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[1]張建喬,曾忠友,宋國浩,等.經(jīng)皮椎體強化聯(lián)合后路經(jīng)肌間隙入路短節(jié)段椎弓根螺釘固定治療無神經(jīng)損傷的Ⅲ期Kmmell病[J].中醫(yī)正骨,2018,30(02):54-58.
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經(jīng)皮椎體強化聯(lián)合后路經(jīng)肌間隙入路短節(jié)段椎弓根螺釘固定治療無神經(jīng)損傷的Ⅲ期Kümmell病()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年02期
頁碼:
54-58
欄目:
臨床報道
出版日期:
2018-02-20

文章信息/Info

作者:
張建喬曾忠友宋國浩俞偉籍劍飛宋永興
中國人民武裝警察部隊浙江省總隊嘉興醫(yī)院,浙江 嘉興 314033
關鍵詞:
脊柱骨折mmell病 骨質疏松 椎體成形術 椎體后凸成形術 骨折固定術
摘要:
目的:探討經(jīng)皮椎體強化聯(lián)合后路經(jīng)肌間隙入路短節(jié)段椎弓根螺釘固定治療無神經(jīng)損傷的Ⅲ期Kümmell病的臨床療效和安全性。方法:2014年9月至2016年9月收治21例Ⅲ期Kümmell病患者。男2例,女19例; 年齡60~82歲,中位數(shù)75歲; 均為單椎體病變,其中T11病變3例、T12病變5例、L1病變9例、L2病變2例、L3病變2例; 3例有輕微外傷史,其余18例均無明顯外傷史; 腰椎骨密度(雙能X線吸收法測定)T值<-2.5; 合并非相鄰椎體陳舊性骨折3例,腰椎退行性側彎2例,Ⅱ型糖尿病13例,高血壓病21例,慢性支氣管炎8例,尿毒癥1例; 均無脊髓和(或)神經(jīng)根受壓癥狀,均未合并嚴重心肺功能及凝血功能障礙、惡性腫瘤。應用抗骨質疏松藥物及非甾體類抗炎藥治療2周無效。均采用經(jīng)皮椎體成形術或經(jīng)皮椎體后凸成形術聯(lián)合后路經(jīng)肌間隙入路短節(jié)段椎弓根螺釘固定術治療。記錄患者的手術時間、出血量,分別于術前、術后7 d及末次隨訪時評定患者的疼痛視覺模擬量表(visual analogue scale,VAS)評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、后凸Cobb角及傷椎前、后緣高度,同時觀察治療及隨訪期間并發(fā)癥的發(fā)生情況。結果:21例患者均順利完成手術。手術時間60~95 min,中位數(shù)75 min; 出血量20~50 mL,中位數(shù)35 mL。所有患者均獲得隨訪,隨訪時間12~25個月,中位數(shù)18個月。切口均甲級愈合,均未發(fā)生脊髓神經(jīng)損傷、肺栓塞、心腦血管意外、內(nèi)固定松動及骨水泥團塊移位等并發(fā)癥。7例發(fā)生骨水泥滲漏,其中椎體周圍滲漏6例、椎間盤內(nèi)滲漏1例,隨訪期間均未出現(xiàn)相應臨床癥狀。患者術前、術后7 d及末次隨訪時的疼痛VAS評分[(8.0±0.9)分,(2.0±0.5)分,(1.8±0.4)分]、ODI[(82.3±2.0)%,(30.9±1.3)%,(20.9±1.3)%]、傷椎前緣高度[(50.5±7.0)%,(74.6±7.9)%,(72.4±7.6)%]、傷椎后緣高度[(72.6±5.1)%,(81.4±5.1)%,(79.0±4.8)%]及后凸Cobb角(19.4°±2.5°,10.5°±2.3°,11.3°±2.0°)總體比較,各時間點之間的差異均有統(tǒng)計學意義(F=680.300,P=0.000; F=9 534.000,P=0.000; F=66.540,P=0.000; F=17.470,P=0.000; F=95.770,P=0.000)。術后7 d和末次隨訪時的VAS評分、ODI、后凸Cobb角均小于術前(P=0.017,P=0.012; P=0.001,P=0.001; P=0.001,P=0.001),傷椎前緣高度、傷椎后緣高度均大于術前(P=0.001,P=0.002; P=0.001,P=0.001); 末次隨訪時的ODI小于術后7 d(P=0.002),VAS評分、傷椎前緣高度、傷椎后緣高度及后凸Cobb角與術后7 d比較,差異均無統(tǒng)計學意義(P=0.430; P=0.630; P=0.270; P=0.460)。結論:對于無神經(jīng)損傷的Ⅲ期Kümmell病,采用經(jīng)皮椎體強化聯(lián)合后路經(jīng)肌間隙入路短節(jié)段椎弓根螺釘固定治療,能有效減輕疼痛、恢復傷椎高度、糾正后凸畸形、改善腰部功能,并能在短期內(nèi)維持傷椎高度及Cobb角,而且具有較高的安全性。

