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[1]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(duì)比研究[J].中醫(yī)正骨,2018,30(06):15-22.
　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(06):15-22.
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經(jīng)椎弓根打壓植骨與經(jīng)后路椎體次全切除治療Ⅲ期Kümmell病的 對(duì)比研究()
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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06期
頁(yè)碼:
15-22
欄目:
kümmell病
出版日期:
2018-06-20

文章信息/Info

Title:
A comparative study of transpedicular impaction bone grafting versus subtotal vertebrectomy through posterior approach for treatment of phaseⅢKümmell's diseases
作者:
王慶德; 梅偉; 張振輝; 毛克政; 姜文濤; 李格; 牛軍杰
河南省鄭州市骨科醫(yī)院,河南 鄭州 450052
Author(s):
WANG Qingde; MEI Wei; ZHANG Zhenhui; MAO Kezheng; JIANG Wentao; LI Ge; NIU Junjie
Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
脊柱骨折;  骨質(zhì)疏松性骨折;  Kü; mmell病;  骨移植;  骨折固定術(shù); 內(nèi);  椎體次全切除
Keywords:
spinal fractures;  osteoporotic fractures;  Kü; mmell's disease;  bone transplantation;  fracture fixation; internal;  subtotal vertebrectomy
文獻(xiàn)標(biāo)志碼:
A
摘要:
目的:比較經(jīng)傷椎椎弓根打壓植骨聯(lián)合后路長(zhǎng)節(jié)段椎弓根螺釘內(nèi)固定術(shù)和經(jīng)后路椎體次全切除聯(lián)合后路長(zhǎng)節(jié)段椎弓根螺釘內(nèi)固定術(shù)治療Ⅲ期Kümmell病的臨床療效和安全性。方法:收集2010年8月至2015年10月在鄭州市骨科醫(yī)院住院治療的Ⅲ期Kümmell病患者的病例資料進(jìn)行回顧性研究。符合要求的患者共46例,其中24例采用經(jīng)傷椎椎弓根打壓植骨術(shù)治療(椎弓根植骨組)、22例采用經(jīng)后路椎體次全切除術(shù)治療(椎體次全切組),同時(shí)兩組均行后路長(zhǎng)節(jié)段椎弓根螺釘內(nèi)固定術(shù)。比較2組患者的手術(shù)時(shí)間、術(shù)中出血量、疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、脊柱后凸Cobb角、日本整形外科協(xié)會(huì)(Japanese orthopaedic association,JOA)腰痛疾患評(píng)分、JOA腰痛疾患恢復(fù)率,以及治療和隨訪期間的并發(fā)癥發(fā)生情況。結(jié)果:所有患者均順利完成手術(shù),椎弓根植骨組的手術(shù)時(shí)間、術(shù)中出血量均小于椎體次全切組[(98±11)min,(192±26)min,t=5.624,P=0.003;(290±26)mL,(890±95)mL,t=2.638,P=0.028]。2組患者均獲得隨訪,隨訪時(shí)間16～63個(gè)月,中位數(shù)34個(gè)月。椎弓根植骨組2例患者術(shù)后出現(xiàn)手術(shù)切口延遲愈合,經(jīng)換藥及應(yīng)用抗生素治療后愈合。椎體次全切組2例術(shù)中發(fā)生硬膜撕裂,術(shù)中未進(jìn)行硬膜缺損修補(bǔ),術(shù)后6～8 d腦脊液漏自行停止; 1例發(fā)生短暫性神經(jīng)損傷,2周后完全恢復(fù)。2組均未發(fā)現(xiàn)內(nèi)固定松動(dòng)斷裂、脊柱后凸矯正丟失等并發(fā)癥。2組患者的并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.011,P=0.918)。術(shù)前2組患者的疼痛VAS評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義(t=0.829,P=0.412); 術(shù)后3個(gè)月時(shí),2組患者的疼痛VAS評(píng)分均降低[(9.20±0.60)分,(2.70±0.50)分,t=40.771,P=0.000;(8.70±0.50)分,(2.90±0.70)分,t=31.625,P=0.000],2組患者疼痛VAS評(píng)分的差異無統(tǒng)計(jì)學(xué)意義(t=0.583,P=0.667)。術(shù)前2組患者的JOA評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義(t=0.817,P=0.416); 術(shù)后3個(gè)月時(shí),2組患者的JOA評(píng)分均增加[(13.20±2.90)分,(27.20±1.50)分,t=21.007,P=0.000;(12.60±2.40)分,(27.60±1.80)分,t=23.452,P=0.000],2組患者JOA評(píng)分的差異無統(tǒng)計(jì)學(xué)意義(t=0.679,P=0.593)。術(shù)后3個(gè)月時(shí),2組患者JOA腰痛疾患恢復(fù)率的差異無統(tǒng)計(jì)學(xué)意義[(83.20±11.50)%,(81.70±10.80)%,t=0.385,P=0.617]。術(shù)前2組患者的脊柱后凸Cobb角比較,差異無統(tǒng)計(jì)學(xué)意義(t=0.735,P=0.455); 術(shù)后3個(gè)月時(shí),2組患者的脊柱后凸Cobb角均減小(32.5°±2.3°,7.60°±0.60°,t=51.319,P=0.000; 37.40°±2.80°,0.80°±0.30°,t=60.962,P=0.000),椎體次全切組的脊柱后凸Cobb角小于椎弓根植骨組(t=3.506,P=0.008)。結(jié)論:經(jīng)傷椎椎弓根打壓植骨聯(lián)合后路長(zhǎng)節(jié)段椎弓根螺釘內(nèi)固定術(shù)和經(jīng)后路椎體次全切除聯(lián)合后路長(zhǎng)節(jié)段椎弓根螺釘內(nèi)固定術(shù)治療Ⅲ期Kümmell病,均能有效減輕患者的疼痛癥狀、糾正脊柱后凸畸形、改善脊柱功能,并且均具有較好的安全性; 后者糾正脊柱后凸畸形的效果優(yōu)于前者,但前者的手術(shù)時(shí)間短、術(shù)中出血量少。
Abstract:
