84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]張建喬,俞偉,曾忠友,等.肌間隙入路經(jīng)椎弓根基底外側(cè)壁椎體內(nèi)打壓植骨聯(lián)合椎弓根螺釘內(nèi)固定治療Ⅱ~Ⅲ期Kümmell病[J].中醫(yī)正骨,2023,35(01):63-69.
點擊復(fù)制

肌間隙入路經(jīng)椎弓根基底外側(cè)壁椎體內(nèi)打壓植骨聯(lián)合椎弓根螺釘內(nèi)固定治療Ⅱ~Ⅲ期Kümmell病()
分享到:

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年01期
頁碼:
63-69
欄目:
臨床報道
出版日期:
2023-01-20

文章信息/Info

作者:
張建喬1俞偉2曾忠友2胡旭琪1陸惠根1陳寶1
(1.嘉興市第二醫(yī)院,浙江 嘉興 314001; 2.中國人民武裝警察部隊海警總隊醫(yī)院,浙江 嘉興 314033)
關(guān)鍵詞:
脊柱骨折 骨質(zhì)疏松性骨折 骨移植 骨折固定術(shù)內(nèi) 椎體成形術(shù) Kümmell病
摘要:
目的:探討肌間隙入路經(jīng)椎弓根基底外側(cè)壁椎體內(nèi)打壓植骨聯(lián)合椎弓根螺釘內(nèi)固定治療Ⅱ~Ⅲ期Kümmell病的臨床療效和安全性。方法:2016年7月至2020年4月,采用肌間隙入路經(jīng)椎弓根基底外側(cè)壁椎體內(nèi)打壓植骨聯(lián)合椎弓根螺釘內(nèi)固定治療Ⅱ~Ⅲ期Kümmell病患者20例。男3例,女17例; 年齡(69.5±7.6)歲; Ⅱ期8例,Ⅲ期12例; 均為單椎體病變,其中T112例、T126例、L17例、L24例、L31例; 腰椎骨密度(雙能X線吸收法測定)T值<-2.5 SD; 均伴有頑固性腰背痛,經(jīng)胸腰支具固定及應(yīng)用非甾體類抗炎藥和抗骨質(zhì)疏松藥物治療2周無效; 合并其他椎體陳舊性骨折8例,Ⅱ型糖尿病13例,高血壓病16例,慢性阻塞性肺氣腫2例; 均未合并嚴重心肺功能障礙、凝血功能障礙、惡性腫瘤等,均無脊髓神經(jīng)損傷。病程(1.5±0.6)個月。記錄患者的手術(shù)時間、術(shù)中出血量,術(shù)后12個月根據(jù)傷椎CT片評價患者傷椎內(nèi)植骨愈合情況,分別于術(shù)前、術(shù)后7 d、末次隨訪時評定患者的腰背部疼痛視覺模擬量表(visual analogue scale,VAS)評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、傷椎后凸Cobb角、傷椎楔形角、傷椎前緣高度比(傷椎前緣高度/傷椎上下相鄰椎體前緣高度的平均值×100%)、傷椎后緣高度比(傷椎后緣高度/傷椎上下相鄰椎體后緣高度的平均值×100%),觀察治療及隨訪期間并發(fā)癥的發(fā)生情況。結(jié)果:本組患者均順利完成手術(shù),手術(shù)時間(107.0±20.2)min,術(shù)中出血量(240.0±90.2)mL。20例患者均獲隨訪,隨訪時間(18.4±4.2)個月。術(shù)后12個月,20例患者椎體內(nèi)裂隙消失、新骨形成,達到骨性融合,其中16例傷椎與鄰近椎體側(cè)方形成骨橋連接。