| 骨水泥强化螺钉内固定技术在矫正 Kümmell病伴后凸畸形的临床效果对比研究 |
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投稿时间：2024-02-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 杭海峰 |
HANG Hai-feng |
江苏医药职业学院, 江苏 盐城 224000
扬州市江都人民医院脊柱外科, 江苏 扬州 225200 |
Jiangsu Vocational College of Medicine, Yancheng 224000, Jiangsu, China
Department of Spine Surgery, Yangzhou Jiangdu People's Hospital, Yangzhou 225200, Jiangsu, China |
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| 王宏伟 |
WANG Hong-wei |
江苏医药职业学院, 江苏 盐城 224000 |
Jiangsu Vocational College of Medicine, Yancheng 224000, Jiangsu, China |
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| 陈礼鑫 |
CHEN Li-xin |
扬州市江都人民医院脊柱外科, 江苏 扬州 225200 |
Department of Spine Surgery, Yangzhou Jiangdu People's Hospital, Yangzhou 225200, Jiangsu, China |
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| 汤新兵 |
TANG Xin-bing |
扬州市江都人民医院脊柱外科, 江苏 扬州 225200 |
Department of Spine Surgery, Yangzhou Jiangdu People's Hospital, Yangzhou 225200, Jiangsu, China |
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| 黄爱兵 |
HUANG Ai-bing |
泰州市人民医院脊柱外科, 江苏 泰州 225300 |
Department of Spine Surgery, Taizhou People's Hospital, Taizhou 225300, Jiangsu, China |
hab165@bjmu.edu.cn |
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| 期刊信息：《中国骨伤》2025年，第38卷，第3期，第280-286页 |
| DOI：10.12200/j.issn.1003-0034.20230446 |
| 基金项目:江苏医药职业学院校外教学基地科研发展基金项目(编号:20229139) |
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中文摘要:
目的: 探讨骨水泥强化椎弓根螺钉技术应用于矫正Ⅲ期无神经症状Kümmell病伴后凸畸形的临床疗效。
方法: 回顾性分析2019年3月至2021年12月收治的40例无神经症状Ⅲ期Kümmell病患者的临床资料,男15例,女25例,年龄61~81(67.4±5.2)岁,根据手术方式不同分为经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)组和强化钉组。PKP组18例,男7例,女11例;年龄61~78(66.2±5.5)岁;病程5~12(7.33±1.78)个月;骨密度(bone mineral density,BMD) T值为-2.45~-4.00(-3.08±0.46);T8-T9 2例,T10-T12 10例,L1-L2 6例;予PKP治疗。强化钉组22例,男8例,女14例;年龄65~81(68.5±3.8)岁;病程4~15(7.86±2.73)个月;BMD的T值-2.40~-4.50(-3.18±0.54);T8-T9 3例,T10-T12 12例,L1-L2 7例;行骨水泥强化椎弓根螺钉内固定联合伤椎后凸成形术治疗。比较两组术前、术后3 d和12个月伤椎后凸Cobb角、伤椎椎体前缘高度;比较两组术前和术后12个月疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI);比较两组术后并发症发生情况。
结果: 两组患者获得随访,PKP组随访时间11~14(11.97±0.96)个月,强化钉组随访时间10~14(12.05±1.09)个月,两组比较差异无统计学意义(P>0.05)。强化钉组术后3 d、12个月Cobb角分别为(7.34±2.26)°、(18.86±1.96)°,PKP组分别为(18.88±1.89)°、(23.28±1.90)°,差异有统计学意义(P<0.05);强化钉组术后3 d、12个月伤椎前缘高度分别为(25.28±1.33)、(19.62±2.22) mm,与PKP组(18.61±2.16)、(15.93±1.34) mm比较,差异有统计学意义(P<0.05);两组术后3 d及12个月Cobb角与伤椎前缘高度均较术前明显改善,差异有统计学意义(P<0.05)。术后12个月,PKP组、强化钉组VAS分别为(2.00±0.69)、(1.91±0.61)分,ODI分别为(13.44±4.02)%、(10.18±4.26)%,均较术前(6.89±0.76)、(7.23±0.75)分及(36.33±3.40)%、(37.09±3.73)%明显降低,差异有统计学意义(P<0.05);两组术后12个月VAS比较,差异无统计学意义(P>0.05);强化钉组术后12个月ODI较PKP组减小,差异有统计学意义(P<0.05)。两组并发症比较,差异无统计学意义(χ2=0.071,P>0.05)。
结论: PKP与骨水泥强化钉联合伤椎PKP两种术式均可改善脊柱后凸畸形和术后功能,缓解疼痛。骨水泥强化钉内固定技术的应用能提供一个更稳定的支撑,功能恢复更明显,伤椎再塌陷的风险更低,能够更好地维持脊柱长期的稳定性。 |
| 【关键词】骨水泥强化 椎弓根螺钉 Kümmell病 经皮椎体后凸成形术 后凸畸形 矫形 |
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| Comparative study on clinical effect of bone cement-strengthened screw fixation in the correction of Kümmell's disease with kyphosis |
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ABSTRACT
Objective To explore clinical effect of bone cement-strengthened pedicle screw technique in the correction of stage Ⅲ asymptomatic Kümmell disease with kyphosis.
