短节段内固定联合经皮椎体后凸成形术治疗Ⅲ期Kümmell病  

Short-segment reduction and fixation combined with percutaneous kyphoplasty for stageⅢKümmell’s disease

作　　者：董连峰 骆海虎 刘铁龙 高欣 王静 韩志涛 Dong Lianfeng;Luo Haihu;Liu Tielong;Gao Xin;Wang Jing;Han Zhitao(Department of Orthopaedics,Funan County People’s Hospital,Funan Hospital,Fuyang Normal University,Fuyang 236300,Anhui,China;Department of Orthopaedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China;Graduate School,Nanjing University of Chinese Medicine,Nanjing 210000,Jiangsu,China)

机构地区：[1]阜南县人民医院(阜阳师范大学附属阜南医院)骨科,阜阳236300 [2]海军军医大学长征医院骨科,上海200003 [3]南京中医药大学研究生院,南京210000

出　　处：《脊柱外科杂志》2024年第6期386-391,共6页Journal of Spinal Surgery

基　　金：阜阳市卫生健康委科研项目青年项目(FY2021-122)。

摘　　要：目的探讨短节段骨水泥椎弓根螺钉内固定联合经皮椎体后凸成形术(PKP)治疗Ⅲ期Kümmell病的疗效。方法2019年7月—2023年5月阜南县人民医院收治Ⅲ期Kümmell病患者21例,采用短节段骨水泥椎弓根螺钉内固定联合PKP治疗。记录手术时间、术中出血量及骨水泥注入量。测量术前、术后3 d、术后3个月及末次随访时伤椎Cobb角、伤椎前缘高度(并计算丢失百分比)。术前、术后3个月及末次随访时采用疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)评价疼痛程度及功能状态。观察有无椎体继续塌陷、螺钉拔出、断棒等并发症情况。结果所有手术顺利完成,所有患者随访(20.8±7.5)个月,手术时间为(109.5±15.1)min,术中出血量为(67.2±28.5)mL,伤椎骨水泥注入量为(6.0±1.1)mL。所有患者术后各时间点伤椎Cobb角、伤椎前缘高度丢失百分比、VAS评分及ODI较术前显著改善,差异均有统计学意义(P<0.05);所有指标术后各时间点间差异无统计学意义(P>0.05)。术中发生骨水泥渗漏4例(19%),其中3例为椎体侧方静脉渗漏,1例为患椎上终板渗漏。术后均未出现骨水泥移位、螺钉拔出、断棒等情况。结论短节段骨水泥椎弓根螺钉内固定联合PKP治疗Ⅲ期Kümmell病可有效纠正伤椎椎体高度及后凸角,缓解疼痛,提高患者生活质量,疗效可靠。Objective To investigate the efficacy of short-segment bone cement pedicle screw fixation combined with percutaneous kyphoplasty(PKP)in the treatment of stageⅢKümmell’s disease.Methods From July 2019 to May 2023,21 patients with stageⅢKümmell’s disease were admitted to Funan County People’s Hospital and treated with short-segment bone cement pedicle screw fixation combined with PKP.The operation time,intraoperative blood loss and bone cement injection volume were recorded.The Cobb angle and percentage of anterior vertebral height loss of the injured vertebra were measured at pre-operation,postoperative 3 d,postoperative 3 months and the final follow-up.Pain severity and functional status were evaluated using the visual analog scale(VAS)score and Oswestry disability index(ODI)at pre-operation,postoperative 3 months and the final follow-up.The complications such as vertebral collapse,nail extraction and rod breakage were observed.Results All the patients were followed up for(20.8±17.5)months.The operation time was(109.5±15.1)min;the intraoperative blood loss was(67.2±28.5)mL;the bone cement injection volume was(6.0±1.1)mL.All the patients showed significant improvement in Cobb angle,percentage of anterior vertebral height loss,VAS score and ODI at various postoperative time points compared to preoperative levels,all with a statistical significance(P<0.05);there was no statistically significant difference in all the indicators between different time points after surgery(P>0.05).During the operation,there were 4 cases(19%)of bone cement leakage,including 3 of lateral vertebral vein leakage and 1 of upper vertebral endplate leakage.There were no cases of bone cement displacement,screw extraction or rod breakage after surgery.Conclusion Short-segment bone cement pedicle screw fixation combined with PKP for treatment for stageⅢKümmell’s disease can effectively correct the vertebral height and kyphosis angle,relieve pain,improve patients’quality of life,and have reliable therapeutic effects.

关 键 词：胸椎 腰椎 脊柱骨折 骨折 压缩性 骨质疏松 内固定器 骨代用品 椎体后凸成形术 

分 类 号：R683.2[医药卫生—骨科学]