| 朱云荣,杨武,张云庆,许国华.经皮椎体成形术联合短节段椎弓根螺钉内固定术和经皮椎体成形术中采用填充网袋内注入骨水泥治疗无神经症状Ⅲ期Kümmell病[J].脊柱外科杂志,2021,19(5):296-301. |
经皮椎体成形术联合短节段椎弓根螺钉内固定术和经皮椎体成形术中采用填充网袋内注入骨水泥治疗无神经症状Ⅲ期Kümmell病  点此下载全文 (Fulltext) |
| 朱云荣1 杨武1 张云庆1* 许国华2 |
1. 江阴市人民医院骨科, 无锡 214400;
2. 海军军医大学长征医院骨科, 上海 200003 |
| 基金项目：江苏省卫生健康委科研项目（Z2019015） |
| DOI：10.3969/j.issn.1672-2957.2021.05.002 |
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| 摘要： |
| 目的 探讨经皮椎体成形术（PVP）联合短节段椎弓根螺钉内固定术和PVP术中采用填充网袋内注入骨水泥治疗无神经症状Ⅲ期Kümmell病的疗效。方法 回顾性分析江阴市人民医院2015年1月-2019年12月收治的52例无神经症状Ⅲ期Kümmell病患者的临床资料。前期24例患者采用PVP联合短节段椎弓根螺钉内固定术治疗（A组），后期28例采用PVP术中向置入的填充网袋内注入骨水泥治疗（B组）。记录2组手术时间、术中出血量、住院时间、医疗费用及术前、术后3 d、术后3个月、末次随访时疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）、伤椎前缘高度压缩比、节段后凸Cobb角；观察术后并发症情况。结果 所有手术顺利完成。所有患者随访时间>12个月。B组手术时间、术中出血量、住院时间和医疗费用均少于A组，差异有统计学意义（P<0.05）。2组患者术后VAS评分和ODI均较术前显著改善，差异有统计学意义（P<0.05）。A组术后3个月及末次随访时VAS评分和ODI较术后3 d降低，差异均有统计学意义（P<0.05）；B组术后3个月及末次随访时VAS评分和ODI与术后3 d相比，差异无统计学意义（P>0.05）。B组术后3 d VAS评分和ODI低于A组，差异均有统计学意义（P<0.05）；末次随访时，2组VAS评分和ODI差异无统计学意义（P>0.05）。2组患者术后伤椎前缘高度压缩比和节段后凸Cobb角均较术前改善，差异有统计学意义（P<0.05）。B组术后3 d、术后3个月及末次随访时伤椎前缘高度压缩比及术后3 d、术后3个月节段后凸Cobb角大于A组，差异均有统计学意义（P<0.05）。A组发生骨水泥渗漏8例，B组3例，差异有统计学意义（P<0.05）。2组术后均未出现下肢神经症状和其他严重并发症。结论 对于无神经症状Ⅲ期Kümmell病患者，PVP联合短节段椎弓根螺钉内固定术和PVP术中采用填充网袋内注入骨水泥可获得相似的临床效果，前者更有助于改善伤椎高度、矫正后凸畸形，后者创伤小、恢复快且医疗费用低。 |
| 关键词：胸椎 脊柱骨折 骨折,压缩性 骨质疏松 内固定器 骨代用品 椎体成形术 |
| Percutaneous vertebroplasty combined short-segmental pedicle screw fixation and percutaneous vertebroplasty with cement injected into filling mesh bag for treatment of stage Ⅲ Kümmell disease without neurological symptom Fulltext |
| Zhu Yunrong1 Yang Wu1 Zhang Yunqing1* Xu Guohua2 |
1. Department of Orthopaedics, Jiangyin People's Hospital, Wuxi 214400, Jiangsu, China;
2. Department of Orthopaedics, Changzheng Hospital, Navy Medical University, Shanghai 200003, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the effect of percutaneous vertebroplasty(PVP) combined short-segmental pedicle screw fixation and PVP with cement injected into filling mesh bag for the treatment of stageⅢ Kümmell disease without neurological symptom. Methods From January 2015 to December 2019,the clinical data of 52 patients with stageⅢ Kümmell disease without neurological symptom in Jiangyin people's Hospital were retrospectively analyzed. In the early stage,24 patients were treated with PVP combined short-segmental pedicle screw fixation(group A),and in the late stage,28 patients were treated with PVP with cement injected into filling mesh bag(group B). The operation time,intraoperative blood loss,hospital stay,medical expenses,and visual analogue scale(VAS) score,Oswestry disability index(ODI),compression ratio of anterior edge height of injured vertebra and segmental kyphosis Cobb's angle at pre-operation,postoperative 3 d,postoperative 3 months and the final follow-up were recorded. The postoperative complications were observed. Results All the operations were successfully completed. All the patients were followed up for more than 12 months. The operation time,intraoperative blood loss,hospital stay and medical expenses in group B were less than those in group A,and the differences werestatistically significant(P<0.05). The VAS score and ODI of the 2 groups were significantly improved after operation compared with pre-operation,and the differences were statistically significant(P<0.05). In group A,the VAS score and ODI at postoperative 3 months and the final follow-up were significantly lower than those at postoperative 3 d,and the differences were statistically significant(P<0.05). In group B,there was no significant difference in VAS score and ODI between postoperative 3 months,the final follow-up and postoperative 3 d(P>0.05). At postoperative 3 d,the VAS score and ODI of group B were lower than those of group A,and the differences were statistically significant(P<0.05). At the final follow-up,there was no significant difference in VAS score and ODI between the 2 groups(P>0.05). The compression ratio of anterior edge height of injured vertebra and segmental kyphosis Cobb's angle of the 2 groups were improved after operation compared with pre-operation,and the differences were statistically significant(P<0.05). At postoperative 3 d,postoperative 3 months and the final follow-up,the compression ratio of anterior edge height of injured vertebra and the segmental kyphosis Cobb's angle in group B were higher than those in group A,and the differences were statistically significant(P<0.05). There were 8 cases of bone cement leakage in group A and 3 in group B,and the difference was statistically significant(P<0.05). There were no neurological symptoms of the lower extremity and other serious complications in both groups. Conclusions For patients with stageⅢ Kümmell disease without neurological symptom,PVP combined short-segmental pedicle screw fixation and PVP with cement injected into filling mesh bag can obtain similar clinical effect. The former is more helpful to improve the height of injured vertebra and correct kyphosis,while the latter with less invasive,faster recovery and low medical expenses. |
| Keywords:Thoracic vertebrae Spinal fractures Fractures,compression Osteoporosis Internal fixators Bone substitutes Vertebroplasty |
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