[1]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):70-73.
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伤椎椎体成形联合后路融合固定术治疗Ⅲ期Kümmell病()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年06期
页码:
70-73
栏目:
kümmell病
出版日期:
2018-06-20

文章信息/Info

作者:
赖欧杰; 胡勇; 袁振山; 董伟鑫; 孙肖阳
浙江省宁波市第六医院,浙江 宁波 315040
关键词:
脊柱骨折;  骨质疏松性骨折;  Kü; mmell病;  椎体成形术;  脊柱融合术;  内固定器;  骨移植
文献标志码:
A
摘要:
目的:观察伤椎椎体成形联合后路融合固定术治疗Ⅲ期Kümmell病的临床疗效和安全性。方法:2013年7月至2015年7月,采用伤椎椎体成形联合后路融合固定术治疗Ⅲ期Kümmell病患者19例,男10例、女9例。年龄55～73岁,中位数63岁。按照美国脊柱损伤协会神经功能分级,C级2例、D级7例、E级10例。病变椎体位于T113例、T124例、L17例、L22例、L31例、L42例。术后随访观察腰背部疼痛缓解、椎体高度恢复、后凸畸形矫正、神经功能恢复、腰椎功能恢复及并发症发生情况。结果:19例患者均顺利完成手术。手术时间140～210 min,中位数160 min。术中出血量250～450 mL,中位数320 mL。所有患者均获随访,随访时间12～21个月,中位数16个月。术后即刻与末次随访时腰背部疼痛视觉模拟量表评分分别由术前(7.53±1.55)分降至(3.32±0.67)分、(2.92±0.64)分,椎体前缘高度百分比[伤椎前缘高度×2/(伤椎上位椎体前缘高度+伤椎下位椎体前缘高度)×100%]由术前(48.34±15.45)%增高至(78.23±8.31)%、(76.07±7.83)%,椎体后缘高度百分比[伤椎后缘高度×2/(伤椎上位椎体后缘高度+伤椎下位椎体后缘高度)×100%]由术前(84.52±4.39)%增高至(91.88±4.43)%、(89.19±5.75)%,Cobb角由术前13.75°±5.48°降低至4.23°±2.45°、6.59°±3.34°。末次随访时,Oswestry功能障碍指数由术前(89.22±27.35)%降至(29.68±5.08)%; 部分患者的神经功能有所恢复,按美国脊柱损伤协会神经功能分级,D级1例、E级18例。9例患者出现不同程度的骨水泥渗漏,其中6例为骨水泥椎旁渗漏、3例为骨水泥椎间盘渗漏,因其无临床症状,未做任何处理; 均未出现神经损害加重、脑脊液漏、骨水泥毒性反应、切口感染及内固定松动、断裂等并发症。结论:采用伤椎椎体成形联合后路融合固定术治疗Ⅲ期Kümmell病,手术时间短,术中出血少,能有效缓解腰背部疼痛、改善腰椎功能、纠正后凸畸形,且并发症少,值得临床推广应用。

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更新日期/Last Update: 2018-10-30