Methods A retrospective analysis was conducted on clinical data of 40 asymptomatic stage Ⅲ Kümmell disease patients admitted between March 2019 and December 2021,including 15 males and 25 females,aged from 61 to 81 years old with an average of (67.4±5.2) years old;according to different surgical methods,they were divided into percutaneous kyphoplasty group (PKP) and reinforced screw group. There were 18 patients in PKP group,including 7 males and 11 females,aged from 61 to 78 years old with an average of (66.2±5.5) years old;the courses of disease ranged from 5 to 12 months with an average of (7.33±1.78) months;bone mineral density(BMD) T values ranged from -2.45 to -4.00 with an average of (-3.08±0.46);2 patients with T8-T9,10 patients with T10-T12,and 6 patients with L1-L2;treated with PKP. There were 22 patients in reinforced screw group,including 8 males and 14 females,aged from 65 to 81 years old with an average of (68.5±3.8) years old;the courses of disease ranged from 4 to 15 months with an average of (7.86±2.73)months;bone mineral density(BMD) T values ranged from -2.40 to -4.50 with an average of (-3.18±0.54);3 patients with T8-T9,12 patients with T10-T12,and 7 patients with L1-L2;treated with bone cement reinforced pedicle screw internal fixation combined with kyphoplasty. Cobb angle and anterior margin height of the injured vertebra were compared before operation,3 d and 12 months after operation. Visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between two groups before operation and 12 months after operation. The incidence of postoperative complications was compared between two groups.
Results All patients were followed up,PKP group followed up for 11 to 14 months with an average of (11.97±0.96) months and 10 to 14 months with an average of (12.05±1.09) months in reinforced screw group;there was no significant difference between two groups (P>0.05). Postoperative Cobb angle at 3 days and 12 months in reinforced screw group were (7.34±2.26) ° and (18.86±1.96) °,while in PKP group were (18.88±1.89) ° and (23.28±1.90) °;there were statistical difference between two groups (P<0.05). The anterior margin height of the injured vertebra in reinforced screw group were (25.28±1.33) mm and (19.62±2.22) mm at 3 days and 12 months after operation,while in PKP group were (18.61±2.16) mm and(15.93±1.34) mm;there were statistical difference between two groups (P<0.05). Cobb angle and the anterior margin height of the injured vertebra were significantly improved at 3 days and 12 months after operation between two groups (P<0.05). Postoperative VAS and ODI at 12 months in PKP group were (2.00±0.69) score and (13.44±4.02)%,while in reinforced screw group were(1.91±0.61) score and (10.18±4.26)%;which were significantly lower than (6.89±0.76) score and (36.33±3.40)% in PKP group,(7.23±0.75) score and (37.09±3.73)% in reinforced screw group before operation. There were no difference in postoperative VAS between two groups at 12 months (P>0.05);postoperative ODI in reinforced screw group at 12 months was lower than that in PKP group(P<0.05). There was no significant difference in complications between two groups (χ2=0.071,P>0.05).
Conclusion PKP and bone cement reinforced nail combined with PKP could improve kyphotic deformity and postoperative function,and relieve pain. The application of bone cement-reinforced nail fixation technology could provide a more stable support,more obvious functional recovery,lower the risk of re-collapse of the injured vertebra,and maintain the long-term stability of spine. |
| KEY WORDS Bone cement strengthening Pedicle screw Kümmell disease Percutaneous kyphoplasty Kyphosis Orthopaedic |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 杭海峰,王宏伟,陈礼鑫,汤新兵,黄爱兵.骨水泥强化螺钉内固定技术在矫正 Kümmell病伴后凸畸形的临床效果对比研究[J].中国骨伤,2025,38(3):280~286 |
| 英文格式: | HANG Hai-feng,WANG Hong-wei,CHEN Li-xin,TANG Xin-bing,HUANG Ai-bing.Comparative study on clinical effect of bone cement-strengthened screw fixation in the correction of Kümmell's disease with kyphosis[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(3):280~286 |
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