[1]王庆德,梅伟,张振辉,等.经椎弓根打压植骨与经后路椎体次全切除治疗Ⅲ期Kmmell病的对比研究[J].中医正骨,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.
点击复制

经椎弓根打压植骨与经后路椎体次全切除治疗Ⅲ期Kümmell病的 对比研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年06期
页码:
15-22
栏目:
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:
王庆德; 梅伟; 张振辉; 毛克政; 姜文涛; 李格; 牛军杰
河南省郑州市骨科医院,河南 郑州 450052
Author(s):
WANG Qingde; MEI Wei; ZHANG Zhenhui; MAO Kezheng; JIANG Wentao; LI Ge; NIU Junjie
Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China
关键词:
脊柱骨折;  骨质疏松性骨折;  Kü; mmell病;  骨移植;  骨折固定术; 内;  椎体次全切除
Keywords:
spinal fractures;  osteoporotic fractures;  Kü; mmell's disease;  bone transplantation;  fracture fixation; internal;  subtotal vertebrectomy
文献标志码:
A
摘要:
目的:比较经伤椎椎弓根打压植骨联合后路长节段椎弓根螺钉内固定术和经后路椎体次全切除联合后路长节段椎弓根螺钉内固定术治疗Ⅲ期Kümmell病的临床疗效和安全性。方法:收集2010年8月至2015年10月在郑州市骨科医院住院治疗的Ⅲ期Kümmell病患者的病例资料进行回顾性研究。符合要求的患者共46例,其中24例采用经伤椎椎弓根打压植骨术治疗(椎弓根植骨组)、22例采用经后路椎体次全切除术治疗(椎体次全切组),同时两组均行后路长节段椎弓根螺钉内固定术。比较2组患者的手术时间、术中出血量、疼痛视觉模拟量表(visual analogue scale,VAS)评分、脊柱后凸Cobb角、日本整形外科协会(Japanese orthopaedic association,JOA)腰痛疾患评分、JOA腰痛疾患恢复率,以及治疗和随访期间的并发症发生情况。结果:所有患者均顺利完成手术,椎弓根植骨组的手术时间、术中出血量均小于椎体次全切组[(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组患者均获得随访,随访时间16～63个月,中位数34个月。椎弓根植骨组2例患者术后出现手术切口延迟愈合,经换药及应用抗生素治疗后愈合。椎体次全切组2例术中发生硬膜撕裂,术中未进行硬膜缺损修补,术后6～8 d脑脊液漏自行停止; 1例发生短暂性神经损伤,2周后完全恢复。2组均未发现内固定松动断裂、脊柱后凸矫正丢失等并发症。2组患者的并发症发生率比较,差异无统计学意义(χ2=0.011,P=0.918)。术前2组患者的疼痛VAS评分比较,差异无统计学意义(t=0.829,P=0.412); 术后3个月时,2组患者的疼痛VAS评分均降低[(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组患者疼痛VAS评分的差异无统计学意义(t=0.583,P=0.667)。术前2组患者的JOA评分比较,差异无统计学意义(t=0.817,P=0.416); 术后3个月时,2组患者的JOA评分均增加[(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组患者JOA评分的差异无统计学意义(t=0.679,P=0.593)。术后3个月时,2组患者JOA腰痛疾患恢复率的差异无统计学意义[(83.20±11.50)%,(81.70±10.80)%,t=0.385,P=0.617]。术前2组患者的脊柱后凸Cobb角比较,差异无统计学意义(t=0.735,P=0.455); 术后3个月时,2组患者的脊柱后凸Cobb角均减小(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),椎体次全切组的脊柱后凸Cobb角小于椎弓根植骨组(t=3.506,P=0.008)。结论:经伤椎椎弓根打压植骨联合后路长节段椎弓根螺钉内固定术和经后路椎体次全切除联合后路长节段椎弓根螺钉内固定术治疗Ⅲ期Kümmell病,均能有效减轻患者的疼痛症状、纠正脊柱后凸畸形、改善脊柱功能,并且均具有较好的安全性; 后者纠正脊柱后凸畸形的效果优于前者,但前者的手术时间短、术中出血量少。
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.

