短节段骨水泥钉棒固定联合椎体成形术治疗Ⅲ期Kümmell病

Treatment of stage Ⅲ Kümmell disease with short segment bone cement screw fixation combined with vertebroplasty

中文关键词:  短节段固定  椎体成形术  Kümmell病

英文关键词:Short segment fixation  Vertebroplasty  Kümmell′s disease

中文摘要:

  【摘要】 目的：探讨短节段骨水泥钉棒固定联合椎体成形术治疗Ⅲ期Kümmell病的可行性和有效性。方法：回顾性分析2014年1月~2016年6月本院采用短节段骨水泥钉棒固定联合椎体成形术治疗20例单节段Ⅲ期Kümmell病患者，其中男3例，女17例，年龄73.0±8.4岁（58~93岁），病程16~54 周，平均22.4±11.7周。ASIA分级：C级1例，D级5例，E级14例。术前、术后1周和末次随访时对患者进行疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）评分，同时通过X线测量伤椎椎体前缘高度、受累节段后凸 Cobb 角及并发症。结果：均顺利完成手术，伤椎注入骨水泥量4.43±0.86ml，手术时间为187.65±51.84min，出血量为374.00±198.00ml，住院日为18.65±8.39d。5例发生骨水泥渗漏，其中渗漏至椎体前方2例，椎体旁1例，上终板1例，椎间隙1例，但均无相关神经或脊髓症状。术后随访17.34±2.41个月（12~24个月）。患者的VAS评分由术前7.30±0.98分降低到术后1周时的3.65±0.67分（P＜0.05），末次随访时为1.55±0.83分，较术后1周时进一步降低（P＜0.05）；ODI由术前（67.05±6.21）%降低到术后1周时的（34.95±5.35）%（P＜0.05），末次随访时为（18.60±3.99）%，进一步改善（P＜0.05）；椎体前缘高度由术前的14.42±2.33mm恢复到术后1周时的21.00±1.84mm（P＜0.05），末次随访时为20.93±1.83mm，无明显丢失（P＞0.05）；椎体后凸角由术前的23.37°±6.58°矫正为术后1周时的12.27°±2.79°（P＜0.05），末次随访时为12.26°±2.84°，无明显丢失（P＞0.05）。末次随访时患者AISA分级，D级3例，E级17例。随访过程中未见内固定松动断裂等。结论：短节段骨水泥钉棒固定联合椎体成形术治疗Ⅲ期Kümmell病，能有效恢复脊柱序列，同时也能较好地矫正后凸畸形，并能维持伤椎的高度和强度。

英文摘要:

  【Abstract】 Objectives: To investigate the feasibility and effect of short segment bone cement screw fixation combined with vertebroplasty for stage Ⅲ Kümmell disease. Methods: A retrospective analysis of 20 hospitalized patients with stage Ⅲ Kümmell disease treated by the combination of short segment bone cement screw fixation and vertebroplasty from January 2014 to June 2016 was reviewed retrospectively. Among them, there were 3 males and 17 females, aged 58-93 years, with an average age of 73.0±8.4 years. The course of disease was 16-54 weeks, averaging 22.4±11.7 weeks. According to the American Spinal Injury Association(ASCI) grade, 1 case was graded as C level, 5 cases as D level, 14 cases as E level. The visual analogue scale(VAS) score, Oswestry disability index(ODI) score were used for assessment, at the same time the X-ray results of anterior height of injured vertebra body, the Cobb of kyphosis angle and the complications at preoperation, 1 week after operation and at the final follow-up were recorded to evaluate the outcome. Results: All the patients underwent the operation successfully. The operation time was 187.65±51.84min, the amount of bleeding was 374.00±198.00ml, the injured vertebra bone cement injection volume was 4.43±0.86ml, the hospital stay was 18.65±8.39d. 5 cases were noted bone cement leakage. Among them, 2 cases were noted leakage in front of the vertebral body, at lateral side in 1 case, 1 case in the upper end plate and 1 case in the disc space, no nerve and spinal cord related symptoms were noted. After surgery, all cases were followed up for 12-24 months, with an average of 17.34±2.41 months. The VAS score decreased from preoperative 7.30±0.98 to 3.65±0.67 points 1 week after operation, and 1.55±0.83 points at final follow-up. The ODI score decreased from preoperative (67.05±6.21)% to (34.95±5.35)% 1 week after operation, and (18.60±3.99)% at final follow-up. The anterior height of injured vertebra body decreased from preoperative 14.42±2.33mm to 21.00±1.84mm 1 week after operation, and 20.93±1.83mm at final follow-up. The Cobb of kyphosis angle decreased from preoperative 23.37°±6.58° to 12.27°±2.79° 1 week after operation, and reached 12.26°±2.84° at final follow-up. At the final follow-up, 3 cases reached D level, 17 cases to E level. During the follow-up, no instrument failure was noted. Conclusions: The combination of short segment bone cement screw fixation and vertebroplasty can alleviate the symptoms of stage Ⅲ Kümmell disease, effectively restore the sagittal alignment of spine, better correct the kyphosis, maintain the height and strength of the injured vertebra body.