短节段钉棒固定联合伤椎植骨治疗不稳定型Kümmell病

黎钟遍; 魏均强

doi:10.13898/j.cnki.issn.1000-2200.2021.02.017

短节段钉棒固定联合伤椎植骨治疗不稳定型Kümmell病

Effect of the short segment nail rod fxation combined with injured vertebral bone grafting in the treatment of unstable Kümmell disease

摘要

摘要:
目的探讨短节段钉棒固定联合伤椎植骨治疗不稳定型Kümmell病临床疗效。
方法回顾性分析不稳定型Kümmell病病人47例病历资料，短节段钉棒固定联合伤椎植骨治疗病人25例作为伤椎植骨组，短节段钉棒固定联合椎体成形治疗病人22例作为椎体成形组，比较2组病人手术相关指标，比较手术前和手术后7 d、6个月及末次随访时疼痛视觉模拟（VAS）评分、Cobb角以及伤椎前缘高度比，记录并发症发生情况。
结果2组病人手术时间、出血量、住院时间差异均无统计学意义（P>0.05）。2组术后7 d、6个月和末次随访时伤椎前缘高度比均明显高于术前（P < 0.01），VAS评分、Cobb角均明显低于术前（P < 0.01）。伤椎植骨组术后7 d VAS评分明显高于椎体成形组（P < 0.01），术后6个月和末次随访VAS评分均明显低于椎体成形组（P < 0.01）；2组Cobb角以及伤椎前缘高度比差异均无统计学意义（P>0.05）。椎体成形组并发症发生率为31.82%（7/22），明显高于伤椎植骨组的8.00%（2/25）（P < 0.01）。
结论短节段钉棒固定联合伤椎植骨与椎体成形均能够有效恢复不稳定型Kümmell病椎体高度和生理曲度，但联合伤椎植骨远期疼痛改善效果更好，并发症发生率更低。

Abstract:
ObjectiveTo explore the clinical effect of short segment nail rod fixation combined with injured vertebral bone grafting in the treatment of unstable Kümmell disease.
MethodsThe clinical data of 47 patients with unstable Kümmell disease were retrospectively analyzed.Twenty-five patients treated with short segmental nail rod fixation combined with injured vertebral bone grafting were set as the injured vertebral bone grafting group, and 22 patients treated with short segment nail rod fixation combined vertebroplasty were set as the vertebroplasty group.The surgery-related indicators between two groups were compared.The pain visual analogue(VAS)score, Cobb angle and anterior margin height ratio of injured vertebrae before surgery, after 7 days, 6 months and last following-up of operation were compared between two groups.The occurrence of complications in two groups was recorded.
ResultsThe differences of the operation time, amount of bleeding and length of hospital stay between two groups were not statistically significant(P>0.05).After 7 days, 6 months and last following-up of operation, the height ratio of anterior margin in two groups were significantly higher than that before operation(P < 0.01), the VAS score and Cobb angle were significantly lower than that before surgery(P < 0.01).The 7-day VAS score in injured vertebraling bone grafting group was significantly higher than that in vertebroplasty group(P < 0.01), and the VAS scores in injured vertebral bone grafting group after 6 months and last following-up of operation were significantly lower than that in vertebroplasty group(P < 0.01).The differences of the Cobb angle and height ratio of anterior margin between two groups were not statistically significant(P>0.05).The incidence rate of complication in vertebroplasty group(31.82%)was significantly higher than that in injured vertebral bone grafting group(8.00%)(P < 0.01).
ConclusionsShort segment nail rod fixation combined with injured vertebral bone grafting and vertebroplasty can effectively restore the vertebral height and physiological curvature of unstable Kümmell disease, which combined with injured vertebral bone grafting can improve the long-term pain, and decrease the incidence rate of complication.

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