椎弓根螺钉联合经皮椎体后凸成形术治疗陈旧性椎体骨折不愈合  

The pedicle screw combined with percutaneous kyphoplasty foRtreatment of nonunion of old vertebral fractures

作　　者：周顺[1] 富灵杰[2] 金文杰[2] ZHOU Shun;FU Ling-jie;JIN Wen-jie(Dept of Orthopaedics and Traumatology,Pinghu Hospital of TCM,Pinghu,Zhejiang 314200,China)

机构地区：[1]平湖市中医院骨伤科,浙江平湖314200 [2]上海交通大学医学院附属第九人民医院脊柱外科,上海200011

出　　处：《临床骨科杂志》2022年第2期161-165,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨椎弓根螺钉联合经皮椎体后凸成形术(PKP)治疗陈旧性椎体骨折不愈合(Kummell病)的手术疗效。方法采用椎弓根螺钉联合PKP治疗25例Ⅱ、Ⅲ期Kummell病患者。采用疼痛VAS评分评估患者疼痛程度及ODI评价脊柱功能改善情况,比较手术前后脊柱后凸Cobb角、椎体前缘及中线高度。结果患者均获得随访,时间24~32个月。切口均一期愈合。术后1例椎旁及椎体前骨水泥渗漏,未损伤椎体前方重要血管,未出现明显不适及疼痛,未予处理;术后6个月,1例L_(1)椎体邻近的T_(12)椎体发生骨折,再次行PKP治疗。在椎体前缘高度、中线高度、后凸Cobb角、疼痛VAS评分及ODI方面,术后3 d及12、24个月均明显优于术前(P<0.05);术后各时间点比较差异均无统计学意义(P>0.05)。末次随访时均未见后凸Cobb角明显增大、椎弓根螺钉松动及椎体序列失稳等情况发生。结论采用椎弓根螺钉联合PKP可以矫正Ⅱ、Ⅲ期Kummell病患者脊柱后凸畸形,能迅速恢复脊柱功能,减轻疼痛,并能较长时间维持病椎的高度和强度,避免了继发性神经损伤及长期卧床并发症的发生。Objective To evaluate the effect of pedicle screw fixation combined with percutaneous kyphoplasty(PKP) in the treatment of old vertebral fracture nonunion(Kummell disease).Methods Pedicle screw fixation combined with PKP were performed in 25 patients with Kummell disease of Ⅱ,Ⅲ-stage. Pain VAS was used to evaluate the degree of pain, and ODI was used to evaluate the improvement of the spine function. The spine kyphotic Cobb angle, anterior edge height and midline height of vertebrae were compared between the pre-and post-operation.Results All patients were followed up for 24~32 months.All incisions healed in one-stage.After operation, paravertebral and prevertebral bone cement leakage occurred in 1 case, which did not damage the important vessels in front of the veterbrae, without obvious discomfort and pain, and no further treatment.At 6 months after operation, one patient had T;fracture adjacent to L;,so the patient underwent PKP again.In the aspect of vertebral anterior edge height, median line height, kyphotic Cobb angle, pain VAS and ODI,the indators of patients at 3 d, 12,24 months postoperation were better than the preopeation(P<0.05);however, there were no statistical differences among the above indexes at each time-point after operation(P>0.05).At the last follow-up, there were no significant increase of kyphotic Cobb angle, loosening of pedicle screw and instability of vertebrae sequence.Conclusions The pedicle screw fixation combined with PKP can correct kyphosis deformity in patients with Kummell disease of Ⅱ,Ⅲ-stage, restore the spinal function fastly, relieve pain, and maintain the height and strength of spine for long time, which can avoid the the complications of secondary nerve injury and long-term bed rest.

关 键 词：椎弓根螺钉 经皮椎体后凸成形术 骨质疏松性椎体骨折 陈旧性椎体骨折不愈合 

分 类 号：R683.3[医药卫生—骨科学] R681[医药卫生—外科学]