脊柱后路PSO截骨长节段固定治疗Kummells病伴脊柱后凸的临床疗效

doi:10.3877/cma.j.issn.2096-0263.2019.01.007

目的

评估脊柱后路截骨长节段固定治疗Kummells病伴脊柱后凸的临床疗效。

方法

回顾性收集2014年1月至2017年6月期间浙江中医药大学附属江南医院诊断并行脊柱后路截骨长节段固定治疗的Kummells病伴脊柱后凸患者11例，其中男性3例，女性8例，平均年龄（67.2±2.4）岁。随访并分析患者一般资料，手术时间，术中失血量及术后并发症，临床疗效评价包括后凸Cobb角的改善，Oswestry残疾指数（ODI）和疼痛视觉模拟评分（VAS）。

结果

11例患者平均随访时间为（14.6±2.4）个月，患者的平均手术时间为（240±22）min，失血量为（1260±130）mL，输血量为（600±200）ml，X线显示术前Cobb角为（44±11）°，术后2 w为（9±3）°，末次随访时为（13±4）°，结果显示术后Cobb角与术前相比显着改善（F=81.141，P<0.05）。此外，术后VAS评分显着下降（F=71.962, P<0.05），术后ODI低于术前ODI（F=29.031，P<0.05）。

结论

脊柱后路截骨长节段固定是治疗Kummell病伴后凸畸形的有效安全手术方法，但仍需长期随访研究。

关键词: 骨质疏松性骨折, 脊柱后凸, 外科手术

Objective

The aim of this study was to evaluate the clinical efficacy of posterior spine osteotomy long segment fixation in treating osteoporotic Kummell disease with kyphosis.

Methods

Between January 2014 to June 2017, 11 patients diagnosed with Kummell disease with kyphosis underwent posterior spine osteotomy long segment fixation treatment, and their medical records were retrospectively collected. There were 3 males and 8 females, average age were (67.2±2.4) years old. Clinical efficacy of Posterior spine osteotomy long segment fixation treatment was evaluated by normal information, kyphotic Cobb's angle, Oswestry disability index (ODI) and visual analogue scale (VAS) score.

Results

11 patients were followed up for more than 1 year. The average follow-up time was 14.6±2.4 months. The average operation time was 240±22 min, the blood loss was 1260±130 ml, the blood transfusion was 600±200 ml, and the X-ray showed Cobb angle was (44±11)° preoperatively, (9±3)° for two weeks after surgery, and (13±4)° at the last follow-up. The results showed that the Cobb's angle after surgery was significantly improved compared with preoperative (F=81.141, P<0.05). In addition, postoperative VAS scores decreased significantly (F=71.962, P<0.05), postoperative ODI was less than preoperative ODI (F=29.031, P<0.05).

Conclusions

Long-segmental fixation of the posterior spinal osteotomy is an effective and safe surgical procedure for the treatment of Kummell's disease with kyphosis, but long-term follow-up studies are still needed.

Key words: Osteoporotic fractures, Kyphosis, Surgical procedures, operative

图10~15 女性，70岁，L₁椎体Kummells病伴脊柱后凸。图10　术前正位X线；图11　术前侧位X线（Cobb角32°）；图12~13　术前MRI；图14　术后X线正位；图15　术后X线侧位（术后Cobb角10°）

表1 11例Kummells病伴脊柱后凸手术前后Cobb角、VAS及ODI评分比较（±s）

项目	术前	术后2 w	末次随访	F值	P值
Cobb角（°）	44±11	9±3^*	13±4^*	81.141	<0.05
VAS评分（分）	6.6±1.2	2.8±1.1^*	1.2±0.9^*	71.962	<0.05
ODI（%）	52±15^*	17±14^*	12±13^*	29.031	<0.05

表1 11例Kummells病伴脊柱后凸手术前后Cobb角、VAS及ODI评分比较（±s）

项目	术前	术后2 w	末次随访	F值	P值
Cobb角（°）	44±11	9±3^*	13±4^*	81.141	<0.05
VAS评分（分）	6.6±1.2	2.8±1.1^*	1.2±0.9^*	71.962	<0.05
ODI（%）	52±15^*	17±14^*	12±13^*	29.031	<0.05

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The treatment evaluation for osteoporotic Kummell disease with kyphosis by posterior spine osteotomy long segment fixation

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The treatment evaluation for osteoporotic Kummell disease with kyphosis by posterior spine osteotomy long segment fixation