術(shù)前、術(shù)后7 d及末次隨訪時,患者的腰背部疼痛VAS評分、ODI、傷椎后凸Cobb角、傷椎楔形角、傷椎前緣高度比、傷椎后緣高度比總體比較,差異均有統(tǒng)計學(xué)意義[腰背部疼痛VAS評分:(6.20±0.24)分,(2.05±0.17)分,(1.30±0.11)分,F=65.320,P=0.000; ODI:(71.04±1.62)%,(18.46±0.57)%,(15.31±0.55)%,F=168.400,P=0.000; 傷椎后凸Cobb角:18.70°±0.98°,7.63°±1.44°,8.02°±1.42°,F=79.630,P=0.000; 傷椎楔形角:17.55°±0.97°,6.30°±0.78°,7.41°±0.88°,F=98.160,P=0.000; 傷椎前緣高度比:(44.13±1.07)%,(78.33± 1.11)%,(76.03±0.95)%,F=126.910,P=0.000; 傷椎后緣高度比:(74.16±1.12)%,(83.10± 0.78)%,(82.45±0.80)%,F=93.230,P=0.000]。術(shù)后7 d和末次隨訪時,患者的腰背部疼痛VAS評分(LSD-t=14.27,P=0.000; LSD-t=3.756,P=0.001)、ODI(LSD-t=30.680,P=0.000; LSD-t=3.990,P=0.000)、傷椎后凸Cobb角(LSD-t=6.348,P=0.000; LSD-t=5.764,P=0.000)、傷椎楔形角(LSD-t=9.069,P=0.000; LSD-t=8.453,P=0.000)均小于術(shù)前,傷椎前緣高度比(LSD-t=22.210,P=0.000; LSD-t=20.167,P=0.000)、傷椎后緣高度比(LSD-t=6.533,P=0.000; LSD-t=5.749,P=0.000)均高于術(shù)前; 末次隨訪時,患者的腰背部疼痛VAS評分、ODI均小于術(shù)后7 d(LSD-t=3.756,P=0.001; LSD-t=3.994,P=0.000),傷椎后凸Cobb角、傷椎楔形角、傷椎前緣高度比、傷椎后緣高度比與術(shù)后7 d的差異均無統(tǒng)計學(xué)意義(LSD-t=0.193,P=0.848; LSD-t=0.949,P=0.349; LSD-t=1.576,P=0.123; LSD-t=0.581,P=0.565)。1例患者于術(shù)后7 d出現(xiàn)切口皮下血腫,清除血腫時發(fā)現(xiàn)深筋膜裂開,予以嚴密縫合后切口愈合; 1例患者術(shù)后復(fù)查CT時發(fā)現(xiàn)傷椎一側(cè)椎弓根內(nèi)側(cè)壁破裂,但無臨床癥狀,未做特殊處理; 所有患者均未出現(xiàn)脊髓神經(jīng)損傷、切口感染、內(nèi)固定松動及斷裂等并發(fā)癥。結(jié)論:采用肌間隙入路經(jīng)椎弓根基底外側(cè)壁椎體內(nèi)打壓植骨聯(lián)合椎弓根螺釘內(nèi)固定治療Ⅱ~Ⅲ期Kümmell病,創(chuàng)傷小,骨折愈合率高,可減輕腰背部疼痛、恢復(fù)傷椎高度、改善傷椎后凸畸形、促進傷椎功能恢復(fù),且安全性高,值得臨床推廣應(yīng)用。