參考文獻/References:

[1] PAPPOU IP,PAPADOPOULOS EC,SWANSON AN,et al.Osteoporotic vertebral fractures and collapse with intravertebral vacuum sign(Kümmel's disease)[J].Orthopedics,2008,31(1):61-66.
[2] HE D,YU W,CHEN Z,et al.Pathogenesis of the intravertebral vacuum of Kümmell's disease[J].Exp Ther Med,2016,12(2):879-882.
[3] LI KC,WONG TU,KUNG FC.Staging of Kümmell's disease[J].J Musculoskel Res,2004,8(1):43-55.
[4] CHEN GD,LU Q,WANG GL,et al.Percutaneous kyphoplasty for kummell disease with severe spinal canal stenosis[J].Pain Physician,2015,18(6):1021-1028.
[5] HEO DH,CHIN DK,YOON YS,et al.Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty[J].Osteoporos Int,2009,20(3):473-480.
[6] WANG HS,KIM HS,JU CI,et al.Delayed bone cement displacement following balloon kyphoplasty[J].J Korean Neurosurg Soc,2008,43(4):212-214.
[7] 丁亮華,王祁,張敏,等.經(jīng)皮注射骨水泥椎體成形治療椎體骨折和疾病[J].江蘇醫(yī)藥,2007,33(4):398-399.
[8] FAIRBANK JC,PYNSENT PB.The oswestry disability index[J].Spine(Phila Pa 1976),2000,25(22):2940-2952.
[9] 倪文飛,池永龍,林焱,等.經(jīng)皮椎體強化術并發(fā)骨水泥滲漏的類型及其臨床意義[J].中華外科雜,2006,44(4):231-234.
[10] KIM YJ,LEE JW,KIM KJ,et al.Percutaneous vertebroplasty for intravertebral cleft:analysis of therapeutic effects and outcome predictors[J].Skeletal Radiology,2010,39(8):757-766.
[11] UCHIDA K,KOBAYASHI S,NAKAJIMA H,et al.Anterior expandable strut cage replacement for osteoporotic thoracolumbar vertebral collapse[J].J Neurosurg Spine,2006,4(6):454-462.
[12] LEE SH,KIM ES,EOH W.Cement augmented anterior reconstruction with short posterior instrumentation:a less invasive surgical option for Kummell's disease with cord compression[J].J Clin Neurosci,2011,18(4):509-514
[13] LI KC,LI A,HSIEH CH,et al.Another option to treat Kümmell's disease with cord compression.[J].European Spine Journal,2007,16(9):1479-1487.
[14] CHO Y.Corpectomy and circumferential fusion for advanced thoracolumbar Kümmell's disease[J].Musculoskeletal Surgery,2017,101(3):1-6.
[15] 楊惠林,李茂,王根林,等.勿忽視骨質疏松性椎體壓縮性骨折經(jīng)皮椎體強化術后病椎再骨折[J].中華創(chuàng)傷雜志,2015,31(11):961-962.
[16] KIM P,KIM SW.Balloon Kyphoplasty:An Effective Treatment for Kummell Disease?[J].Korean J Spine,2016,13(3):102-106.
[17] 楊占輝,沈惠良,史宏偉,等.改良經(jīng)皮球囊擴張椎體后凸成形術治療骨質疏松性胸腰椎骨折的療效[J].中華創(chuàng)傷雜志,2016,32(4):313-319.
[18] LIN WC,YC L,LEE CH,et al.Refractures in cemented vertebrae after percutaneous vertebroplasty:a retrospective analysis[J].Eur Spine J,2008,17(4):592-599.
[19] KIM YY,RHYU W.Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture[J].Eur Spine J,2010,19(11):1907-1912.
[20] LEE K,LEE SG,KIM WK,et al.Comparison vertebroplasty with kyphoplasty in delayed post-traumatic osteonecrosis of a vertebral body(Kummell's disease)[J]. Korean J Spine,2008,5(2):70-76.
[21] PARK SJ,KIM HS,LEE SK,et al.Bone Cement-Augmented percutaneous short segment fixation:an effective treatment for kummell's disease?[J].J Korean Neurosurg Soc,2015,58(1):54-59.

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更新日期/Last Update: 2018-07-02