后路长节段固定联合伤椎打压植骨与联合伤椎骨水泥强化治疗Ⅲ期Kümmell病的疗效比较  

Posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation in the treatment of stage Ⅲ Kümmell disease:a comparison of efficacies

作　　者：姜文涛[1] 梅伟 王庆德[1] 朱彦谕 张振辉[1] 刘沛霖[1] 苏锴 康永生[1] Jiang Wentao;Mei Wei;Wang Qingde;Zhu Yanyu;Zhang Zhenhui;Liu Peilin;Su Kai;Kang Yongsheng(Department of Spinal Surgery,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China;Fifth Clinical College of Henan University of Chinese Medicine(Zhengzhou People′s Hospital),Zhengzhou 450002,China;Zhoukou Central Hospital,Zhoukou 466000,China)

机构地区：[1]郑州市骨科医院脊柱外科,郑州450052 [2]河南中医药大学第五临床医学院(郑州人民医院),郑州450002 [3]周口市中心医院骨科,周口466000

出　　处：《中华创伤杂志》2023年第7期611-618,共8页Chinese Journal of Trauma

摘　　要：目的比较后路长节段固定联合伤椎打压植骨与联合伤椎骨水泥强化治疗Ⅲ期Kümmell病的疗效。方法采用回顾性队列研究分析2016年1月至2020年12月郑州市骨科医院收治的38例Ⅲ期Kümmell病患者临床资料,其中男8例,女30例;年龄59~81岁[(68.9±4.9)岁]。骨折椎体:T_(8)1例,T_(11)9例,T_(12)10例,L_(1)8例,L_(2)10例。17例行后路长节段固定联合伤椎椎弓根打压植骨术治疗(打压植骨组),21例行后路长节段固定联合伤椎骨水泥强化术治疗(骨水泥组)。比较两组手术时间、术中出血量;术前、术后1周、术后3个月及末次随访时视觉模拟评分(VAS)、日本骨科学会(JOA)评分、后凸Cobb角;末次随访时骨性愈合情况;并发症发生率。结果患者均获随访24~35个月[(28.7±2.9)个月]。打压植骨组手术时间为(150.7±25.4)min,术中出血量为(285.3±48.6)ml;骨水泥组分别为(132.0±21.1)min和(251.4±44.8)ml(P均<0.05)。术前两组VAS、JOA评分及后凸Cobb角差异无统计学意义(P均>0.05)。术后1周、术后3个月及末次随访时打压植骨组VAS分别为(3.2±0.8)分、(2.7±0.5)分、(2.2±0.7)分,骨水泥组分别为(2.7±0.6)分、(2.6±0.7)分、(2.4±0.8)分,术后1周打压植骨组VAS高于骨水泥组(P<0.05),术后3个月及末次随访时两组差异无统计学意义(P均>0.05)。术后1周、术后3个月及末次随访时两组JOA评分差异无统计学意义(P均>0.05)。术后1周、术后3个月及末次随访时打压植骨组后凸Cobb角分别为(5.1±1.3)°、(5.9±1.8)°、(6.5±2.5)°,低于骨水泥组的(8.4±1.6)°、(12.6±2.1)°、(14.5±3.3)°(P均<0.01)。末次随访时打压植骨组均获骨性愈合,骨水泥组2例骨性愈合不佳。打压植骨组1例手术切口延迟愈合。打压植骨组并发症发生率为5.9%(1/17),骨水泥组为9.5%(2/21)(P>0.05)。结论对于Ⅲ期Kümmell病,后路长节段固定联合伤椎打压植骨与联合伤椎骨水泥强化治疗均能有效减轻疼痛、改善脊柱功�Objective To compare the efficacies of posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation in treating stage Ⅲ Kümmell disease.Methods A retrospective cohort study was conducted to analyze the clinical data of 38 patients with stage Ⅲ Kümmell disease who were admitted to Zhengzhou Orthopedic Hospital between January 2016 and December 2020.The study included 8 male and 30 female patients,with ages ranging from 59 to 81 years[(68.9±4.9)years].The vertebral fractures occurred at T_(8) in 1 patient,T_(11) in 9 patients,T_(12) in 10 patients,and L_(2) in 10 patients.Seventeen patients underwent posterior long segment instrumentation combined with transpedicular impaction bone grafting(impaction bone grafting group),and 21 patients underwent posterior long segment instrumentation combined with bone cement augmentation(bone cement group).The surgical duration,intraoperative blood loss,and incidences of postoperative complications were compared between the two groups.Additionally,the visual analogue score(VAS),Japanese orthopedic association(JOA)score,and Cobb angle were compared before the operation,at 1 week and 3 months post-operation,and at the final follow-up for both groups.The study also compared bone healing at the last follow-up and postoperative complication rates between the two groups.Results All the patients were followed up for 24-35 months[(28.7±2.9)months].The impaction bone grafting group had a surgical duration of(150.7±25.4)minutes and intraoperative blood loss of(285.3±48.6)ml,significantly different from those in the bone cement group[(132.0±21.1)minutes,(251.4±44.8)ml](all P<0.05).Before the operation,there were no significant differences in the VAS,JOA score,or Cobb angle between the two groups(all P>0.05).The VAS was(3.2±0.8)points,(2.7±0.5)points and(2.2±0.7)points in the impaction bone grafting group and was(2.7±0.6)points,(2.6±0.7)points and(2.4±0.8)points in the bone cement group at 1 week and 3 months p

关 键 词：骨质疏松性骨折 胸椎 腰椎 内固定器 骨移植 骨水泥成形术 

分 类 号：R687.3[医药卫生—骨科学]