摘要
目的探讨后路全脊椎切除(vertebral column resection,VCR)截骨矫形融合固定术治疗上、下终板同时破裂的Ⅲb期Kümmell病的疗效。方法回顾性分析自2015年10月至2021年6月于郑州市骨科医院接受后路VCR钛网植骨融合内固定手术治疗的12例上、下终板同时破裂的Ⅲb期Kümmell病患者资料,男3例、女9例,年龄(59.1±5.6)岁(范围53~67岁)。术前、术后2周、术后1、3、6及12个月采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、美国脊髓损伤协会(American Spinal Injury Association,ASIA)损伤分级评估临床疗效,采用标准侧位X线片测量胸腰段Cobb角评估胸腰段后凸畸形矫正情况,采用CT扫描、冠状面及矢状面重建评估截骨矫形植骨区的骨性融合情况。结果12例患者均顺利完成手术并均获得随访,随访时间(11.6±1.8)个月(范围10~13个月)。术前、术后2周及末次随访时患者疼痛VAS、ODI、JOA评分及胸腰段后凸Cobb角的差异均有统计学意义(P<0.05),其中末次随访与术后2周的差异无统计学意义(P>0.05)。末次随访时疼痛VAS改善率为79.5%、ODI改善率为73.2%、JOA评分改善率为72.1%、胸腰段后凸Cobb角矫正率为77.3%。末次随访时ASIA分级结果:2例由术前C级改善至D级、8例由术前D级改善至E级、2例患者术前D级维持不变。末次随访时12例患者截骨矫形植骨区均骨性融合。术后1例患者出现脂肪液化致切口延迟愈合,经局部扩创、引流及物理治疗后痊愈;余11例患者切口均一期愈合。1例患者术后出现单侧胫后静脉血栓形成,经尿激酶溶栓治疗后出院。结论对上、下终板同时破裂的Ⅲb期胸腰椎Kümmell病患者,后路VCR矫形钛网植骨融合内固定手术治疗是一种较为可靠的选择,可获得良好的早期疗效。
ObjectiveTo evaluate the clinical outcomes of posterior approach vertebral column resection(VCR)osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage Ⅲb Kummell disease.MethodsTwelve patients(3 males,9 females)diagnosed with special type stage Ⅲb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled.The mean age was 59.1±5.6 years(range,53-67 years).All patients underwent VCR osteotomy,pedicle screw fixation,and posterior bone-graft fusion using titanium mesh.Preoperative and postoperative outcomes were assessed using visual analogue scale(VAS)scores,Oswestry Disability Index(ODI),Japanese Orthopaedic Association(JOA)scores,American Spinal Injury Association(ASIA)grading,Cobb angle correction,and bone graft fusion rate.Intraoperative and postoperative complications were also recorded.ResultsAll surgeries were completed successfully.The average follow-up duration was 11.6±1.8 months(range,10-13 months).Significant improvements were observed in VAS scores,ODI,JOA scores,and Cobb angles at both two weeks postoperatively and at the final follow-up(P<0.05),with no significant differences between the two time points(P>0.05).The final recovery rates were 79.5%for VAS score,73.2%for ODI,72.1%for JOA score,and 77.3%for Cobb angle correction.Neurological function showed marked improvement.One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy.The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening.One patient developed postoperative deep venous thrombosis of the lower limbs,which resolved with drug therapy.ConclusionPosterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage Ⅲb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.
作者
焦云龙
郭营
张猛
郭小伟
潘玉林
张怀栓
申薇
梅伟
Jiao Yunlong;Guo Ying;Zhang Meng;Guo Xiaowei;Pan Yulin;Zhang Huaishuan;Shen Wei;Mei Wei(Department of Spinal SurgeryⅡ,Zhengzhou Orthopaedics Hospital,Zhengzhou 450052,China)
出处
《中华骨科杂志》
北大核心
2025年第9期588-595,共8页
Chinese Journal of Orthopaedics
关键词
胸椎
腰椎
骨坏死
截骨术
脊柱融合术
Thoracic vertebrae
Lumbar vertebrae
Osteonecrosis
Osteotomy
Spinal fusion
