椎弓根螺钉强化固定联合椎体成形术与截骨矫形术治疗Ⅲ期Kummell病的疗效分析  

Efficacy of pedicle screw enhancement combined with vertebroplasty and osteotomy in the treat-ment of stage Ⅲ Kummell's disease

作　　者：李杰[1] 朱宇[1] 李毅[1] 李高磊 樊晓韩 黎少言 Li Jie;Zhu Yu;Li Yi;Li Gaoei;Fan Xiaohan;Li Shaoyan(Department of Orthopaedics,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院骨科二病区,郑州450014

出　　处：《中华实验外科杂志》2024年第7期1432-1436,共5页Chinese Journal of Experimental Surgery

摘　　要：目的探讨椎弓根螺钉强化固定联合椎体成形术与截骨矫形术治疗Ⅲ期Kummell病的手术方法, 比较两种术式的临床疗效。方法选取郑州大学第二附属医院自2020年9月至2023年9月收治的Ⅲ期Kummell病患者42例, 根据治疗方案分为椎体成形组及截骨矫形组, 椎体成形组25例, 行上下椎弓根螺钉强化固定、病椎椎体成形术, 截骨矫形组17例, 行上下椎弓根螺钉强化固定、病椎楔形截骨矫形术。比较两组患者手术相关指标(手术时间、术中出血量、术后引流量、住院时间、并发症发生率)、临床疗效评价[术前、术后、末次随访的疼痛视觉模拟评分(VAS), 腰痛日本骨科协会评分(JOA), Oswestry功能障碍指数(ODI), 脊柱后凸Cobb角]。计量资料采用独立样本t检验;计数资料采用χ^(2)检验。结果所有患者均顺利完成手术, 腰背痛、下肢麻木无力等症状明显改善。椎体成形组出现1例切口感染, 截骨矫形组出现1例脑脊液漏, 治疗后均恢复良好。患者获随访(11.2±4.5)个月(8~20个月)。椎体成形组在手术时间、术中出血量、术后引流量方面低于截骨矫形组, 差异有统计学意义[椎体成形组:(129.81±8.94) min、(133.82±14.34) ml、(62.90±7.27) ml;截骨矫形组:(165.07±7.84) min、(244.93±19.24) ml、(95.00±9.09) ml, t=-161.691、61.542、104.251, P<0.05]。结论椎弓根螺钉强化固定联合椎体成形术与截骨矫形术治疗Ⅲ期Kummell病, 均可解除神经压迫, 纠正后凸畸形, 重建脊柱稳定性, 随访疗效良好。Objective The surgical methods of pedicle screw enhancement fixation combined with vertebroplasty and osteotomy in the treatment of stage II Kummell's disease were discussed,and their clini-cal efficacy was compared.Methods A total of 42 patients with stage II Kummell's disease who were ad-mitted to the Second Affiliated Hospital of Zhengzhou University from September 2020 to September 2023 were selected and divided into vertebroplasty group and osteotomy group according to the treatment plan:25 cases in the vertebroplasty group underwent enhanced fixation of upper and lower pedicles and vertebro-plasty,and 17 cases in the osteotomy group underwent enhanced fixation of upper and lower pedicles and wedge-shaped osteotomy and orthopedics.The two groups were compared with the relevant indexes of surgery(operation time,intraoperative blood loss,postoperative drainage volume,hospital stay,complication rate),clinical efficacy evaluation[pain visual analogue score(VAS),low back pain efficacy Japanese Orthopaedic Association score(JOA),Oswestry dysfunction index(ODI),kyphosis Cobb angle preoperation,postoper-ation and at last follow-up].The continuous data were expressed as mean±standard deviation(x±s)using independent samples t-tests.The χ^(2) test was used for counting.Results All patients successfully comple-ted the operation,and the symptoms of low back pain,numbness and weakness of the lower limbs were sig-nificantly improved.There was one case of incision infection in the vertebroplasty group and one case of ce-rebrospinal fluid leakage in the osteotomy group,and both recovered well after treatment.The patients were followed up for mean(11.2±4.5)months(8-20 months).The operation time,intraoperative blood loss,and postoperative drainage volume in the vertebroplasty group were significantly reduced as compared with those in the osteotomy group[vertebroplasty group:(129.81±8.94)min,(133.82±14.34)ml,(62.90±7.27)ml;osteotomy group:(165.07±7.84)min,(244.93±19.24)ml,(95.00±9.09)ml,t=-161.691,61.542,104.251,P<0,0

关 键 词：椎弓根螺钉 椎体成形术 截骨矫形术 Kummell病 

分 类 号：R687.3[医药卫生—骨科学]