经椎弓根打压植骨联合后路长节段固定治疗Ⅲ期Kümmell病

Transpedicular impaction bone grafting combined with long segmental posterior instrumentation in treating stage Ⅲ Kümmell′s disease

中文关键词:  Kümmell病  经椎弓根打压植骨  内固定  疗效

英文关键词:Kümmell′s disease  Transpedicular impaction bone grafting  Pedicle screw fixation  Efficacy

中文摘要:

  【摘要】 目的：探讨经椎弓根椎体内打压植骨联合后路长节段固定治疗Ⅲ期Kümmell病的临床疗效。方法：回顾性分析2011年8月～2015年12月我院收治的Ⅲ期Kümmell病患者24例，其中男5例、女19例，年龄67.3±3.5岁（58～81岁），均采用经伤椎椎弓根打压植骨联合后路长节段（伤椎上下各固定2个及以上节段）椎弓根螺钉内固定术治疗（6例重度骨质疏松患者均经椎弓根注射骨水泥以强化椎体）。统计手术时间及术中出血量，术前、术后1周及末次随访时分别应用疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）评估进行临床结果，术后1周及末次随访时采用X线和CT平扫评估伤椎前缘高度、椎体后凸Cobb角及植骨椎体骨性愈合情况，观察有无相关手术并发症的发生。结果：所有患者均获随访，随访时间31.6±1.8个月（15～62个月）。手术时间142.6±21.5min（110～180min）、术中出血量290.3±51.2ml（220～410ml）。术前VAS评分为7.2±1.8分，术后1周时为3.2±1.1分，末次随访时为2.9±0.7分；术前ODI评分为（83.5±3.8）%，术后1周为（32.6±2.6）%，末次随访时为（29.8±1.9）%，术前、术后1周及末次随访时后凸Cobb角度分别为28.1°±2.3°，6.3°±0.9°，7.6°±0.6°，术后1周及末次随访与术前比较，差异具有统计学意义（P<0.05），末次随访与术后1周时无统计学差异（P>0.05）。术后1周椎体前缘高度20.6±2.1mm较术前13.2±1.3mm明显增加（P>0.05），末次随访椎体前缘高度（19.8±2.3）mm，与术后1周比较无统计学差异（P>0.05）。末次随访时X线和CT影像结果显示伤椎椎体内骨填充充分，无裂隙样死腔，骨性愈合良好。结论：采用经伤椎椎弓根打压植骨联合后路长节段固定治疗Ⅲ期Kümmell病，能够很好地矫正后凸，恢复椎体高度，是一种治疗Ⅲ期Kümmell病的有效技术。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy of transpedicular impaction bone grafting combined with long segmental pedicle screw fixation in treating stage Ⅲ Kümmell′s disease． Methods: This retrospective study comprised a consecutive series of a total of 24 patients with stage Ⅲ Kümmell′s disease, including 5 males and 19 females with ages ranging from 58-81 years(an average age of 67.3±3.5 years). They were treated by posterior transpedicular impaction bone grafting combined with long segmental pedicle screw fixation(two or more segments of above/below injury vertebrae were fixed, transpedicular bone cement injection were used in 6 osteoporotic patients) from August 2011 to December 2015 in our hospital. The mean operation time and blood loss were collected. The clinical outcome was evaluated by using the visual analogue scale(VAS) and the Oswestry disability index(ODI) at preoperation, one-week postoperation and final follow-up. X-ray and CT scan were used to evaluate the anterior vertebral body height of the injured vertebra, the segmental kyphosis and bone graft healing status preoperatively, at one-week postoperation and final follow-up. Complication events were also analyzed. Results: All patients were followed up for 15 to 62 months(31.6±1.8 months). The average operation time was 142.6±21.5min(110-180min). Mean operative blood loss was 290.3±51.2ml(220-410ml). VAS score of preoperation, 1 week postoperation and final follow-up was 7.2±1.8, 3.2±1.1, 2.9±0.7 respectively; ODI score was (83.5±3.8)%, (32.6±2.6)%, (29.8±1.9)% respectively; anterior vertebral height was 13.2±1.3mm, 20.6±2.1mm, 19.8±2.3mm respectively; kyphosis was 28.1°±2.3°, 6.3°±0.9°, 7.6°±0.6° respectively． The VAS score, ODI score, anterior vertebral height and vertebral kyphosis were significantly different between preoperation and one week after operation(P<0.05). But there was no significant difference in anterior vertebral height and vertebral kyphosis between one week after operation and final follow-up(P>0.05), which suggested that there was no vertebral collapse or loss of correction in kyphosis at final follow-up. Conclusions: Posterior transpedicle intracorporeal bone grafting combined with long segmental posterior instrumentation is an efficient strategy in treating stage Ⅲ Kümmell′s disease, which can correct kyphosis and restore the vertebral body height.