微创双重锚定联合经皮椎体后凸成形术治疗Kümmell病的临床研究  

Clinical investigation of minimally invasive double anchoring combined with percutaneous vertebral augmentation in the treatment of Kümmell disease

作　　者：冯青 苗军[2] 曹盛林 张泽佩 刘迎博 任旺 冯红卫 东彬 李超 及宁 张炳耀 安丽军 Feng Qing;Miao Jun;Cao Shenglin;Zhang Zepei;Liu Yingbo;Ren Wang;Feng Hongwei;Dong Bin;Li Chao;Ji Ning;Zhang Bingyao;An Lijun(Department of Orthopaedics,Cangzhou People's Hospital,Cangzhou 061000,China;Department of Spine,Tianjin Hospital,Tianjin 300211,China;Graduate School,Chengde Medical College,Chengde 067000,China)

机构地区：[1]沧州市人民医院骨科,沧州061000 [2]天津市天津医院脊柱科,天津300211 [3]承德医学院研究生学院,承德067000

出　　处：《中华骨科杂志》2025年第7期412-419,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨应用微创双重锚定联合经皮椎体后凸成形术(percutaoneous kyphoplasty,PKP)治疗Kümmell病的临床疗效。方法回顾性分析2022年10月至2024年3月在沧州市人民医院采用微创双重锚定联合PKP治疗24例Kümmell病患者的临床资料。男6例、女18例,年龄(72.05±4.52)岁(范围66~80岁),T_(10)2例、T_(11)5例、T_(12)7例、L_(1)6例、L_(2)4例。骨密度T值为-3.41±0.77(范围-2.5~4.5);Kümmell病分期:Ⅱ期13例,Ⅲ期11例。记录手术时间、术中出血量、骨水泥注入量,测量手术前后椎体指数、椎体角、病变节段Cobb角。采用疼痛视觉模拟评分(visual analogue scale,VAS)评价疼痛程度,采用Oswestry功能障碍指数(Oswestry disability index,ODI)和日本骨科协会(Japanese Orthopaedic Association,JOA)腰背痛评分评估脊柱功能。采用医学结局研究36项健康调查简表(the Medical Outcome Study short form 36 item health survey,SF-36)评估患者的健康状况。采用Odom标准评价术后症状恢复情况。结果24例患者手术时间为(35.32±6.86)min,术中出血量为(16.56±5.21)ml,骨水泥注入量为(4.39±1.72)ml。所有患者术后均获得随访,随访时间10~14个月,平均11.7个月。术后CT检查示螺钉位置均良好,未发生骨水泥团块松动、移位。术后第1天椎体指数、椎体角、病变节段Cobb角分别为77.71%±2.75%、12.40°±1.53°、25.77°±4.49°,较术前的43.09%±5.66%、22.12°±2.92°、46.98°±5.68°均有改善(P<0.05);末次随访时分别为76.18%±2.32%、12.41°±2.53°、26.14°±4.87°,较术前均有改善(P<0.05),与术后第1天比较差异均无统计学意义(P>0.05)。术后第1天VAS、ODI、JOA评分分别为(2.11±0.87)分、(22.46±5.49)分、(27.68±2.45)分,较术前(7.50±0.98)分、(76.25±8.56)分、(14.96±4.91)分均有改善(P<0.05);末次随访时分别为(2.26±0.88)分、(23.87±3.25)分、(26.58±2.77)分,较术前均有改善(P<0.05),与术后第1天比较差异均无统计学意义(P>0.05)。24例全部�Objective To investigate the clinical efficacy of minimally invasive double anchoring combined with percutaneous kyphoplasty(PKP)for Kümmell disease.Methods The clinical data of 24 patients with Kümmell disease who were treated with minimally invasive double anchoring combined with PKP in Cangzhou People's Hospital from October 2022 to March 2024 were retrospectively analyzed.Among them,there were 2 T_(10) vertebrae,5 T_(11) vertebrae,7 T_(12) vertebrae,6 L_(1) vertebrae,and 4 L_(2) vertebrae.There were 6 males and 18 females.The average age was 72.05±4.52 years(range,66-80 years).The bone mineral density T value was-3.41±0.77(range,-2.5-4.5).The stages of Li's Kümmell disease included 13 cases of stage II and 11 cases of stage III.The operation time,intraoperative blood loss,and volume of bone cement injected were recorded.The vertebral index,vertebral angle and Cobb angle of diseased segment were measured before and after operation.The visual analogue scale(VAS)was used to assess the degree of pain,the Oswestry disability index(ODI)and the Japanese Orthopaedic Association(JOA)low back pain scale were used to assess spinal function.The Medical Outcome Study short form 36 item health survey(SF-36)was used to assess the general health status of the patients.The postoperative symptom recovery was evaluated by Odom criteria.Results The mean operative time of the 24 patients was 35.32±6.86 min,the injected volume of bone cement was 4.39±1.72 ml,and the intraoperative blood loss was 16.56±5.21 ml.All patients were followed up for 10 to 14 months,with an average of 11.7 months.Postoperative CT examination showed that the screw positions were satisfactory,and no loosening or displacement of bone cement mass occurred.On the first day after surgery,the vertebral body index,vertebral body angle and Cobb angle of diseased segment were 77.71%±2.75%,12.40°±1.53°and 25.77°±4.49°,respectively,which represented significant improvements from the preoperative values of 43.09%±5.66%,22.12°±2.92°and 46.98°±5.68�

关 键 词：骨质疏松性骨折 骨折 压缩性 椎体后凸成形术 椎弓根钉 

分 类 号：R687.3[医药卫生—骨科学]