參考文獻/References:

[1] PAPPOU I P,PAPADOPOULOS E C,SWANSON A N,et al.Osteoporotic vertebral fractures and collapse with intravertebral vacuum sign(Kümmell’s disease)[J].Orthopedics,2008,31(1):61-66.
[2] HE D, YU W,CHEN Z.Pathogenesis of the intravertebral vacuum of Kümmell’s disease[J].Exp Ther Med,2016,12(2):879-882.
[3] LEE S H,KIM E S,EOH W.Cement augmented anterior reconstruction with short posterior instrumentation:a less invasive surgical option for Kümmell’s disease with cord compression[J].J Clin Neurosci,2011,18(4):509-514.
[4] FABBRICIANI G,PIRRO M,FLORIDI P,et al.Osteoanabolic therapy:a non-surgical option of treatment for Kümmell’s disease?[J].Rheumatol Int,2012,32(5):1371-1374.
[5] ROSSINI M,VIAPIANA O,GATTI D,et al.Capacitively coupled electric field for pain relief in patients with vertebral fractures and chronic pain[J].Clin Orthop Relat Res,2010,468(3):735-740.
[6] LI H,LIANG C Z,CHEN Q X.Kümmell’s disease,an uncommon and complicated spinal disorder:a review[J].J Int Med Res,2012,40(2):406-414.
[7] YANG D L,YANG S D,CHEN Q,et al.The treatment evaluation for osteoporotic Kummell disease by modified posterior vertebral column resection: minimum of one-year follow-up[J].Med Sci Monit,2017,23(2):606-612.
[8] CHO Y.Corpectomy and circumferential fusion for advanced thoracolumbar Kümmell’s disease[J].Musculoskelet Surg,2017,101(3):269-274.
[9] FORMICA M,ZANIRATO A,CAVAGNARO L,et al.Vertebral body osteonecrosis: proposal of a treatment oriented classification system[J].Eur Spine J,2018,27(Suppl 2):190-197.
[10] 張建喬,曾忠友,宋永興,等.經(jīng)皮后凸成形和椎體成形術(shù)治療老年人無神經(jīng)損傷Ⅲ期Kümmell病[J].中華老年醫(yī)學(xué)雜志,2018,37(3):301-305.
[11] LIN W C,LEE Y C,LEE C H,et al.Refractures in cemented vertebrae after percutaneous vertebroplasty:a retrospective analysis[J].Eur Spine J,2008,17(4):592-599.
[12] WANG H S,KIM H S,JU C I,et al.Delayed bone cement displacement following balloon kyphoplasty[J].J Korean Neurosurg Soc,2008,43(4):212-214.
[13] KIM J E,CHOI S S,LEE M K,et al.Failed percutaneous vertebroplasty due to insufficient correction of intravertebral instability in Kümmell’s disease:a case report[J].Pain Pract,2017,17(8):1109-1114.
[14] 蔣協(xié)遠,王大偉.骨科臨床療效評價標準[M].北京:人民衛(wèi)生出版社,2005:119-121.
[15] PATIL S,RAWALL S,SINGH D,et al.Surgical patterns in osteoporotic vertebral compression fractures[J].Eur Spine J,2013,22(4):883-891.
[16] SHABAT C S,ARINZON Z,FOLMAN Y,et al.Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians[J].J Spinal Disord Tech,2011,24(3):142-145.
[17] ZHANG G Q,GAO Y Z,CHEN S L,et al.Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell’s disease:a retrospective study[J].Indian J Orthop,2015,49(6):577-582.
[18] HUANG Y,PENG M,HE S,et al.Clinical efficacy of percutaneous kyphoplasty at the hyperextension position for the treatment of osteoporotic kümmell disease[J].Clin Spine Surg,2016,29(4):161-166.
[19] XIA Y H,CHEN F,ZHANG L,et al.Percutaneous kyphoplasty treatment evaluation for patients with Kümmell disease based on a two-year follow-up[J].Exp Ther Med,2018,16(4):3617-3622.
[20] CHEN G D,LU Q,WANG G L,et al.Percutaneous kyphoplasty for kummell disease with severe spinal canal stenosis[J].Pain Physician,2015,18(6):E1021-1028.
[21] PARK J W,PARK J H,JEON H J,et al.Kümmell’s disease treated with percutaneous vertebroplasty:minimum 1 year follow-up[J].Korean J Neurotrauma,2017,13(2):119-123.
[22] KIM Y Y,RHYU K W.Recompression of vertebral body after balloom kyphoplasty for osteoporotic vertebral compression fracture[J].Eur Spine J,2010,19(11):1907-1912.
[23] KIM P,KIM S W.Balloon kyphoplasty:an effective treatment for kummell disease?[J].Korean J Spine,2016,13(3):102-106.
[24] 張振輝,王慶德,王仲偉,等.后路長、短節(jié)段椎弓根螺釘固定聯(lián)合經(jīng)椎弓根打壓植骨治療Ⅲ期Kümmell病的療效比較[J].中華創(chuàng)傷雜志,2021,37(1):22-29.
[25] 王慶德,梅偉,張振輝,等.經(jīng)椎弓根打壓植骨聯(lián)合后路長節(jié)段固定治療Ⅲ期 Kümmell病[J].中國脊柱脊髓雜志,2018,28(6):522-528.
[26] 張建喬,曾忠友,葉招明,等.微創(chuàng)經(jīng)椎間孔椎間融合術(shù)并單側(cè)椎弓根固定治療老年人腰椎退變性疾病的臨床療效觀察[J].中華老年醫(yī)學(xué)雜志,2015,34(3):290-293.
[27] 曾忠友,張建喬,嚴衛(wèi)鋒,等.雙側(cè)肌間隙入路通道下椎弓根螺釘復(fù)位融合固定治療腰椎滑脫癥[J].中華骨科雜志,2018,38(20):1220-1229.
[28] 易西南,沈民仁,羅剛,等.腰椎側(cè)面節(jié)段血管及神經(jīng)的應(yīng)用解剖[J].中國臨床解剖學(xué)雜志,2005,23(5):470-473.
(收稿日期:2021-11-01 本文編輯:時紅磊)

