短节段椎弓根螺钉固定联合椎体成形术治疗伴有后凸畸形Kümmell病  

Short-segment pedicle screw fixation combined with vertebroplasty for the treatment of Kümmell disease with kyphosis

作　　者：黄兆波[1] 颜少峰 李生鋆 刘军辉[1] 范顺武[1] 赵凤东[1] HUANG Zhao-bo;YAN Shao-feng;LI Sheng-yun;LIU Jun-hui;FAN Shun-wu;ZHAO Feng-dong(Department of Orthopaedics,Sir Run Run Shaw Hospital Affiliated to Zhejiang University,Hangzhou310016,Zhejiang,China)

机构地区：[1]浙江大学附属邵逸夫医院骨科,浙江杭州310016

出　　处：《中国骨伤》2021年第8期694-700,共7页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金(编号:81871796)。

摘　　要：目的:探讨后路短节段椎弓根螺钉内固定联合椎体成形术治疗伴有后凸畸形Kümmell病的临床疗效。方法:回顾性分析2016年1月至2018年12月采用后路短节段椎弓根螺钉内固定联合椎体成形术治疗的24例伴有后凸畸形Kümmell病患者,其中男6例,女18例,年龄63~85(73.1±6.5)岁。比较患者术前、术后3 d及末次随访时的疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI),伤椎椎体前缘高度,受累节段矢状面Cobb角等指标以评价临床疗效,并观察手术并发症。结果:所有24例患者获得随访,时间12~24(15.5±3.2)个月。VAS评分由术前的5.21±1.06下降至术后3 d的2.38±0.58以及末次随访时的1.71±0.75;ODI由术前的(50.4±13.5)%下降至术后3 d的(20.9±8.0)%以及末次随访时的(16.7±9.6)%;椎体前缘高度由术前的(8.0±4.2)mm恢复至术后3 d的(18.1±5.0)mm以及末次随访时的(16.8±5.1)mm;Cobb角由术前的(19.5±6.3)°下降至术后3 d的(7.6±2.1)°以及末次随访时的(8.4±1.7)°。术后3 d和末次随访VAS、ODI、椎体前缘高度、Cobb角较术前明显改善(P<0.05)。术后出现1例无症状骨水泥渗漏,1例浅表切口感染。结论:后路短节段椎弓根螺钉内固定联合椎体成形术治疗伴有后凸畸形Kümmell病具有手术创伤相对小、临床效果优良、椎体高度恢复良好、后凸角度纠正满意、并发症少等优势,是治疗伴有明显后凸畸形Kümmell病的一种较为安全有效的手术方式。Objective:To explore the clinical effects of posterior short segment pedicle screw internal fixation combined with vertebroplasty for the treatment of Kümmell disease with kyphosis. Methods:Twenty four patients with Kümmell disease complicated with kyphosis treated by posterior short segment pedicle screw internal fixation combined with vertebroplasty from January 2016 to December 2018 were retrospectively analyzed,including 6 males and 18 females,aged 63 to 85(73.1±6.5)years old. The clinical effect was evaluate by visual analogue scale(VAS),Oswestry Disability Index(ODI),the anterior height of injured vertebral body,and the sagittal Cobb angle of the affected segment before operation,at 3 days and final follow up after operation. And the surgical complications were observed. Results:All 24 patients were followed up from 12 to 24 months with an average of(15.5±3.2) months. The VAS score was decreased from 5.21±1.06 preoperatively to 2.38±0.58 at 3 days postoperatively and 1.71±0.75 at final follow up;ODI was decreased from(50.4±13.5)% preoperatively to(20.9±8.0)%at 3 days postoperatively and(16.7±9.6)% at final follow up;the anterior height of injured vertebral body was restored from(8.0±4.2) mm before surgery to(18.1±5.0) mm at 3 days after surgery and(16.8±5.1) mm at final follow up;the sagittal Cobb angle of affected segment was decreased from(19.5±6.3)° preoperatively to(7.6±2.1)° at 3 days after surgery and(8.4±1.7)°at final follow up. VAS,ODI,anterior height of injured vertebral body,and sagittal Cobb angle of affected segment were significantly improved at 3 days after operation and at final follow up(P<0.05). Two patients had complications,including asymptomatic cement leakage in 1 patient and superficial wound infection in 1 patient. Conclusion:Posterior short segment pedicle screw internal fixation combined with vertebroplasty for the treatment of Kümmell disease with kyphosis has relatively small surgical trauma,excellent clinical results,good vertebral height recovery,satisfactory

关 键 词：Kümmell病 骨折固定术 内 椎体成形术 骨质疏松 

分 类 号：R681.5[医药卫生—骨科学]