Kümmell病的临床疗效差异。方法:选取在医院行手术治疗的55例Ⅲ期Kümmell病患者的临床资料,根据患者手术方法的不同将其分为观察组(26例)和对照组(29例),观察组采用经伤椎椎弓根钉棒固定联合高粘度骨水泥灌注强化治疗;对照组采用高粘度骨水泥椎体成形术治疗。比较两组患者的手术时间、术中出血量、卧床时间、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎高度和局部脊柱侧弯倾斜的两个椎体间最大角度夹角(Cobb角)恢复情况,记录相关并发症发生情况。结果:观察组患者治疗中的手术时间、术中出血量及卧床时间明显高于对照组,差异有统计学意义(t=13.127,t=31.931,t=18.641;P<0.05);术后两组患者VAS评分及ODI均较术前有显著降低,差异有统计学意义(FVAS评分=68.362,F=59.861;FODI=76.583,F=72.649;P<0.05);两组术后1周及1年时比较,差异无统计学意义。术后两组患者的椎体高度及Cobb角较术前均有显著恢复(F伤椎体高度=40.821,F=49.936;FCobb角=80.223,F=75.420;P<0.05);观察组恢复效果明显优于对照组,术后1周和1年时伤椎平均高度及局部Cobb角差异有统计学意义(t伤椎平均高度=2.355,t=3.164;tCobb角=2.164,t=3.022;P<0.05);术后1年时,对照组伤椎平均高度及局部Cobb角较前出现明显丢失,差异有统计学意义(t=2.265,t=2.183;P<0.05)。观察组伤椎骨水泥渗漏发生率为19.2%(5/26),对照组骨水泥渗漏率为20.7%(6/29),差异无统计学意义。结论:经伤椎椎弓根钉棒固定联合骨水泥强化与PVP均是治疗Ⅲ期Kümmell病的有效术式,前者手术创伤大,但椎体高度及后凸角改善及维持的更好,临床需根据患者情况合理选择术式。Objective:To observe and analyze the difference of clinical efficacies of the combined intensive treatment of transpedicular pedicle screw fixation and priming of high-viscosity bone cement and the percutaneous vertebroplasty(PVP)in treating Kümmell disease of stageⅢ.Methods:The clinical data of the total of 55 patients with Kümmell disease in stageⅢwho admitted to hospital were enrolled in this research.According to the different surgical method,these patients were divided into observation group(26 cases)and control group(29 cases).The observation group adopted the intensive treatment that transpedicular pedicle screw fixation combined with highviscosity bone cement priming,and the control group adopted PVP.The operative time,intraoperative blood loss,recumbent time,visual analogue scale(VAS),Oswestry dysfunction index(ODI),height of injured vertebra,and recovery situation of the intersection angle(Cobb angle)of the largest angle between two vertebra when local spine lateral bended and leaned of two groups were compared,and the occurrences of the complication of them were recorded.Results:The operative time,intraoperative blood loss and recumbent time of observation group were significantly higher than those of control group(t=13.127,t=31.931,t=18.641,P<0.05).The VAS score and ODI both two groups post-surgery were significantly lower than those pre surgery(Fv1=68.362,Fv2=59.861,FO1=76.583,FO2=72.649,P<0.05),and the differences of these indicators both two groups between 1 week post-surgery and 1 year post surgery were no significant.Compared with the results pre surgery,the height of vertebra and Cobb angle both two groups post-surgery were significantly recovered(Fheight of injured centrum=40.821,F=49.936,FCobb angle=80.223,F=75.420,P<0.05).The recovery effect of observation group was significantly better than that of control group,and the differences of the average height of injured vertebra and local Cobb angle between 1 week post-surgery and 1 year post-surgery were significant tthe average height of i

关 键 词：椎弓根螺钉 经皮椎体成形术 Kümmell病 高粘度骨水泥 

分 类 号：R681.5[医药卫生—骨科学]