相似文獻/References:

[1]鄧紅軍.硫酸鈣骨水泥椎體成形聯(lián)合后路短節(jié)段椎弓根螺釘 內(nèi)固定治療創(chuàng)傷性胸腰椎骨折[J].中醫(yī)正骨,2015,27(10):35.
[2]李鵬,徐世濤,譚磊.椎旁肌間隙入路傷椎單側(cè)植骨內(nèi)固定治療 單節(jié)段胸腰椎骨折[J].中醫(yī)正骨,2015,27(06):43.
[3]孫德舜,王小鶴,王曉燕,等.氣囊托板復(fù)位配合骨傷復(fù)元湯口服治療 胸腰椎單純壓縮骨折[J].中醫(yī)正骨,2015,27(05):65.
[4]郭世明,石玲玲,郭志民,等.手法復(fù)位石膏外固定和切開復(fù)位鋼板內(nèi)固定治療 骨質(zhì)疏松性橈骨遠端骨折的比較研究[J].中醫(yī)正骨,2015,27(04):15.
 GUO Shiming,SHI Lingling,GUO Zhimin,et al.A comparative study of manual reduction and plaster external fixation versus open reduction and plate internal fixation for treatment of osteoporotic distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):15.
[5]武祥仁,胡海濤,茅祖斌.經(jīng)椎旁肌間隙入路傷椎植骨內(nèi)固定治療 無神經(jīng)損傷的胸腰椎骨折[J].中醫(yī)正骨,2015,27(03):56.
[6]劉杰,朱小龍,石晨.手法復(fù)位聯(lián)合經(jīng)皮椎體后凸成形術(shù)治療胸腰椎壓縮性骨折[J].中醫(yī)正骨,2016,28(05):28.
[7]楊振國,王樹強,范杰,等.釘棒系統(tǒng)復(fù)位內(nèi)固定聯(lián)合經(jīng)椎弓根撬撥植骨術(shù)治療胸腰椎壓縮性骨折[J].中醫(yī)正骨,2016,28(05):31.
[8]陳思凱,邢金明.骨水泥強化椎弓根螺釘內(nèi)固定治療老年胸腰椎壓縮性骨折[J].中醫(yī)正骨,2016,28(05):35.
[9]徐無忌,劉曉嵐.體位復(fù)位結(jié)合經(jīng)皮椎體成形術(shù)與經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體壓縮骨折的對比研究[J].中醫(yī)正骨,2016,28(07):20.
 XU Wuji,LIU Xiaolan.Effect of Qianggu Yin(強骨飲,QGY)on bone microstructure in the ovariectomized osteoporosis rats[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):20.
[10]孫彥鵬,史相欽,馬虎升,等.小開窗減壓短力臂傷椎置釘復(fù)位內(nèi)固定術(shù)治療胸腰椎爆裂性骨折[J].中醫(yī)正骨,2016,28(11):26.
[11]許兵,葉小雨,王蕭楓,等.小管徑經(jīng)皮椎體后凸成形術(shù)治療 骨質(zhì)疏松性椎體重度壓縮骨折[J].中醫(yī)正骨,2015,27(11):29.
[12]謝小利,李曉程.經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體 壓縮骨折的圍手術(shù)期護理[J].中醫(yī)正骨,2015,27(05):79.
[13]李格,梅偉,劉沛霖,等.骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體成形術(shù)后鄰近椎體再骨折的危險因素探討[J].中醫(yī)正骨,2016,28(06):18.
