| 单节段胸腰椎Ⅲ期Kümmell病短节段和长节段强化固定的临床比较研究 |
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投稿时间：2019-01-09
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| 作者 | Author | 单位 | Address | E-Mail |
| 邓轩赓 |
DENG Xuan-geng |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
tigerd@163.com |
| 熊小明 |
XIONG Xiao-ming |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 万趸 |
WAN Dun |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 石华刚 |
SHI Hua-gang |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 崔伟 |
CUI Wei |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 陈星 |
CHEN Xing |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 梅国龙 |
MEI Guo-long |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 宋偲茂 |
SONG Si-mao |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 侯伟 |
HOU Wei |
四川省骨科医院, 四川 成都 610041 |
Sichuan Orthopedic Hospital, Chengdu 610041, Sichuang, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第7期，第598-603页 |
| DOI：10.3969/j.issn.1003-0034.2019.07.003 |
| 基金项目:四川省干部保健课题（编号：2018-612） |
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中文摘要:目的：比较单节段胸腰椎Ⅲ期Kümmell病短节段和长节段固定的临床疗效，探讨更适宜的固定节段。
方法：对2013年7月至2016年12月收治的46例单节段胸腰椎Ⅲ期Kümmell病患者的临床资料进行回顾性分析，46例患者因不同的骨水泥钉棒固定方法分为短节段固定组（病椎上下各1椎）和长节段固定组（病椎上下各2椎）。其中短节段固定组25例，男9例，女16例，年龄（75.3±4.5）岁，腰椎骨密度T值（-3.1±0.3）g/cm3，随访时间（13.0±2.3）个月；长节段固定组21例，男6例，女15例，年龄（74.5±3.9）岁，腰椎骨密度T值（-3.2±0.3）g/cm3，随访时间（14.7±3.6）个月。比较两组患者的性别、年龄、随访时间、手术时间、术中出血量、骨水泥渗漏、邻椎骨折率，以及手术前后的疼痛VAS评分、ODI、后凸角变化。
结果：术前两组患者年龄、性别、骨密度、疼痛VAS评分、ODI、后凸角比较差异无统计学意义，手术时间及术中出血量短节段固定组少于长节段固定组，术后7 d及末次随访时两组患者的疼痛VAS评分、ODI、后凸角较术前均有显著改善，组间比较差异无统计学意义。两组骨水泥渗漏（9/25 vs 11/21）及邻椎骨折发生（4/25 vs 3/21）差异无统计学意义。
结论：长短节段固定均可有效缓解疼痛、纠正后凸、提高功能指数，取得较好临床疗效，但短节段骨水泥钉棒固定手术时间更短、术中出血更少，因此对于胸腰椎单节段Ⅲ期Kümmell病无需延长固定节段，短节段固定更符合临床需要，值得进一步研究。 |
| 【关键词】Kümmell病 内固定 椎体强化 |
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| Clinical comparative study of short-segment and long-segment fixation for single-segment thoracic and lumbar spine Ⅲ stage Kümmell disease |
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ABSTRACT Objective:By comparing the clinical efficacy of short-segment and long-segment fixation for single-segment thoracic and lumbar spine Ⅲ stage Kümmell disease to explore a more suitable fixed segment for the disease.
Methods:The clinical data of 46 patients with single-segment thoracic and lumbar spine Ⅲ stage Kümmell disease treated from July 2013 to December 2016 were retrospectively analyzed. Forty-six patients were divided into short-segment fixation group(one vertebra above and below the diseased vertebra) and long-segment fixation group(two vertebrae on the upper and lower of the diseased vertebra) according to different methods of cement stick fixation. There were 25 patients in the short-segment fixation group,including 9 males and 16 females,with an average age of (75.3±4.5) years old,lumbar spine bone mineral density T-value of (-3.1±0.3) g/cm3,follow-up time of (13.0±2.3) months;there were 21 patients in long-segment fixation group,6 males and 15 females,with an average age of (74.5±3.9) years old,lumbar spine bone mineral density T-value of (-3.2±0.3) g/cm3,follow-up time of (14.7±3.6) months.The gender,age,follow-up time,operation time,intraoperative blood loss,cement leakage,and the rate of adjacent vertebrae fractures were compared between two groups,as well as pain VAS score,ODI,and kyphosis angle before and after surgery.
Results:There were no significant differences in age,gender,bone density,pain VAS score,ODI,and kyphosis between two groups before surgery. The operation time and intraoperative blood loss of short-segment fixation group were less than that of long-segment fixation group. The pain VAS score,ODI and kyphosis of the two groups were significantly improved at 7 days after the operation and at the latest follow-up,there was no significant difference between two groups. There were no significant differences in bone cement leakage(9/25 vs 11/21) and adjacent vertebrae fractures(4/25 vs 3/21).
Conclusion:Both long-segment fixation and short-segment fixation can effectively relieve pain,correct kyphosis,improve functional index,and achieve better clinical results,but short-segment fixation has less operation time and less intraoperative blood. So single-segment thoracic and lumbar spine Ⅲ stage Kümmell disease does not need to extend the fixed segment,short-segment fixation is more in line with clinical needs and worthy of further study. |
| KEY WORDS Kümmell disease Internal fixation Vertebral strengthening |
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| 中文格式: | 邓轩赓,熊小明,万趸,石华刚,崔伟,陈星,梅国龙,宋偲茂,侯伟.单节段胸腰椎Ⅲ期Kümmell病短节段和长节段强化固定的临床比较研究[J].中国骨伤,2019,32(7):598~603 |
| 英文格式: | DENG Xuan-geng,XIONG Xiao-ming,WAN Dun,SHI Hua-gang,CUI Wei,CHEN Xing,MEI Guo-long,SONG Si-mao,HOU Wei.Clinical comparative study of short-segment and long-segment fixation for single-segment thoracic and lumbar spine Ⅲ stage Kümmell disease[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(7):598~603 |
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