骨水泥强化短节段椎弓根螺钉固定III期Kümmell病△

Cement-augmented short-segment pedicle screw fixation for the stage III Kümmell’s disease

摘要:

[目的]介绍骨水泥强化短节段椎弓根螺钉固定 III 期 Kümmell 病的手术技术和初步临床疗效。[方法]2018 年 1 月 —2021 年 1 月采用上述技术治疗 III 期 Kümmell 病患者 20 例。透视定位病椎，并做体表标记，于病椎上下各经皮置入 1 对， 病椎一侧 1 枚空心骨水泥椎弓钉。首先于上下邻椎注入骨水泥，侍固化后，经皮穿入双侧连接棒，撑开复位病椎，保留病椎非置钉侧棒，维持复位。于病椎未置入椎弓钉一侧置入穿刺针，经病椎空心椎弓钉和穿刺针注入骨水泥，在病椎椎体内形成完全相融的骨水泥块，待病椎椎体内水泥凝固后，撤出穿刺针，连接棒并锁紧尾塞；缝合 5 个小切口。[结果]20 例患者均顺利完成手术，无严重并发症。随访 12~36 个月。末次随访，VAS 和 ODI 评分显著减少(P＜0.05)，神经功能 Frankel 分级显著改善。影像方面，术后伤椎椎体前缘高度显著增加、手术节段 Cobb 角及伤椎楔形角显著减少(P＜0.05)。[结论]骨水泥强化短节段椎弓根螺钉固定治疗 III 期 Kümmell 病能有效恢复伤椎椎体高度，矫正后凸，防止病变椎体再次塌陷，临床效果满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of cement-augmented short-segment pedi- cle screw fixation for the stage III Kümmell disease. [Methods] From January 2018 to January 2021, 20 patients received abovesaid surgical treatment for the stage III Kümmell disease. As the affected vertebrae were located by fluoroscopy, the markers was made on the body surface. Two pairs of cannulated cemented pedicles screws were placed percutaneously into the vertebrae above and below the affected vertebra re- spectively, whereas only one cannulated pedicle screw was placed on one side of the affected vertebra. Bone cement was injected into the above and below adjacent vertebrae firstly. After the bone cement cured, bilateral connecting rods were inserted percutaneously to reduce the kyphotic deformity of affected vertebrae by distraction, and then retain the non-screw side rod of the affected vertebra to maintain the reduc- tion. A puncture needle was inserted on the side of the affected vertebra where the pedicle screw was not inserted, and bone cement was inject- ed into the affected vertebra through the cannulated pedicle screw and the puncture needle to form a completely integrated bone cement block in the affected vertebral body. After the cement solidified in the affected vertebra, the puncture needle was withdrawn, and the screw side was inserted the rod again percutaneously, and lock the tail plug. Finally, the 5 small incisions were closed by suture. [Results] All the 20 patients had the surgical procedures performed successfully without serious complications, and followed up for 12~36 months. The VAS and ODI scores significantly reduced (P＜ 0.05) , while the Frankel grade of neurological function significantly improved at the last follow-up compared with those preoperatively. In terms of imaging, the anterior height of the injured vertebra increased significantly, whereas the kyphotic Cobb angle of the surgical segments and the wedge angle of the injured vertebra decreased significantly postoperatively (P＜0.05) . [Conclusion] This cement-enhanced short-segment pedicle screw fixation for the stage III Kümmell’s disease does effectively restore the height of the in- jured vertebral body, correct kyphosis, prevent the re-collapse of the affected vertebral body, achieve satisfactory clinical outcomes.