经皮植骨椎弓钉固定治疗严重Kümmell病△

Percutaneous bone grafting and pedicle screw fixation for severe Kümmell's disease

摘要:

[目的]介绍经皮植骨椎弓钉固定治疗严重 Kümmell 病的手术技术和初步临床结果。[方法]2019 年 6 月—2021 年 6 月采用经皮植骨椎弓钉固定治疗严重 Kümmell 病患者 14 例。全麻后取俯卧位，透视定位进钉点，做体表标记，牵引按压复位。经皮置入椎弓钉，先旋出伤椎一侧螺钉，顺导钉道置入植骨通道，将骨粒以通道植入椎体裂隙中，再行对侧相同操作。最后紧固钉-棒系统。[结果] 所有患者均顺利完成手术，无严重并发症。手术时长平均 （112.6±28.2） min，术中出血量平均 （131.4±77.6） ml。随术前，术后 1 周及末次随访的时间推移，VAS 评分 [(7.1±0.8), (3.1±0.6), (1.6±0.6), P＜0.001] 及 ODI 评分 [(75.4±4.1), (30.9±3.7), (16.0±3.5), P＜0.001] 均显著降低。影像显示内固定位置良好，与术前相比，术后 Cobb 角 [(29.1±4.4)°, (12.8±3.8)°, (13.6±3.2)°, P＜0.001] 和前缘高度 [(11.8±4.0) mm, (20.1±1.5) mm, (19.6±1.2) mm, P＜0.001] 均显著改善。[结论]经皮植骨椎弓钉固定治疗严重 Kümmell 病手术微创，技术可行，能有效缓解疼痛、矫正后凸畸形、恢复椎体高度。

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of percutaneous bone grafting and pedicle screw fixation for severe Kümmell's disease. [Methods] From June 2019 to June 2021, 14 patients received the abovementioned surgical pro- cedures for severe Kümmell's disease. After general anesthesia, the location of screw insertion points under fluoroscopy with body surface marks in prone position were conducted, and manual reduction of the fracture by traction and compression, the pedicle screws were placed percutaneously. The screw in the injured vertebra on one side was temporally removed, then a channel was inserted into the fissure of the fractured vertebrae over the screw tract and granular bone autografts were implanted through the channel followed by reinserting the pedicle screw. After that, the same operation was performed on the opposite side. Finally, the pedicle screw-rod system was fastened to finish the fix- ation. [Results] All patients had operations performed smoothly without serious complications with operation time of (112.6±28.2) min, and intraoperative blood loss of (131.4±77.6) ml. With time preoperatively, 1 week postoperatively and the latest follow-up, the VAS [(7.1±0.8), (3.1±0.6), (1.6±0.6), P＜0.001] and ODI scores [(75.4±4.1), (30.9±3.7), (16.0±3.5), P＜0.001] significantly decreased. In term of radiograph, all the patients had the implants in good position, with significantly improved local kyphotic Cobb angle [(29.1±4.4)°, (12.8±3.8)°, (13.6± 3.2)°, P＜0.001] and anterior vertebral height [(11.8±4.0) mm, (20.1±1.5) mm, (19.6±1.2) mm, P＜0.001] postoperatively compared with those preoperatively. [Conclusion] The percutaneous bone grafting and pedicle screw fixation are minimally invasive and technically feasible, and do effectively relieve pain, correct kyphotic deformity and restore vertebral height for severe Kümmell's disease.