文章摘要
张树威,李景峰,徐振华.短节段骨水泥螺钉内固定联合椎体成形术治疗Ⅲ期Kümmell病的疗效研究.骨科,2021,12(5): 409-413.
短节段骨水泥螺钉内固定联合椎体成形术治疗Ⅲ期Kümmell病的疗效研究
Effectiveness of Short-Segment Bone Cement Screws Fixation Combined with Vertebroplasty in the Treatment of Stage Ⅲ Kümmell Disease
投稿时间:2021-05-18  
DOI:10.3969/j.issn.1674-8573.2021.05.004
中文关键词: Kümmell病  骨水泥强化椎弓根螺钉  短节段固定  椎体成形术
英文关键词: Kümmell disease  Cement-enhanced pedicle screw  Short-segment fixation  Vertebroplasty
基金项目:
作者单位E-mail
张树威 武汉大学中南医院脊柱与骨肿瘤科武汉 430071  
李景峰 武汉大学中南医院脊柱与骨肿瘤科武汉 430071  
徐振华 武汉大学中南医院脊柱与骨肿瘤科武汉 430071 xuzhenhua28@163.com 
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中文摘要:
      目的 评估短节段骨水泥强化椎弓根螺钉固定联合椎体成形术治疗Ⅲ期Kümmell病的临床疗效。方法 回顾性分析2016年9月至2020年9月我科收治的24例Ⅲ期Kümmell病病人,年龄为65~93岁,均采用短节段骨水泥强化椎弓根螺钉内固定联合椎体成形术治疗,记录术前、术后7 d、末次随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI),测量X线片上病椎Cobb角、椎体前缘及后缘高度,根据术后病椎X线片观察骨水泥填充及渗漏情况。结果 24例病人平均随访12个月(6~22个月)。病人术中无血管神经损伤、椎管内骨水泥渗漏等严重并发症发生,术后24~72 h下地行走。3例术后12个月内出现邻近节段或其他椎体骨折,采用经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗后症状缓解。术后7 d及末次随访时的VAS评分、ODI和病椎Cobb角较术前显著降低,椎体前缘高度较术前显著升高,与术前比较,差异均有统计学意义(P<0.05);但末次随访时的数值与术后7 d时的比较,差异无统计学意义(P>0.05)。术后7 d及末次随访时的椎体后缘高度与术前比较,差异无统计学意义(P>0.05)。结论 短节段骨水泥强化椎弓根螺钉内固定联合椎体成形术治疗Ⅲ期Kümmell病,能够安全有效地改善临床症状、恢复病椎高度,并且对脊柱后凸畸形有满意的矫正效果。
英文摘要:
      Objective To evaluate the efficacy of short-segment cement-enhanced pedicle screws fixation combined with vertebroplasty in the treatment of stage Ⅲ Kümmell disease. Methods A retrospective analysis of 24 cases of stage Ⅲ Kümmell disease from September 2016 to September 2020, aged 65-93 years, was performed. All patients underwent short-segment cement-enhanced pedicle screws fixation combined with vertebroplasty, and the effectiveness of the operation was evaluated by visual analogue scale (VAS), Oswestry disability index (ODI) and Cobb angle of X-ray film, anterior and posterior edge heights of the vertebral body. The bone cement filling and leakage was observed according to the postoperative X-ray film. Results All 24 patients were followed up for an average of 12 months (6 to 22 months). The patients had no serious complications such as vascular and nerve injury and bone cement leakage in the spinal canal during the operation. The patients were allowed to walk 24-72 h after the operation. Three cases had adjacent segment or other vertebral fractures within 12 months after surgery, and their symptoms were relieved after PKP treatment. The VAS score, ODI and Cobb angle of the diseased vertebral body at 7 days postoperatively and at the last follow-up were significantly lower than those before the operation. The height of the anterior edge of the vertebral body was significantly higher than that before the operation (P<0.05); but there was no statistically significant difference in the values between the last follow-up and 7 days after surgery (P>0.05). However, there was no statistically significant difference in the height of the posterior edge of the vertebral body at 7 days after operation and the last follow-up compared with that before operation (P>0.05). Conclusion Short-segment cement-enhanced pedicle screws fixation combined with vertebroplasty for stage Ⅲ Kümmell disease can safely and effectively improve the clinical symptoms, restore the height of the diseased vertebrae, and obtain a satisfactory correction effect on kyphosis.
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