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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:

第32卷

期数:

2024年04期

页码:

77-80+88

栏目:

临床报道

出版日期:

2024-04-01

文章信息/Info

Title:

Clinical Observation of the Treatment of Non-Union of Thoracolumbar Fracture with Reconstruction of Middle Column before Unilateral Pedicle Resection

文章编号:

1005-0205(2024)04-0077-04

作者:

陈广林¹; 冯婷婷¹; 王进强¹; 高鹏¹; 高兆青¹; 徐世涛^1△

¹潍坊市中医院(山东 潍坊,261041)

Author(s):

CHEN Guanglin¹; FENG Tingting¹; WANG Jinqiang¹; GAO Peng¹; GAO Zhaoqing¹; XU Shitao^1△

¹Weifang Hospital of Traditional Chinese Medicine,Weifang 261041,Shandong China.

关键词:

胸腰椎骨折不愈合Ⅲ期;  单侧椎弓根切除;  前中柱重建

Keywords:

Kummell's disease stage Ⅲ;  unilateral pedicle resection;  anterior middle column reconstruction

分类号:

R683.2

DOI:

10.20085/j.cnki.issn1005-0205.240416

文献标志码:

B

摘要:

目的:探讨单侧椎弓根切除减压病椎前中柱重建治疗Ⅲ期Kummell's 病的可行性及技术要点,分析该术式的安全性及有效性。方法:回顾性分析2018年9月至2021年1月采用单侧椎弓根切除减压病椎前中柱重建治疗Ⅲ期Kummell's 病的患者13例,男1例,女12例,年龄为(69.53±8.71)岁。术前X线、CT、MR确定椎体内存在真空征(X线/CT)或者椎体内积液积气(MR)。所有患者切除症状侧或者症状较重侧椎板、关节突及椎弓根,对侧使用椎弓根螺钉撑开恢复部分病椎高度,通过椎体内打压植骨、PEEK材料椎间融合器植入进一步恢复病椎高度; 同时,采用后路椎弓根螺钉系统固定病椎邻近上下两个节段椎体,术中X线透视确定病椎恢复到有效高度; 最终,重建病椎前中柱并纠正后凸畸形。观察指标包括手术时间、术中出血量、术后引流量、病椎椎体高度以及手术前后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、病椎局部矢状面Cobb角。 结果:所有患者均顺利完成手术,无神经血管损伤,腰背痛、下肢痛麻等症状明显改善。手术时间为(192.00±87.16)min,术中出血量为(249.00±128.26)mL,术后引流量为(283.27±76.71)mL。1例患者出现切口脂肪液化,清创后愈合。1例患者出现下肢肌间静脉血栓。12例患者获得完整随访,1例患者术后半年出现脑梗并肢体活动障碍,失访。随访时间为8～11个月,平均为10.1个月。VAS评分、ODI评分由术前(6.46±1.32)分和(68.16±4.43)分分别改善至(1.18±0.59)分和(15.35±7.64)分,差异有统计学意义(F=16.556,P<0.001; F=29.368,P<0.001)。椎体前缘高度由术前(1.03±0.41)cm改善至术后1周(2.24±0.55)cm和末次随访(2.11±0.46)cm,手术前后变化差异有统计学意义(F=11.578,P<0.001),术后随访变化差异无统计学意义(q=3.12,P=0.081)。局部后凸畸形由术前28.72°±8.12°改善至术后1周8.16°±3.27°和末次随访9.32°±2.13°,手术前后变化差异有统计学意义(F=18.461,P<0.001),术后随访变化差异无统计学意义(q=0.53,P=1.101)。结论:单侧椎弓根切除病椎前中柱重建治疗Ⅲ期Kummell's 病不仅可以解除神经压迫,纠正矢状位后凸畸形,重建脊柱稳定性,而且可以减少术中创伤及术后并发症。单侧椎弓根切除减压病椎前中柱重建治疗Ⅲ期Kummell's 病有良好的疗效。

Abstract:

Objective:To investigate the feasibility and technical points of prevertebral column reconstruction for stage Ⅲ Kummell's disease after unilateral pedicle resection for decompression sickness,and to analyze the safety and effectiveness of this procedure.Methods:A retrospective analysis was performed on 13 patients(1 male and 12 female,aged(69.53±8.71)years old)with unilateral pedicle decompression sickness prevertebral column reconstruction for stage Ⅲ Kummell's disease from September 2018 to January 2021.Preoperative X-rays,CT,and MR determined the presence of a vacuum sign(X-ray /CT)in the vertebral body or a fluid accumulation in the vertebral body(MR).In all patients,the lamina,articular process and pedicle were removed on the symptomatic or more severe side,and the pedicle screw was used on the opposite side to restore part of the height of the affected vertebrae,and the height of the affected vertebrae was further restored by intra-vertebral compression bone grafting and PEEK interbody fusion implant.At the same time,posterior pedicle screw system was used to fix the upper and lower vertebrae of the affected vertebrae,and intraoperative X-ray fluoroscopy was used to determine the effective height of the affected vertebrae.Finally,the affected anterior midcolumn was reconstructed and the kyphotic deformity was corrected.The outcome measures included operative time,intraoperative blood loss,postoperative drainage volume,vertebral height of the affected vertebra,visual analogue scale(VAS)before and after surgery,Oswestry disability index(ODI),Cobb angle of the local sagittal plane of the affected vertebra.Results:All patients successfully completed the operation,no neurovascular injury,low back pain,lower limb pain and numbness symptoms were significantly improved.The operative time was(192.00±87.16)min,the intraoperative blood loss was(249.00±128.26)mL,and the postoperative drainage volume was(283.27±76.71)mL.Incision fat liquefaction occurred in 1 patient,which healed after debridement.1 patient developed lower extremity intermuscular venous thrombosis.12 patients were followed up completely,and 1 patient had cerebral infarction and limb movement disorder half a year after surgery,and was lost to follow-up.The duration was 811 months,with an average of 10.1 months.VAS scores and ODI scores were significantly improved from 6.46±1.32 and 68.16±4.43 to 1.18±0.59 and 15.35±7.64 respectively(F=16.556,P<0.001; F=29.368,P<0.001).The vertebral anterior margin height improved from(1.03±0.41)cm before surgery to(2.24±0.55)cm and(2.11±0.46)cm at the last follow-up 1 week after surgery,and the changes before and after surgery were statistically significant(F=11.578,P<0.001).There was no significant change in postoperative follow-up(q=3.12,P=0.081).Local kyphosis improved from 28.72°±8.12° before and after surgery to 8.16°±3.27° and 9.32°±2.13° at the last follow-up.The changes before and after surgery were statistically significant(F=18.461,P<0.001),while the changes after follow-up were not statistically significant(q=0.53,P=1.101).Conclusion:The treatment of stage Ⅲ Kummell's disease with unilateral pedicle resection can not only effectively relieve nerve compression,correct sagittal kyphosis,restore spinal stability,but also reduce intraoperative trauma and postoperative complications.The treatment of stage Ⅲ Kummell's disease with unilateral pedicle resection decompression sickness prevertebral column reconstruction has a good efficacy.

备注/Memo

备注/Memo:

基金项目:潍坊市科技发展计划项目(2021YX021,2023YX018)
^△通信作者 E-mail:jizhuguke@126.com

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更新日期/Last Update: 2024-04-15