【摘要】 目的 探讨椎体成形术联合短节段椎弓根螺钉内固定治疗Ⅱ、Ⅲ期Kümmell病的临床疗效。方法 2017年11月—2021年9月，嘉兴市中医医院、嘉兴市第二医院和武警海警总医院采用椎体成形术联合短节段椎弓根螺钉内固定治疗Ⅱ、Ⅲ期Kümmell病患者48例，其中Ⅱ期22例，Ⅲ期26例；均为单椎体病变。记录手术时间和术中出血量，术前、术后1周及末次随访时采用疼痛视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI）评估疼痛程度及功能状况；术前、术后1周及末次随访时测量伤椎后凸Cobb角、楔形角及前缘、后缘相对高度；记录术后并发症发生情况。结果 所有手术顺利完成，患者随访12～38(28.3±4.2)个月。手术时间为95～160(120±20) min；术中出血量为20～100(50±20) m L；手术切口均一期愈合，术中无脊髓神经或血管损伤。末次随访时VAS评分、ODI、伤椎后凸Cobb角、伤椎楔形角及伤椎前缘相对高度较术前改善，差异均有统计学意义（P <0.05）。术后发生伤椎骨水泥渗漏8例，Ⅰ型7例、Ⅳ型1例（术后2个月椎弓根螺钉断裂）；上位邻椎骨折3例；椎弓根螺钉松动3例。结论 椎体成形术联合短节段椎弓根螺钉内固定治疗Ⅱ、Ⅲ期Kümmell病虽可获得较好的早期临床疗效，但随访期间并发症发生率较高，须严格把握手术适应证并采用规范的抗骨质疏松辅助治疗。更多还原

【Abstract】 Objective To investigate the effect of vertebroplasty combined with short-segment pedicle screw fixation in the treatment of stages Ⅱand Ⅲ Kümmell’s disease. Methods From November 2017 to September 2021,48 patients with stages Ⅱ and Ⅲ Kümmell’s disease were treated with vertebroplasty combined with short-segment pedicle screw internal fixation in Jiaxing Hospital of Traditional Chinese Medicine,Second Hospital of Jiaxing and Marine Police General Hospital of Armed Police,including stage Ⅱ in 22 cases and stage Ⅲ in 26;all were single vertebral lesion. The operation time and intraoperative blood loss were recorded. The pain intensity and functional status were evaluated by visual analogue scale(VAS) score and Oswestry disability index(ODI) at pre-operation,postoperative 1 week and the final follow-up. The kyphosis Cobb angle,wedge angle and the relative height of the anterior and posterior edges of the injured vertebrae were measured at pre-operation,postoperative 1 week and the final follow-up. Postoperative complications were recorded. Results All the operations were successfully completed,and the patients were followed up for 12-38(28.3±4.2) months. The operation time was 95-160(120±20) min,intraoperative blood loss was 20-100(50±20) mL. All the surgical incisions healed at one stage,and there was no spinal cord nerve or blood vessel injury during the operation. At the final follow-up,VAS score,ODI,Cobb angle,wedge angle and the relative height of the anterior edges were significantly improved compared with those before operation,all with a statistical significance(P <0.05). There were 8 cases of bone cement leakage,7 cases of type Ⅰand 1 of type Ⅳ（pedicle screw fracture at postoperative 2 months）,upper adjacent vertebral fracture in 3,and pedicle screw loosening in 3. Conclusion Although vertebroplasty combined with short-segment pedicle screw fixation in the treatment of stages Ⅱ and Ⅲ Kümmell’s disease can achieve good early clinical efficacy,the complication rate during follow-up is high,so it is necessary to strictly grasp the surgical indications and use regular anti-osteoporosis adjuvant treatment.更多还原