[1]张建乔,俞伟,曾忠友,等.肌间隙入路经椎弓根基底外侧壁椎体内打压植骨联合椎弓根螺钉内固定治疗Ⅱ～Ⅲ期Kümmell病[J].中医正骨,2023,35(01):63-69.
点击复制

肌间隙入路经椎弓根基底外侧壁椎体内打压植骨联合椎弓根螺钉内固定治疗Ⅱ～Ⅲ期Kümmell病()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年01期
页码:
63-69
栏目:
临床报道
出版日期:
2023-01-20

文章信息/Info

作者:
张建乔1; 俞伟2; 曾忠友2; 胡旭琪1; 陆惠根1; 陈宝1
(1.嘉兴市第二医院,浙江 嘉兴 314001; 2.中国人民武装警察部队海警总队医院,浙江 嘉兴 314033)
关键词:
脊柱骨折;  骨质疏松性骨折;  骨移植;  骨折固定术; 内;  椎体成形术;  Kümmell病
摘要:
目的:探讨肌间隙入路经椎弓根基底外侧壁椎体内打压植骨联合椎弓根螺钉内固定治疗Ⅱ～Ⅲ期Kümmell病的临床疗效和安全性。方法:2016年7月至2020年4月,采用肌间隙入路经椎弓根基底外侧壁椎体内打压植骨联合椎弓根螺钉内固定治疗Ⅱ～Ⅲ期Kümmell病患者20例。男3例,女17例; 年龄(69.5±7.6)岁; Ⅱ期8例,Ⅲ期12例; 均为单椎体病变,其中T112例、T126例、L17例、L24例、L31例; 腰椎骨密度(双能X线吸收法测定)T值<-2.5 SD; 均伴有顽固性腰背痛,经胸腰支具固定及应用非甾体类抗炎药和抗骨质疏松药物治疗2周无效; 合并其他椎体陈旧性骨折8例,Ⅱ型糖尿病13例,高血压病16例,慢性阻塞性肺气肿2例; 均未合并严重心肺功能障碍、凝血功能障碍、恶性肿瘤等,均无脊髓神经损伤。病程(1.5±0.6)个月。记录患者的手术时间、术中出血量,术后12个月根据伤椎CT片评价患者伤椎内植骨愈合情况,分别于术前、术后7 d、末次随访时评定患者的腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、伤椎后凸Cobb角、伤椎楔形角、伤椎前缘高度比(伤椎前缘高度/伤椎上下相邻椎体前缘高度的平均值×100%)、伤椎后缘高度比(伤椎后缘高度/伤椎上下相邻椎体后缘高度的平均值×100%),观察治疗及随访期间并发症的发生情况。结果:本组患者均顺利完成手术,手术时间(107.0±20.2)min,术中出血量(240.0±90.2)mL。20例患者均获随访,随访时间(18.4±4.2)个月。术后12个月,20例患者椎体内裂隙消失、新骨形成,达到骨性融合,其中16例伤椎与邻近椎体侧方形成骨桥连接。术前、术后7 d及末次随访时,患者的腰背部疼痛VAS评分、ODI、伤椎后凸Cobb角、伤椎楔形角、伤椎前缘高度比、伤椎后缘高度比总体比较,差异均有统计学意义[腰背部疼痛VAS评分:(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; 伤椎后凸Cobb角:18.70°±0.98°,7.63°±1.44°,8.02°±1.42°,F=79.630,P=0.000; 伤椎楔形角:17.55°±0.97°,6.30°±0.78°,7.41°±0.88°,F=98.160,P=0.000; 伤椎前缘高度比:(44.13±1.07)%,(78.33± 1.11)%,(76.03±0.95)%,F=126.910,P=0.000; 伤椎后缘高度比:(74.16±1.12)%,(83.10± 0.78)%,(82.45±0.80)%,F=93.230,P=0.000]。术后7 d和末次随访时,患者的腰背部疼痛VAS评分(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)、伤椎后凸Cobb角(LSD-t=6.348,P=0.000; LSD-t=5.764,P=0.000)、伤椎楔形角(LSD-t=9.069,P=0.000; LSD-t=8.453,P=0.000)均小于术前,伤椎前缘高度比(LSD-t=22.210,P=0.000; LSD-t=20.167,P=0.000)、伤椎后缘高度比(LSD-t=6.533,P=0.000; LSD-t=5.749,P=0.000)均高于术前; 末次随访时,患者的腰背部疼痛VAS评分、ODI均小于术后7 d(LSD-t=3.756,P=0.001; LSD-t=3.994,P=0.000),伤椎后凸Cobb角、伤椎楔形角、伤椎前缘高度比、伤椎后缘高度比与术后7 d的差异均无统计学意义(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例患者于术后7 d出现切口皮下血肿,清除血肿时发现深筋膜裂开,予以严密缝合后切口愈合; 1例患者术后复查CT时发现伤椎一侧椎弓根内侧壁破裂,但无临床症状,未做特殊处理; 所有患者均未出现脊髓神经损伤、切口感染、内固定松动及断裂等并发症。结论:采用肌间隙入路经椎弓根基底外侧壁椎体内打压植骨联合椎弓根螺钉内固定治疗Ⅱ～Ⅲ期Kümmell病,创伤小,骨折愈合率高,可减轻腰背部疼痛、恢复伤椎高度、改善伤椎后凸畸形、促进伤椎功能恢复,且安全性高,值得临床推广应用。

参考文献/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] 张建乔,曾忠友,宋永兴,等.经皮后凸成形和椎体成形术治疗老年人无神经损伤Ⅲ期Kümmell病[J].中华老年医学杂志,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] 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,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] 张振辉,王庆德,王仲伟,等.后路长、短节段椎弓根螺钉固定联合经椎弓根打压植骨治疗Ⅲ期Kümmell病的疗效比较[J].中华创伤杂志,2021,37(1):22-29.
[25] 王庆德,梅伟,张振辉,等.经椎弓根打压植骨联合后路长节段固定治疗Ⅲ期 Kümmell病[J].中国脊柱脊髓杂志,2018,28(6):522-528.
[26] 张建乔,曾忠友,叶招明,等.微创经椎间孔椎间融合术并单侧椎弓根固定治疗老年人腰椎退变性疾病的临床疗效观察[J].中华老年医学杂志,2015,34(3):290-293.
[27] 曾忠友,张建乔,严卫锋,等.双侧肌间隙入路通道下椎弓根螺钉复位融合固定治疗腰椎滑脱症[J].中华骨科杂志,2018,38(20):1220-1229.
[28] 易西南,沈民仁,罗刚,等.腰椎侧面节段血管及神经的应用解剖[J].中国临床解剖学杂志,2005,23(5):470-473.
(收稿日期:2021-11-01 本文编辑:时红磊)

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(01):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(01):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(01):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(01):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(01):4.
[18]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.
　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]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.
[20]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.

备注/Memo

备注/Memo:
基金项目:浙江省医药卫生科技计划项目(2021KY1114)通讯作者:曾忠友 E-mail:zjzengzy@126.com
更新日期/Last Update: 1900-01-01