短节段固定骨水泥强化联合伤椎椎体成形治疗Ⅲ期Kümmell病

Effect of short segment fixation with bone cement augmentation combined with vertebroplasty in the treatment of stage Ⅲ Kümmell disease

目的探讨短节段固定骨水泥强化联合伤椎椎体成形治疗Ⅲ期Kümmell病的疗效。方法回顾性研究2015年01月~2018年4月本院采用短节段固定骨水泥强化联合伤椎椎体成形术治疗的28例Ⅲ期Kümmell病患者。其中男8例,女20例,年龄61~83岁,平均73.8岁。病程4~48周,平均19.6周。骨密度值-3.7^-2.6 SD,平均-3.1 SD。病变节段:T 103例,T 116例,T 128例,L 17例,L 24例。神经功能Frankle分级:C级2例,D级4例,E级22例。术前、术后1周和末次随访时观察其VAS评分、ODI指数、伤椎前缘高度、伤椎后凸Cobb角及并发症等指标。结果28例患者均顺利完成手术。手术时间120~195 min,平均152.6 min;术中出血量180~600 mL,平均345.4 mL;伤椎骨水泥注射量4.3~7.5 mL,平均5.6 mL。8例发生骨水泥渗漏,但均无相关神经或脊髓症状。术后随访12~36个月,平均为25.3个月。术后1周及末次随访时VAS评分、ODI均较术前明显减小(P<0.05),末次随访时较术后1周显著下降(P<0.05)。术后1周及末次随访时伤椎前缘高度、伤椎后凸Cobb角均较术前明显改善(P<0.05),末次随访时与术后1周比较,差异无统计学意义(P>0.05)。末次随访时神经功能Frankle分级:D级4例,E级24例。随访期间无手术椎体塌陷,无内固定松动断裂等并发症。结论短节段固定骨水泥强化联合伤椎椎体成形治疗Ⅲ期Kümmell病安全、有效,是治疗Ⅲ期Kümmell较理想的手术方式。

Objective To investigate the efficacy of short segment fixation with bone cement augmentation combined with vertebroplasty in the treatment of stageⅢKümmell disease.Methods From January 2015 to April 2018,28 patients with stageⅢKümmell disease who were treated in our hospital by short segment fixation with bone cement augmentation combined with vertebroplasty were selected.There were 8 males and 20 females,the age was 61-83 years,with an average of 73.8 years.The course of disease was 4-48 weeks,with an average of 19.6 weeks.The bone mineral density was-3.7^-2.6 SD,with an average of-3.1 SD.Lesion segments:T 103 cases,T 116 cases,T 128 cases,L 17 cases,L 24 cases.Frankle classification of neural function:2 cases of grade C,4 cases of grade D and 22 cases of grade E.Before operation,one week after operation and at the last follow-up,the visual analogue scale(VAS),Oswestry disability index(ODI),the height of anterior edge of injured vertebrae,Cobb angle of kyphosis and complications were used to evaluate the curative effect.Results The procedure was successfully completed in 28 patients.The operation time was 120-195 min,with an average of 152.6 min.The amount of intraoperative blood loss was 180-600 ml,with an average of 345.4 ml.The amount of cement injection in injured vertebrae was 4.3-7.5 ml,with an average of 5.6 ml.There were 8 cases of bone cement leakage,but none of the related nerve or spinal cord symptoms occurred.The follow-up period was 12-36 months,with an average of 25.3 months.The VAS score and ODI at 1 week after operation and the last follow-up were significantly lower than before operation(P<0.05),and those at the last follow-up were significantly lower than 1 week after operation(P<0.05).The height of anterior edge of injured vertebrae and Cobb angle of kyphosis were significantly improved at 1 week after operation and the last follow-up(P<0.05),but there was no significant difference between the last follow-up and 1 week after operation(P>0.05).At the last follow-up,regarding Frankle classification of nerve function,there were 4 patients with grade D and 24 patients with grade E.During the follow-up period,there were no complications such as vertebral collapse and loosening and fracture of internal fixation.Conclusions Short segment fixation with bone cement augmentation combined with vertebroplasty is safe and effective in the treatment of stageⅢKümmell disease.It is an ideal method for the treatment of stageⅢKümmell disease.