摘要目的 探讨经椎弓根椎体内植骨联合椎弓根螺钉内固定治疗Ⅲa、Ⅲb期Kümmell病的疗效. 方法 2006年11月至2011年12月收治Ⅲ期Kümmell病患者15例,根据术前神经症状、神经压迫来源将Ⅲ期患者进一步划分为3个亚型:Ⅲa型2例,Ⅲb型6例,Ⅲc型7例.将Ⅲa型和Ⅲb型共8例患者纳入本研究,男3例,女5例;年龄57 ～ 79岁,平均71.1岁;采用经椎弓根椎体内植骨联合后路椎弓根螺钉内固定手术治疗;分别于术前及术后半年测定疼痛视觉模拟评分(VAS),并测量后凸cobb角、骨折椎体前、后缘高度及椎体楔形角变化. 结果 所有患者均获随访,时间18 ～66个月(平均33.5个月).平均手术时间157 min(110 ～190 min),平均失血量450 mL(350～800 mL),神经功能损伤Frankel分级由术前C级5例、D级1例、E级2例改善为术后E级6例、D级2例.VAS评分术后较术前降低,术后后凸cobb角、椎体前缘高度、椎体楔形角均获明显恢复.随访中观察到椎体前缘高度和椎体楔形角有丢失,椎体后缘高度在术前、术后及随访中无明显变化. 结论 对于Kümmell病的Ⅲa和Ⅲb两种亚型,经椎弓根椎体内植骨联合椎弓根螺钉内固定是一种简便、安全、有效的治疗方法,可以获得良好的矫形率及症状缓解率.

abstractsObjective To evaluate the posterior transpedicle intracorporeal bone grafting combined with segmental pedicle screw fixation for stage Ⅲ Kümmell' s disease.Methods Fifteen patients with stage Ⅲ Kümmell' s disease were treated in our department from November 2006 to December 2011.On the basis of the staging system put forward by Li et al,we further classified stage Ⅲ Kümmell's disease into 3 subtypes:Ⅲ a without any neurological deficit,vertebral posterior cortex collapse,encroachment on the spinal canal by midsection posterior cortex,or breakage of superior and inferior endplates; Ⅲ b,with radiologic features similar to Ⅲa except pre-operative neurological compromise; Ⅲ c,with apparent pre-operative neurological compromise,superior or inferior endplate breakage,encroachment on the spinal canal by posterior superior or posterior inferior corner of the collapsed vertebra.Included in the present study were 8 cases of subtypes Ⅲa and Ⅲ b.They received posterior transpedicle intracorporeal bone grafting combined with segmental pedicle screw fixation.Their lateral cobb angle,anterior and posterior vertebral height,wedge angle,and visual analogue scale(VAS) were measured preoperatively and 6 months postoperatively to evaluate the results.Results The 8 patients were followed up from 18 to 66 months (mean,33.5 months).Mean operation time was 157 minutes (from 110 to 190 minutes).Mean blood loss was 450 mL (from 350 to 800 mL).Frankel classification was improved from 5 C,1 D,and 2 E preoperatively to 6 E and 2 D postoperatively.Their VAS score decreased after operation.Although loss of correction of anterior vertebral height and wedge angle was observed at the final visit,no significant differences in the posterior vertebral height were observed between pre-operation,immediate post-operation and the final visit.Conclusion For patients with stage Ⅲ Kümmell's disease of subtypes Ⅲa and Ⅲ b,posterior transpedicle intracorpareal bone grafting combined with segmental pedicle screw fixation is the optimal selection,which can effectively relieve back pain,achieve good correction of kyphosis,and lead to clinical success.