参考文献/References:

[1] HEINI PF.Comment on"Transpedicle body augmenter in painful osteoporotic compression fractures"(Kung-Chia Li,Anna F.-Y.Li,Ching-Hsiang Hsieh,Hsiang-Ho Chen)[J].Eur Spine J,2007,16(5):599-600. [2] FORMICA M,BASSO M,CAVAGNARO L,et al.Kümmell disease:illustrative case for definition criteria[J].Spine J,2016,16(10):707-708. [3] MATZAROGLOU C,GEORGIOU CS,PANAGOPOULOS A,et al.Kümmell's Disease:Clarifying the Mechanisms and Patients' Inclusion Criteria[J].Open Orthop J,2014,8:288-297. [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] PARK JW,PARK JH,JEON HJ,et al.Kümmell's disease treated with percutaneous vertebroplasty:minimum 1 year follow-up[J].Korean J Neurotrauma,2017,13(2):119-123. [6] KIM P,KIM SW.Balloon Kyphoplasty:an effective treatment for Kummell disease?[J].Korean J Spine,2016,13(3):102-106. [7] 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. [8] YANG DL,YANG SD,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,2017,23:606-612. [9] ITO Y,HASEGAWA Y,TODA K,et al.Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture[J].Spine J,2002,2(2):101-106. [10] LI KC,WONG TU,KUNG FC,et al.Staging of kümmell's disease[J].Journal of Musculoskeletal Research,2004,8(1):43-55. [11] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2007:118-119. [12] YOUNG WF,BROWN D,KENDLER A,et al.Delayed post-traumatic osteonecrosis of a vertebral body(Kummell's disease)[J].Acta Orthop Belg,2002,68(1):13-19. [13] BENEDEK TG,NICHOLAS JJ.Delayed traumatic vertebral body compression fracture; partⅡ:pathologic features[J].Semin Arthritis Rheum,1981,10(4):271-277. [14] 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. [15] WANG H,SRIBASTAV SS,YE F,et al.Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures:a meta-analysis of the literature[J].Pain Physician,2015,18(3):209-222. [16] PEH WC,GELBART MS,GILULA LA,et al.Percutaneous vertebroplasty:treatment of painful vertebral compression fractures with intraosseous vacuum phenomena[J].AJR Am J Roentgenol,2003,180(5):1411-1417. [17] LI KC,LI AF,HSIEH CH,et al.Another option to treat Kümmell's disease with cord compression[J].Eur Spine J,2007,16(9):1479-1487. [18] SUK SI,KIM JH,KIM WJ,et al.Posterior vertebral column resection for severe spinal deformities[J].Spine(Phila Pa 1976),2002,27(21):2374-2382. [19] SUCATO DJ.Management of severe spinal deformity:scoliosis and kyphosis[J].Spine(Phila Pa 1976),2010,35(25):2186-2192. [20] 黎一兵,闫宏伟.经椎弓根椎体内骨水泥强化结合后路短节段内固定治疗Kummell病43例[J].陕西医学杂志,2015,44(3):317-320.[21] 尹知训,丁红梅,靳安民,等.胸腰椎骨质疏松压缩性骨折经椎弓根植骨的生物力学研究[J].中国临床解剖学杂志,2008,26(2):196-198. [22] LEE GW,YEOM JS,KIM HJ,et al.A therapeutic efficacy of the transpedicular intracorporeal bone graft with short-segmental posterior instrumentation in osteonecrosis of vertebral body:a minimum 5-year follow-up study[J].Spine(Phila Pa 1976),2013,38(4):244-250.

