经皮后路短节段椎弓根螺钉固定联合椎体成形术治疗无神经损伤Ⅲ期Kümmell病

Percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty for stage Ⅲ Kümmell's disease without neurological deficit

目的探讨经皮后路短节段椎弓根螺钉固定联合椎体成形术治疗无神经损伤Ⅲ期Kümmell病的临床疗效。方法采用回顾性病例系列研究分析2012年1月—2017年1月杭州市萧山区中医院收治的36例无神经损伤Ⅲ期Kümmell病患者临床资料,其中男10例,女26例;年龄55~75岁,平均67.5岁。损伤节段:T11 9例,T12 12例,L1 10例,L2 5例。病程6~48个月,平均28.5个月。术前行X线片、CT、MRI等影像学检查。患者均行后路经皮短节段椎弓根螺钉固定联合椎体成形术治疗。记录手术时间、术中出血量、手术并发症,比较术前、术后1周及末次随访视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及伤椎矢状面Cobb角。结果患者均获随访12~48个月,平均32.5个月。手术时间0.6~1.5 h[(1.1±0.4)h]。术中出血量50~90 ml[(62.5±17.5)ml]。未发生内固定松动或断裂、邻椎骨折等并发症。VAS术前为(8.6±0.4)分,术后1周为(2.5±0.7)分,末次随访时为(2.9±0.7)分,与术前比较差异均有统计学意义(P<0.05)。ODI术前为68.2±3.9,术后1周为22.7±4.3,末次随访时为25.3±4.8,与术前比较差异均有统计学意义(P<0.05)。伤椎矢状面Cobb角术前为(24.3±9.3)°,术后1周为(8.6±3.2)°,末次随访时为(10.5±4.1)°,与术前比较差异均有统计学意义(P<0.05)。结论经皮后路短节段椎弓根螺钉固定联合椎体成形术治疗无神经损伤Ⅲ期Kümmell病,可明显缓解疼痛,改善脊柱功能,并维持脊柱的稳定性。

Objective To investigate the clinical efficacy of percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty for stage Ⅲ Kümmell's disease without neurological deficit.Methods A retrospective case series study was conducted to analyze the clinical data of 36 patients with stage Ⅲ Kümmell's disease without nerve injury admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to January 2017.There were 10 males and 26 females,aged 55-75 years,with an average of 67.5 years.The injuried vertebrae were located at T11 in 9 patients,at T12 in 12,at L1 in 10 and at L2 in 5.The course of disease ranged from 6 to 48 months,with an average of 28.5 months.X-ray,CT and MRI were performed before operation.All patients underwent percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty.The operation time,intraoperative bleeding volume,complications,visual analogue scale (VAS),Oswestry dysfunction index (ODI) and sagittal Cobb angle of the injured vertebrae were recorded before operation,1 week after operation and at the last follow-up.Results All patients were followed up for an average of 32.5 months (range,12-48 months).Operation time ranged from 0.6 to 1.5 hours [(1.1 ± 0.4) hours].The intraoperative blood loss was 50-90 ml [(62.5 ± 17.5)ml].There was no internal fixation failure or fracture of adjacent vertebra.The VAS was improved from preoperative (8.6± 0.4) points to (2.5 ±0.7) points one week after operation and (2.9 ± 0.7) points at the last follow-up (P < 0.05).The ODI was improved from preoperative 68.2 ± 3.9 to 22.7 ± 4.3 one week after operation and 25.3 ± 4.8 at the last follow-up (P < 0.05).The Cobb angle was improved from preoperative (24.3 ± 9.3) ° to (8.6 ±3.2)° 1 week after operation and (10.5 ±4.1)° at the last follow-up (P<0.05).Conclusion For stage Ⅲ Kümmell's disease without neurological deficit,percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty can significantly relieve pain,improve spinal function and maintain spinal stability.