| 陈述伟,谈仁渊,雷宜松,等.Wiltse入路后路固定联合伤椎强化微创治疗高龄Ⅲ期Kümmell病.骨科,2023,14(6): 506-510. |
| Wiltse入路后路固定联合伤椎强化微创治疗高龄Ⅲ期Kümmell病 |
| Efficacy of Posterior Fixation Combined with Fractured Vertebral Cement Augmentation by Wiltse Approach in the Minimally Invasive Treatment of Stage Ⅲ Kümmell's Disease in the Elderly |
| 投稿时间：2023-04-04 |
| DOI：10.3969/j.issn.1674-8573.2023.06.004 |
| 中文关键词: Kümmell病 高龄 后路固定 骨水泥成形术 微创 Wiltse入路 骨质疏松症 |
| 英文关键词: Kümmell's disease Elderly Posterior fixation Cementoplasty Minimal invasion Wiltse approach Osteoporosis |
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| 中文摘要: |
| 目的 探讨Wiltse入路后路固定骨水泥强化技术治疗高龄Ⅲ期Kümmell病的安全性与有效性。方法 回顾性分析武汉市江夏区第一人民医院骨科2016年5月至2022年6月采用Wiltse入路后路固定联合伤椎强化技术治疗的39例高龄Ⅲ型Kümmell病病人的临床资料，其中男17例，女22例；年龄为（73.0±4.2）岁（70~85岁）。记录手术时间、失血量、住院时间及手术并发症。比较术前、术后第2天及末次随访的疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）、伤椎高度及脊柱后凸Cobb角。结果 所有病人均获得随访，随访时间为（14.5±2.3）月（9~21个月）。手术时间（75.0±12.1） min（65~92 min），失血量（93.0±11.2） mL（75~110 mL），住院时间（7.2±1.2） d（6~10 d）。术后第2天CT检查发现骨水泥椎间隙漏2例，骨水泥椎旁漏3例，随访过程中未见内固定物松动及断裂。术后第2天的VAS评分、ODI分别为（2.7±0.8）分、33.0%±2.5%，均较术前显著降低，术后第2天的椎体中线高度百分比（87.5%±9.8%）较术前（45.3%±11.2%）明显恢复，后凸Cobb角（6.5°±2.3°）较术前（25.8°±5.1°）明显减小，差异均有统计学意义（P＜0.05）。末次随访时的数据虽较术后第2天时进一步改善，但差异无统计学意义（P＞0.05）。结论 Wiltse入路后路固定联合骨水泥强化技术治疗高龄Ⅲ期Kümmell病安全有效，可以明显减轻胸背部疼痛，恢复伤椎高度，纠正脊柱后凸畸形，改善病人生活质量。 |
| 英文摘要: |
| Objective To investigate the safety and therapeutic effect of posterior fixation combined with fractured vertebral cement augmentation in the treatment of stage Ⅲ Kümmell disease in elderly patients by Wiltse approach. Methods The clinical data of 39 elderly patients with stage Ⅲ Kümmell's disease treated by posterior fixation combined with fractured vertebral cement augmentation by Wiltse approach from May 2016 to June 2022 in the Department of Orthopaedics of the First People's Hospital of Jiangxia District were analyzed retrospectively, including 17 males and 22 females, aged from 70-85 years ［(73.0±4.2) years］. Operation time, blood loss, length of hospital stay, and surgical complications were recorded. The visual analogue scale (VAS) scores, Oswestry disability index (ODI), injured vertebral height, and kyphosis Cobb angle were compared before operation, 2nd day postoperation and at final follow-up. Results All patients were followed up for (14.5±2.3) months (9-21 months). The operation time was (75.0±12.1) min (65-92 min), intraoperative blood loss was (93.0±11.2) mL (75-110 mL), and hospital stay was (7.2±1.2) d (6-10 d). Based on CT examination at 2nd day postoperation, there were 2 patients with intervertebral space leakage, 3 with paravertebral cement leakage, but none reported associated clinical symptoms. No loosening and rupture of internal fixation were detected during the follow-up time. The VAS score and ODI at the second postoperative day were 2.7±0.8, 33%±2.5%, respectively, which were significantly lower than before surgery, the percentage of midline height of the injured vertebral body on the second day after surgery (87.5%±9.8%) was significantly restored compared to preoperative (45.3%±11.2%), and the Cobb angle of kyphosis (6.5°±2.3°) was significantly reduced compared to preoperative (25.8°±5.1°), with statistically significant differences (P＜0.05). Although the data at the last follow-up were improved further compared to the second day after surgery, the difference was not statistically significant (P＞0.05). Conclusion Posterior fixation combined with fractured vertebral cement augmentation in the treatment of stage Ⅲ Kümmell disease in elderly patients by Wiltse approach is safe and effective, which can significantly relieve chest and back pain, restore the height of the injured vertebra, correct kyphosis deformity, and improve the life of patients. |
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