经椎弓根入路椎体内置入cage治疗Ⅲ期Kümmell病的疗效观察

Treatment outcome of stage Ⅲ Kümmell′s disease by placing intra-vertebral cage via transpedicular tunnel

中文关键词:  Kümmell病  椎弓根  cage  脊柱器械  脊柱融合

英文关键词:Kümmell′s disease  Pedicle  Cage  Spinal instrumentation  Spinal fusion

中文摘要:

  【摘要】 目的：研究经椎弓根入路椎体内置入cage治疗Ⅲ期Kümmell病的可行性及效果。方法：本研究共纳入2018年1月～2022年1月于山东大学齐鲁医院脊柱科诊断为Ⅲ期Kümmell病且采用经椎弓根入路椎体内置入cage加后路脊柱稳定技术治疗的8例患者，男性3例，女性5例，年龄59～78岁，平均68.9±6.2岁。统计患者术前、术后3d及随访半年时的Oswestry功能障碍指数（Oswestry disability index，ODI）和腰背部疼痛视觉模拟评分（visual analogue scale，VAS），同时测量术前、术后及随访半年的Cobb角和矢状面骨折椎体椎高比（前缘/后缘）以评价临床疗效。结果：患者术后3d（6.00±1.31分）及术后半年随访（1.25±1.04分）的VAS评分较术前（7.75±1.04分）明显降低（P＜0.05）。患者术后3d[（47.00±6.68）%]及术后半年随访[（10.25±5.70）%]时的ODI较术前[（64.63±6.35）%]明显恢复（P＜0.001）。术后3d时的Cobb角（13.93°±3.69°）较术前（36.89°±11.09°）明显减低（P＜0.001），并且术后半年随访时（13.15°±3.88°）较术后3d时无统计学差异（P=0.689）。术后3d矢状面骨折椎体椎高比（前缘/后缘）（0.94±0.03）较术前（0.57±0.17）明显恢复（P＜0.001），且术后半年随访时（0.93±0.03）较术后3d时无统计学差异（P=0.463）。8例患者均术后疼痛得到缓解、椎体前柱高度恢复满意和后凸畸形有显著改善，且随访期间椎体高度丢失较小[（3.18±2.66）%]。结论：经椎弓根入路椎体内cage置入具有脊柱后凸矫正和促进骨性融合等优点。因此，经椎弓根入路椎体内置入cage治疗Ⅲ期Kümmell病是一个很好的选择。

英文摘要:

  【Abstract】 Objectives: To investigate the feasibility and effects of implanting intra-vertebral cage through transpedicular tunnel in the treatment of stage Ⅲ Kümmell′s disease. Methods: A total of 8 patients diagnosed with stage Ⅲ Kümmell′s disease and treated by minimally invasive technique of intra-vertebral cage through transpedicular tunnel combined with posterior spinal stabilization in the Department of Orthopaedics of Qilu Hospital of Shandong University from January 2018 to January 2022 were enrolled in this study. There were 3 males and 5 femals, aged 68.9±6.2 years(59-78 years) old. The Oswestry disability index(ODI) and visual analogue scale(VAS) score of low back pain before operation, 3d after operation and half a year of follow-up were collected, and the Cobb angle and sagittal fracture vertebral body height ratio(anterior/posterior edge) before operation, after operation and half a year of follow-up were also measured to evaluate the clinical effect. Results: The VAS score of patients at postoperative 3d(6.00±1.31) and half a year(1.25±1.04) were significantly lower than that before operation(7.75±1.04)(P<0.05). The ODI of the patients at postoperative 3d[(47.00±6.68)%] and half a year[(10.25±5.70)%] recovered significantly from that before operation[(64.63±6.35)%](P<0.001). The Cobb angle at postoperative 3d(13.93°±3.69°) was significantly decreased than that at preoperation(36.89°±11.09°)(P<0.001), and no significant difference was found between that at half a year follow-up(13.15°±3.88°) and postoperative 3d(P=0.689). The vertebral height ratio(anterior/posterior edge) of fracture at sagittal plane was significantly improved at postoperative 3d(0.94±0.03) from that at preoperation(0.57±0.17)(P<0.001), and there was no significant difference between that at postoperative half a year(0.93±0.03) and postoperative 3d(P=0.463). All the 8 patients with stage Ⅲ Kümmell′s disease were relieved of pain after operation, with satisfactory recovery of the anterior column height of the vertebral body and significant improvement of kyphosis deformity, and the loss of vertebral height during follow-up was small[(3.18±2.66)%]. Conclusions: Intra-vertebral cage implantation via pedicle tunnel has the advantages of kyphosis correction and bone fusion promotion, which is therefore an optimal choice for the treatment of stage Ⅲ Kümmell′s disease.