骨水泥强化椎弓根螺钉联合椎体成形术治疗Ⅲ型Kümmell病  

Cement-augmented pedicle screw combined with vertebroplasty for the treatment of Kümmell's disease with typeⅢ

作　　者：赵吉鹏[1] 孙传[1] 向学强 刘振辉 吴海安 杜盛阳[2] ZHAO Ji-peng;SUN Chuan;XIANG Xue-qiang;LIU Zhen-hui;WU Hai-an;DU Sheng-yang(Department of Orthopaedics,the First People's Hospital of Xuzhou,Xuzhou 221006,Jiangsu,China)

机构地区：[1]台州市博爱医院骨四科,浙江台州318050 [2]徐州市第一人民医院骨科,江苏徐州221006

出　　处：《中国骨伤》2021年第2期170-174,共5页China Journal of Orthopaedics and Traumatology

基　　金：徐州市科技项目(编号:KC19168)。

摘　　要：目的:探讨骨水泥强化椎弓根螺钉联合椎体成形术治疗Ⅲ型Kümmell病的临床疗效。方法:回顾性分析2015年1月至2018年12月诊治的37例Ⅲ型Kümmell病患者,其中男11例,女26例;年龄61~84(68.6±4.2)岁;病程2~10(6.5±2.3)个月;Frankle分级,C级9例,D级20例,E级8例。所有患者采用骨水泥强化椎弓根螺钉联合椎体成形术进行治疗,评估手术时间、术中出血量、术后引流量、住院时间及其并发症发生率;比较术前及术后不同时间点视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI),伤椎的椎体前缘高度,后凸Cobb角。结果:所有患者获随访,时间12~60(22.4±10.9)个月,手术时间(240.9±77.4)min,术中出血量(315.0±149.2)ml,术后引流量(220.8±72.0)ml,术后住院时间(12.6±4.7)d。患者术后出现切口红肿1例,感染1例,未出现骨水泥松动。术后各时间点的VAS评分、ODI指数低于术前(P<0.05),椎体前缘高度大于术前(P<0.05),Cobb角小于术前(P<0.05)。根据患者末次随访结果进行神经功能Frankel分级,D级2例,E级35例。患者神经功能改善,生活质量明显提高。结论:骨水泥强化椎弓根螺钉联合椎体成形术是Ⅲ型Kümmell病一种安全有效且可行的治疗方法。Objective:To explore clinical effect of cement-augmented pedicle screw combined with vertebroplasty in treating Kümmell disease with typeⅢ.Methods:From January 2015 to December 2018,37 patients with typeⅢKümmell disease were retrospectively analyzed,including 11 males and 26 females,aged from 61 to 84 years old with an average of(68.6±4.2)years old,and the courses of disease ranged from 2 to 10 months with an average of(6.5±2.3)months.Nine patients were grade C,20 patients were grade D and 8 patients were grade E according to Frankle grading.All patients were treated by cement-augmented pedicle screw combined with vertebroplasty.Operation time,blood loss,postoperative drainage,hospital stay and complications were observed after oeprtaion.Visual analogue scale(VAS),Oswestry Disability Index(ODI),height of anterior vertebral body,Cobb angle before and after operation were compared.Results:All patients were followed up from 12 to 60 months with an average of(22.4±10.9)months.Operation time was(240.9±77.4)min,blood loss was(315.0±149.2)ml,postoperative drainage was(220.8±72.0)ml,hospital stay was(12.6±4.7)days.One patient occurred incision redness and 1 patient occurred infection after opertaion.No loosening of bone cement occurred.Postopertaive VAS and ODI were lower than that of before opertaion(P<0.05),height of anterior vertebral body after opertaion was larger than that of before opertaion,Cobb angle after operation was less than that of before operation(P<0.05).According to Frankle grading of never function at the latest follow up,2 patients were grade D and 35 patients were grade E.Nerve function and quality of life was improved.Conclusion:Cement-augmented pedicle screw combined with vertebroplasty is a safe and effective method for the tretament of Kümmell disease with typeⅢ.

关 键 词：骨水泥成形术 椎体成形术 骨折固定术 骨质疏松性骨折 

分 类 号：R681.55[医药卫生—骨科学]