经椎弓根植骨治疗胸腰段严重椎体塌陷伴神经功能障碍Kummell病患者临床疗效  

Clinical effect of transpedicular bone grafting in the treatment of Kummell′s disease with severe collapse of thoracolumbar vertebrae and neurological dysfunction

作　　者：肖伟[1] 殷剑[1] 赵清斌 车立新[1] 孙俊刚[1] XIAO Wei;YIN Jian;ZHAO Qing-bin;CHE Li-xin;SUN Jun-gang(Orthopaedic Centre of Xinjiang Uygur Autonomous Region People′s Hospital,Urumqi 830001,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆维吾尔自治区人民医院骨科中心,新疆维吾尔自治区乌鲁木齐830001

出　　处：《创伤与急危重病医学》2021年第1期50-52,共3页Trauma and Critical Care Medicine

摘　　要：目的探讨经椎弓根植骨治疗胸腰段严重椎体塌陷伴神经功能障碍Kummell病患者的临床疗效。方法选取自2013年8月至2018年4月新疆维吾尔自治区人民医院收治的12例胸腰段严重椎体塌陷伴神经功能障碍Kummell病患者为研究对象,记录患者术中出血量及并发症的发生情况;采用Oswestry功能障碍指数及改良Frankel评分评估术前及末次随访时患者的临床结果;采用X线影像评估术后及末次随访时患者伤椎前缘高度恢复率(RAVH)、伤椎椎体局部后凸角(LKA)、胸腰段后凸角(TLK)及植骨椎体骨性愈合情况。结果本组12例患者的失血量为160~610 m1,平均(390.5±51.5)ml。12例患者术后及末次随访平均RAVH分别是术前的(3.24±2.58)、(2.98±2.85)倍。本组患者术后1周LKA、TLK矫正情况较术前明显改善,差异有统计学意义(P<0.05);术后1周与末次随访LKA、TLK矫正情况比较,差异均无统计学意义(P>0.05)。本组患者术前Oswestry功能障碍指数评分为(38.20±4.40)分,末次随访为(12.80±1.72)分,差异有统计学意义(P<0.05)。末次随访时,所有患者经X线、CT影像检查,伤椎椎体内骨填充充分,无裂隙样死腔,骨性愈合良好,无椎弓根螺钉松动及脊柱失稳,无断钉、断棒现象,除2例患者需拐杖辅助行走外,其余患者均恢复独立行走。结论经椎弓根植骨治疗胸腰段严重椎体塌陷伴神经功能障碍Kummell病的临床疗效较佳,能够很好地矫正后凸,恢复椎体高度。Objective To investigate the clinical effect of transpedicular bone grafting in the treatment of Kummell′s disease with severe collapse of thoracolumbar vertebrae and neurological dysfunction.Methods A retrospective study was performed on 12 cases of patients with Kummell′s disease,severe collapse of thoracolumbar vertebrae and neurological dysfunction who were admitted from August 2013 to April 2018.The amount of intraoperative hemorrhage and complications were recorded;the Oswestry dysfunction index and the modified Frankel score were used to evaluate the clinical results before and at the last follow-up;X-ray was used to evaluate the clinical results after and at the last follow-up to access the restored ratio of anterior vertebral height(RAVH),local kyphotic angle(LKA),thoracolumbar kyphosis(TLK)and bone grafting vertebrae.Results The blood loss of 12 patients in this group was 160-610 ml,with an average of(390.5±51.5)ml.The mean RAVH of the 12 patients after surgery and at the last follow-up was(3.24±2.58)and(2.98±2.85)times of that before surgery,respectively.In this group,LKA and TLK correction 1 week after surgery was significantly improved compared with that before surgery,and the difference was statistically significant(P<0.05).There was no significant difference in LKA and TLK correction between 1 week after the operation and the last follow-up(P>0.05).The preoperative Oswestry disability index score of patients in this group was(38.20±4.40)points and(12.80±1.72)points at the last follow-up(P<0.05).At the last follow-up,X-ray and CT imaging showed that all the patients had full bone filling in the injured vertebra,no cracked dead space,good bone healing,no pedicle screw loosening and spinal instability,and no broken screws or broken rods.Except for 2 patients who needed crutch-assisted walking,all the other patients resumed walking independently.Conclusion The treatment of Kummell′s disease with severe collapse of thoracolumbar vertebrae and neurological dysfunction by transpedicular bone gr

关 键 词：Kummell病 经椎弓根植骨 椎弓根钉内同定 

分 类 号：R687.3[医药卫生—骨科学]