 LI Ge,MEI Wei,LIU Peilin,et al.Investigation on risk factors for adjacent vertebral refractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):18.
[14]張旭橋,王曉暉,黃光明,等.生骨膠囊在經(jīng)皮椎體強化術(shù)治療老年骨質(zhì)疏松性胸腰椎骨折中的應(yīng)用研究[J].中醫(yī)正骨,2016,28(11):21.
 ZHANG Xuqiao,WANG Xiaohui,HUANG Guangming,et al.Application of Shenggu Jiaonang(生骨膠囊)to the treatment of osteoporotic thoracolumbar vertebral fractures in the aged who received percutaneous vertebral augmentation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):21.
[15]張 濤.常規(guī)抗骨質(zhì)疏松療法聯(lián)合脈沖射頻術(shù)和銀質(zhì)針松解術(shù)治療骨質(zhì)疏松性椎體壓縮骨折[J].中醫(yī)正骨,2017,29(04):74.
[16]王建民,李華東,王振東.溫針灸結(jié)合補陽還五湯口服治療骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體后凸成形術(shù)后殘留痛[J].中醫(yī)正骨,2017,29(11):69.
[17]羅科鋒,蔡凱文,盧斌,等.礦化膠原-聚甲基丙烯酸甲酯骨水泥經(jīng)皮椎體后凸成形術(shù)治療Ⅰ、Ⅱ期Kmmell病的臨床研究[J].中醫(yī)正骨,2018,30(06):4.
 LUO Kefeng,CAI Kaiwen,LU Bin,et al.A clinical study of percutaneous kyphoplasty with mineralized collagen-polymethylmethacrylate bone cement for treatment of phaseⅠandⅡKmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(01):4.
[18]王慶德,梅偉,張振輝,等.經(jīng)椎弓根打壓植骨與經(jīng)后路椎體次全切除治療Ⅲ期Kmmell病的對比研究[J].中醫(yī)正骨,2018,30(06):15.
 WANG Qingde,MEI Wei,ZHANG Zhenhui,et al.A comparative study of transpedicular impaction bone grafting versus subtotal vertebrectomy through posterior approach for treatment of phaseⅢKmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(01):15.
[19]陳雯,馬俊明,莫文.骨水泥聯(lián)合Genex人工骨經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性胸腰椎壓縮性骨折[J].中醫(yī)正骨,2018,30(06):40.
[20]韓雷,全仁夫.后路短節(jié)段椎弓根螺釘內(nèi)固定聯(lián)合椎體成形術(shù)治療Ⅲ期Kmmell病[J].中醫(yī)正骨,2018,30(06):47.

備注/Memo

備注/Memo:
基金項目:浙江省醫(yī)藥衛(wèi)生科技計劃項目(2021KY1114)通訊作者:曾忠友 E-mail:[email protected]
更新日期/Last Update: 1900-01-01