Objective:To compare the clinical curative effects and the safety of combination therapy of transpedicular impaction bone grafting and long-segment internal fixation with pedicle screws through posterior approach versus combination therapy of subtotal vertebrectomy and long-segment internal fixation with pedicle screws through posterior approach in the treatment of phaseⅢKümmell's diseases.Methods:The medical records of patients with phaseⅢKümmell's diseases who were treated in Zhengzhou Orthopedic Hospital from August 2010 to October 2015 were collected and retrospectively studied.Forty-six patients enrolled in the study were treated with long-segment internal fixation with pedicle screws through posterior approach,moreover,24 patients were treated with transpedicular impaction bone grafting(group A),and the others were treated with subtotal vertebrectomy through posterior approach(group B).The operative time,intraoperative blood loss,pain visual analogue scale(VAS)scores,Cobb angle of kyphotic deformity,Japanese orthopaedic association(JOA)low back pain scores,JOA low back pain recovery rate and complications during treatment period and follow-up period were compared between the 2 groups.Results:The surgeries were finished successfully in all patients.The operative time was shorter and the intraoperative blood loss was less in group A compared to group B(98+/-11 vs 192+/-26 min,t=5.624,P=0.003; 290+/-26 vs 890+/-95 mL,t=2.638,P=0.028).All patients in the 2 groups were followed up for 16-63 months with a median of 34 months.Delayed healing of surgical incisions were found in 2 patients in group A after surgery,and the incisions healed after dressing change and antibiotic treatment.Intraoperative dural tear(2)and transient nerve injury(1)were found in patients in group B,and no dural defect repairing was performed during the surgery and the cerebrospinal fluid leakage stopped at 6-8 days after surgery,and the transient nerve fully recovered from injury 2 weeks later.No complications such as loosening or breakage of internal fixators and loss of kyphotic correction were found in the 2 groups.There was no statistical difference in complication incidences between the two groups(χ2=0.011,P=0.918).There was no statistical difference in pain VAS scores between the 2 groups before surgery(t=0.829,P=0.412).The pain VAS scores decreased in both of the 2 groups at 3 months after the surgery(9.20+/-0.60 vs 2.70+/-0.50 points,t=40.771,P=0.000; 8.70+/-0.50 vs 2.90+/-0.70 points,t=31.625,P=0.000),and there was no statistical difference in pain VAS scores between the 2 groups(t=0.583,P=0.667).There was no statistical difference in JOA scores between the 2 groups before surgery(t=0.817,P=0.416).The JOA scores increased in both of the 2 groups at 3 months after the surgery(13.20+/-2.90 vs 27.20+/-1.50 points,t=21.007,P=0.000; 12.60+/-2.40 vs 27.60+/-1.80 points,t=23.452,P=0.000),and there was no statistical difference in JOA scores between the 2 groups(t=0.679,P=0.593).There was no statistical difference in JOA low back pain recovery rate between the 2 groups at 3 months after the surgery(83.20+/-11.50 vs 81.70+/-10.80%,t=0.385,P=0.617).There was no statistical difference in Cobb angle of kyphotic deformity between the 2 groups before surgery(t=0.735,P=0.455).The Cobb angle of kyphotic deformity decreased in both of the 2 groups at 3 months after the surgery(32.5+/-2.3 vs 7.60+/-0.60 degrees,t=51.319,P=0.000; 37.40+/-2.80 vs 0.80+/-0.30 degrees,t=60.962,P=0.000),and the Cobb angle of kyphotic deformity was smaller in group B compared to group A(t=3.506,P=0.008).Conclusion:Both the combination therapy of transpedicular impaction bone grafting and long-segment internal fixation with pedicle screws through posterior approach and the combination therapy of subtotal vertebrectomy and long-segment internal fixation with pedicle screws through posterior approach can effectively alleviate pain,correct kyphotic deformity and improve spinal function in the treatment of phaseⅢKümmell's diseases,and both of them have high safety.However,the latter surpasses the former in correcting kyphotic deformity,while the former has the advantages of shorter operative time and less intraoperative blood loss compared to the latter.

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更新日期/Last Update: 2018-10-30