相似文献/References:

[1]邓红军.硫酸钙骨水泥椎体成形联合后路短节段椎弓根螺钉 内固定治疗创伤性胸腰椎骨折[J].中医正骨,2015,27(10):35.
[2]李鹏,徐世涛,谭磊.椎旁肌间隙入路伤椎单侧植骨内固定治疗 单节段胸腰椎骨折[J].中医正骨,2015,27(06):43.
[3]孙德舜,王小鹤,王晓燕,等.气囊托板复位配合骨伤复元汤口服治疗 胸腰椎单纯压缩骨折[J].中医正骨,2015,27(05):65.
[4]郭世明,石玲玲,郭志民,等.手法复位石膏外固定和切开复位钢板内固定治疗 骨质疏松性桡骨远端骨折的比较研究[J].中医正骨,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(06):15.
[5]武祥仁,胡海涛,茅祖斌.经椎旁肌间隙入路伤椎植骨内固定治疗 无神经损伤的胸腰椎骨折[J].中医正骨,2015,27(03):56.
[6]刘杰,朱小龙,石晨.手法复位联合经皮椎体后凸成形术治疗胸腰椎压缩性骨折[J].中医正骨,2016,28(05):28.
[7]杨振国,王树强,范杰,等.钉棒系统复位内固定联合经椎弓根撬拨植骨术治疗胸腰椎压缩性骨折[J].中医正骨,2016,28(05):31.
[8]陈思凯,邢金明.骨水泥强化椎弓根螺钉内固定治疗老年胸腰椎压缩性骨折[J].中医正骨,2016,28(05):35.
[9]徐无忌,刘晓岚.体位复位结合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中医正骨,2016,28(07):20.
　XU Wuji,LIU Xiaolan.Effect of Qianggu Yin(强骨饮,QGY)on bone microstructure in the ovariectomized osteoporosis rats[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(06):20.
[10]孙彦鹏,史相钦,马虎升,等.小开窗减压短力臂伤椎置钉复位内固定术治疗胸腰椎爆裂性骨折[J].中医正骨,2016,28(11):26.
[11]许兵,叶小雨,王萧枫,等.小管径经皮椎体后凸成形术治疗 骨质疏松性椎体重度压缩骨折[J].中医正骨,2015,27(11):29.
[12]谢小利,李晓程.经皮椎体后凸成形术治疗骨质疏松性椎体 压缩骨折的围手术期护理[J].中医正骨,2015,27(05):79.
[13]李格,梅伟,刘沛霖,等.骨质疏松性椎体压缩骨折经皮椎体成形术后邻近椎体再骨折的危险因素探讨[J].中医正骨,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(06):18.
[14]张旭桥,王晓晖,黄光明,等.生骨胶囊在经皮椎体强化术治疗老年骨质疏松性胸腰椎骨折中的应用研究[J].中医正骨,2016,28(11):21.
　ZHANG Xuqiao,WANG Xiaohui,HUANG Guangming,et al.Application of Shenggu Jiaonang(生骨胶囊)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(06):21.
[15]张 涛.常规抗骨质疏松疗法联合脉冲射频术和银质针松解术治疗骨质疏松性椎体压缩骨折[J].中医正骨,2017,29(04):74.
[16]王建民,李华东,王振东.温针灸结合补阳还五汤口服治疗骨质疏松性椎体压缩骨折经皮椎体后凸成形术后残留痛[J].中医正骨,2017,29(11):69.
[17]罗科锋,蔡凯文,卢斌,等.矿化胶原-聚甲基丙烯酸甲酯骨水泥经皮椎体后凸成形术治疗Ⅰ、Ⅱ期Kmmell病的临床研究[J].中医正骨,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(06):4.
[18]陈雯,马俊明,莫文.骨水泥联合Genex人工骨经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折[J].中医正骨,2018,30(06):40.
[19]韩雷,全仁夫.后路短节段椎弓根螺钉内固定联合椎体成形术治疗Ⅲ期Kmmell病[J].中医正骨,2018,30(06):47.
[20]赖欧杰,胡勇,袁振山,等.伤椎椎体成形联合后路融合固定术治疗Ⅲ期Kmmell病[J].中医正骨,2018,30(06):70.

更新日期/Last Update: 2018-10-30