经椎弓根打压植入含富集骨髓的同种异体骨联合后路内固定治疗Ⅲ期Kümmell病  

Transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow in the treatment of stage III Kümmell′s disease

作　　者：丁超利 张振辉[2] 朱彦谕 郑雪静 苏锴 王庆德[2] Ding Chaoli;Zhang Zhenhui;Zhu Yanyu;Zheng Xuejing;Su Kai;Wang Qingde(Second Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450046,China;Department of Spine Surgery,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)

机构地区：[1]河南中医药大学第二临床学院,郑州450046 [2]郑州市骨科医院脊柱外科,郑州450052

出　　处：《中华创伤杂志》2022年第2期116-124,共9页Chinese Journal of Trauma

摘　　要：目的比较经椎弓根打压植入含富集骨髓的同种异体骨联合后路内固定与经后路椎体次全切除联合后路内固定治疗Ⅲ期Kümmell病的临床疗效。方法采用回顾性队列研究分析2015年6月至2018年12月郑州市骨科医院收治的40例Ⅲ期Kümmell病患者的临床资料,其中男10例,女30例;年龄57~79岁[(67.7±6.1)岁]。19例采用经椎弓根打压植入含富集骨髓的同种异体骨联合后路内固定治疗(打压植骨组),21例采用经后路椎体次全切除联合后路内固定治疗(椎体次全切组)。比较两组手术时间和术中出血量。术前、术后1周及末次随访时采用视觉模拟评分(VAS)、日本骨科学会(JOA)评分、Cobb角对两组疼痛程度、腰椎功能障碍情况及脊柱后凸程度进行评估。比较两组骨愈合时间。观察两组并发症发生情况。结果患者均获随访25~64个月[(40.6±10.4)个月]。打压植骨组手术时间及术中出血量分别为(130.0±10.1)min和(284.5±43.5)ml,短于或小于椎体次全切组的(253.8±33.2)min和(889.1±95.7)ml(P均<0.01)。术前、术后1周及末次随访时两组间VAS、JOA评分及脊柱后凸Cobb角差异无统计学意义(P均>0.05)。两组内任意时相点VAS、JOA评分比较,差异有统计学意义(P均<0.01)。术后1周两组脊柱后凸Cobb角与术前比较明显减小(P均<0.01);末次随访时两组脊柱后凸Cobb角与术后1周比较虽有所增加,但与术前比较仍明显减小(P均<0.01)。患者未出现疼痛复发及后凸畸形加重。打压植骨组骨愈合时间为[4.4(4.0,5.0)个月],明显短于椎体次全切组的[6.4(5.2,8.1)个月](P<0.01)。打压植骨组2例出现切口延迟愈合,并发症发生率为11%;椎体次全切组2例出现硬膜撕裂,3例出现切口延迟愈合,并发症发生率为24%。术后两组并发症发生率差异无统计学意义(P>0.05)。随访期间两组均未出现内固定松动、断裂等并发症。结论经椎弓根打压植入含富集骨髓的同种异体骨�Objective To compare the clinical effect of transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation and posterior subtotal vertebrectomy combined with posterior internal fixation in the treatment of stage III Kümmell′s disease.Methods A retrospective cohort study was made on clinical data of 40 patients with stage III Kümmell′s disease admitted to Zhengzhou Orthopedic Hospital from June 2015 to December 2018.There were 10 males and 30 females,at age range of 57-79 years[(67.7±6.1)years].A total of 19 patients were treated by transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation(impaction bone graft group),and 21 patients by posterior subtotal vertebrectomy combined with posterior internal fixation(subtotal vertebrectomy group).Operation time and intraoperative blood loss were compared between the two groups.Degree of pain,lumbar dysfunction and degree of kyphosis were evaluated by visual analogue scale(VAS),Japanese Orthopedic Association(JOA)score and kyphotic Cobb angle before operation,at 1 week after operation and at the last follow-up.Bone healing time was compared between the two groups.The complications of the two groups were observed.Results All patients were followed up for 25-64 months[(40.6±10.4)months].Operation time and intraoperative blood loss were(130.0±10.1)minutes and(284.5±43.5)ml in impaction bone graft group,lower than those in subtotal vertebrectomy group[(253.8±33.2)minutes,(889.1±95.7)ml](both P<0.01).There were no significant differences in VAS,JOA score or kyphotic Cobb angle between the two groups before operation,at 1 week after operation and at the last follow-up(all P>0.05).Both VAS and JOA score showed significant differences within each group at any time point(all P<0.01).In both groups,the kyphotic Cobb angle reduced significantly at 1 week after operation when compared with that before operation(all P<0.01),and the ang

关 键 词：骨坏死 骨髓移植 骨折固定术 内 Kümmell病 

分 类 号：R687.3[医药卫生—骨科学]