骨水泥强化螺钉内固定技术在矫正Kümmell病伴后凸畸形的临床效果对比研究  

Comparative study on clinical effect of bone cement-strengthened screw fixation in the correction of Kümmell's disease with kyphosis

作　　者：杭海峰 王宏伟[1] 陈礼鑫 汤新兵 黄爱兵 HANGHai-feng;WANG Hong-wei;CHEN Li-xin;TANG Xin-bing;HUANG Ai-bing(Jiangsu Vocational College of Medicine,Yancheng 224000,Jiangsu,China;Department of Spine Surgery,Yangzhou Jiangdu People's Hospital,Yangzhou 225200,Jiangsu,China;Department of Spine Surgery,Taizhou People's Hospital,Taizhou225300,Jiangsu,China)

机构地区：[1]江苏医药职业学院,江苏盐城224000 [2]扬州市江都人民医院脊柱外科,江苏扬州225200 [3]泰州市人民医院脊柱外科,江苏泰州225300

出　　处：《中国骨伤》2025年第3期280-286,共7页China Journal of Orthopaedics and Traumatology

基　　金：江苏医药职业学院校外教学基地科研发展基金项目(编号:20229139)。

摘　　要：目的:探讨骨水泥强化椎弓根螺钉技术应用于矫正Ⅲ期无神经症状Kümmell病伴后凸畸形的临床疗效。方法:回顾性分析2019年3月至2021年12月收治的40例无神经症状Ⅲ期Kümmell病患者的临床资料,男15例,女25例,年龄61~81(67.4±5.2)岁,根据手术方式不同分为经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)组和强化钉组。PKP组18例,男7例,女11例;年龄61~78(66.2±5.5)岁;病程5~12(7.33±1.78)个月;骨密度(bone mineral density,BMD)T值为-2.45~-4.00(-3.08±0.46);T_(8)-T_(9)2例,T_(10)-T_(12)10例,L_(1)-L_(2)6例;予PKP治疗。强化钉组22例,男8例,女14例;年龄65~81(68.5±3.8)岁;病程4~15(7.86±2.73)个月;BMD的T值-2.40~-4.50(-3.18±0.54);T_(8)-T_(9)3例,T_(10)-T_(12)12例,L_(1)-L_(2)7例;行骨水泥强化椎弓根螺钉内固定联合伤椎后凸成形术治疗。比较两组术前、术后3 d和12个月伤椎后凸Cobb角、伤椎椎体前缘高度;比较两组术前和术后12个月疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI);比较两组术后并发症发生情况。结果:两组患者获得随访,PKP组随访时间11~14(11.97±0.96)个月,强化钉组随访时间10~14(12.05±1.09)个月,两组比较差异无统计学意义(P>0.05)。强化钉组术后3 d、12个月Cobb角分别为(7.34±2.26)°、(18.86±1.96)°,PKP组分别为(18.88±1.89)°、(23.28±1.90)°,差异有统计学意义(P<0.05);强化钉组术后3 d、12个月伤椎前缘高度分别为(25.28±1.33)、(19.62±2.22)mm,与PKP组(18.61±2.16)、(15.93±1.34)mm比较,差异有统计学意义(P<0.05);两组术后3 d及12个月Cobb角与伤椎前缘高度均较术前明显改善,差异有统计学意义(P<0.05)。术后12个月,PKP组、强化钉组VAS分别为(2.00±0.69)、(1.91±0.61)分,ODI分别为(13.44±4.02)%、(10.18±4.26)%,均较术前(6.89±0.76)、(7.23±0.75)分及(36.33±3.40)%、(37.09±3.73)%明显降低,差异有统计学意义(P<0.05);两组术后12个月VAS比较,差异无Objective To explore clinical effect of bone cement-strengthened pedicle screw technique in the correction of stageⅢasymptomatic Kümmell disease with kyphosis.Methods A retrospective analysis was conducted on clinical data of 40 asymptomatic stageⅢKümmell disease patients admitted between March 2019 and December 2021,including 15 males and 25 females,aged from 61 to 81 years old with an average of(67.4±5.2)years old;according to different surgical methods,they were divided into percutaneous kyphoplasty group(PKP)and reinforced screw group.There were 18 patients in PKP group,including 7 males and 11 females,aged from 61 to 78 years old with an average of(66.2±5.5)years old;the courses of disease ranged from 5 to 12 months with an average of(7.33±1.78)months;bone mineral density(BMD)T values ranged from-2.45 to-4.00 with an average of(-3.08±0.46);2 patients with T_(8)-T_(9),10 patients with T_(10)-T_(12),and 6 patients with L_(1)-L_(2);treated with PKP.There were 22 patients in reinforced screw group,including 8 males and 14 females,aged from 65 to 81 years old with an average of(68.5±3.8)years old;the courses of disease ranged from 4 to 15 months with an average of(7.86±2.73)months;bone mineral density(BMD)T values ranged from-2.40 to-4.50 with an average of(-3.18±0.54);3 patients with T_(8)-T_(9),12 patients with T_(10)-T_(12),and 7 patients with L_(1)-L_(2);treated with bone cement reinforced pedicle screw internal fixation combined with kyphoplasty.Cobb angle and anterior margin height of the injured vertebra were compared before operation,3 d and 12 months after operation.Visual analogue scale(VAS)and Oswestry disability index(ODI)were compared between two groups before operation and 12 months after operation.The incidence of postoperative complications was compared between two groups.Results All patients were followed up,PKP group followed up for 11 to 14 months with an average of(11.97±0.96)months and 10 to 14 months with an average of(12.05±1.09)months in reinforced screw group;there was no s

关 键 词：骨水泥强化 椎弓根螺钉 Kümmell病 经皮椎体后凸成形术 后凸畸形 矫形 

分 类 号：R683.2[医药卫生—骨科学]