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机器人辅助下骨水泥强化椎弓根螺钉固定治疗Ⅱ-Ⅲ期Kümmell病
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作者Author单位UnitE-Mail
张建乔 ZHANG Jian-qiao 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China  
周晓 ZHOU Xiao 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China zhou_master@126.com 
陆惠根 LU Hui-gen 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China  
陈宝 CHEN Bao 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China  
俞叶锋 YU Ye-feng 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China  
胡旭琪 HU Xu-qi 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China  
胡民结 HU Min-jie 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China  
潘学康 PAN Xue-kang 嘉兴市第二医院脊柱外科, 浙江 嘉兴 314000 Department of Spinal Surgery, the Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China  
期刊信息:《中国骨伤》2023年36卷,第5期,第465-472页
DOI:10.12200/j.issn.1003-0034.2023.05.014
基金项目:浙江省医药卫生科研项目(编号:2021KY1114)


目的:评估机器人辅助下经皮短节段骨水泥强化椎弓根螺钉固定治疗Ⅱ-Ⅲ期Kümmell病的早期临床疗效。

方法:回顾性分析2017年6月至2021年1月采用机器人辅助下经皮短节段骨水泥强化椎弓根螺钉固定治疗的20例Ⅱ-Ⅲ期Kümmell's病的临床资料,男4例,女16例;年龄60~81(69.1±8.3)岁;Ⅱ期9例,Ⅲ期11例,均为单椎体病变; T113例,T125例,L18例,L23例,L31例;均无脊髓神经损伤症状。记录手术时间、术中出血量、并发症,根据术后CT二维重建观察椎弓根螺钉的位置及裂隙内骨水泥填充、渗漏情况。并对术前、术后1周、末次随访3个时间点的腰背痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI)及侧位X线片的后凸Cobb角、病椎楔形角、椎体前后缘高度等数据进行统计分析。

结果: 20例患者均获随访,时间10~26(16.0±5.1)个月。所有手术顺利完成,手术时间98~160(122±24) min,术中出血量25~95(45±20) ml,术中无血管神经损伤。共置入螺钉120枚,按照Gertzbein- Robbins标准评定螺钉置入情况,A级111枚,B级9枚。术后CT提示病椎内裂隙骨水泥填充良好,4例患者病椎骨水泥渗漏。术前VAS、ODI分别为(6.05±0.18)分、(71.10±5.37)%,术后1周为(2.05±0.14)分、(18.57±2.77)%,末次随访为(1.35±0.11)分、(15.71±2.12)%,术后1周与术前比较、末次随访与术后1周比较,差异均有统计学意义(P<0.01)。术前病椎椎体前后缘高度、后凸Cobb角、病椎楔形角分别为(45.07±1.06)%、(82.02±2.11)%、(19.49±0.77)°、(17.56±0.94)°,术后1周为(77.00±0.99)%、(83.04±2.02)%、(7.34±0.56)°、(6.15±0.52)°,末次随访为(75.13±0.86)%、(82.39±0.45)%、(8.38±0.63)°、(7.09±0.59)°;术后1周病椎椎体前缘高度、后凸Cobb角、病椎楔形角与术前比较,差异有统计学意义(P<0.01);末次随访与术后1周比较,差异均无统计学意义(P>0.05);椎体后缘高度术后1周与术前、末次随访比较,差异均无统计学意义(P>0.05)。4例术后出现谵妄,经对症处理后好转;1例术后2个月出现远端椎弓根螺钉断裂,术后8个月病椎骨水泥团块碎裂移位,后凸畸形加重,行翻修手术治疗。

结论:采用机器人辅助下经皮短节段骨水泥强化椎弓根螺钉固定治疗Ⅱ-Ⅲ期Kümmell病早期疗效满意,是一种可供选择的微创手术方式,但手术时间较长,需严格把握手术适应证,远期疗效仍需进一步研究。
[关键词]:Kümmell病  骨质疏松  机器人手术
 
Treatment of stage Ⅱ-Ⅲ Kümmell disease with robot-assisted bone cement-augmented pedicle screw fixation
Abstract:

Objective To evaluate the early clinical efficacy of robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation in the treatment of stageⅡ-Ⅲ Kümmell disease.

Methods The clinical data of 20 patients with stageⅡ-Ⅲ Kümmell's disease who underwent robot-assisted percutaneous bone cement-augmented pedicle screw fixation between June 2017 and January 2021 were retrospectively analyzed. There were 4 males and 16 females,aged from 60 to 81 years old with an average age of (69.1±8.3) years. There were 9 cases of stageⅡand 11 cases of stage Ⅲ,all of which were single vertebral lesions,including 3 cases of T11,5 cases of T12,8 cases of L1,3 cases of L2,and 1 case of L3. These patients did not exhibit symptoms of spinal cord injury. The operation time,intraoperative blood loss,and complications were recorded. The position of pedicle screws and the filling and leakage of bone cement in gaps were observed using postoperative CT 2D reconstruction. The data of the visual analogue scale (VAS),Oswestry disability index (ODI),kyphosis Cobb angle,wedge angle of the diseased vertebra,and anterior and posterior vertebral height on lateral radiographs were statistically analyzed preoperatively,1 week postoperatively,and at the final follow-up.

Results Twenty patients were followed up for 10 to 26 months,with an average follow-up of (16.0±5.1) months. All operations were successfully completed. The surgical duration ranged from 98 to 160 minutes,with an average of (122±24) minutes. The intraoperative blood loss ranged from 25 to 95 ml,with an average of (45±20) ml. There were no intraoperative vascular nerve injuries. A total of 120 screws were inserted in this group,including 111 screws at grade A and 9 screws at grade B according to the Gertzbein and Robbins scales. Postoperative CT indicated that the bone cement was well-filled in the diseased vertebra,and cement leakage occurred in 4 cases. Preoperative VAS and ODI were (6.05±0.18) points and (71.10±5.37)%,respectively,(2.05±0.14) points and (18.57±2.77)% at 1 week after operation,and (1.35±0.11) points and (15.71±2.12)% at final follow-up. There were significant differences between postoperative 1 week and preoperative,and between final follow-up and postoperative 1 week(P<0.01). Anterior and posterior vertebral height,kyphosis Cobb angle,and wedge angle of the diseased vertebra were(45.07±1.06)%,(82.02±2.11)%,(19.49±0.77) °,and (17.56±0.94) ° preoperatively,respectively,(77.00±0.99)%,(83.04±2.02)%,(7.34±0.56) °,and (6.15±0.52) ° at 1 week postoperatively,and (75.13±0.86)%,(82.39±0.45)%,(8.38±0.63) °,and (7.09±0.59) ° at the final follow-up.

Conclusion Robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation demonstrates satisfactory short-term efficacy in treating stageⅡ-Ⅲ Kümmell's disease as an effective minimally invasive alternative. However,longer operation times and strict patient selection criteria are necessary,and long-term follow-up is required to determine its lasting effectiveness.
KEYWORDS:Kümmell disease  Osteoporosis  Surgery robot
 
引用本文,请按以下格式著录参考文献:
中文格式:张建乔,周晓,陆惠根,陈宝,俞叶锋,胡旭琪,胡民结,潘学康.机器人辅助下骨水泥强化椎弓根螺钉固定治疗Ⅱ-Ⅲ期Kümmell病[J].中国骨伤,2023,36(5):465~472
英文格式:ZHANG Jian-qiao,ZHOU Xiao,LU Hui-gen,CHEN Bao,YU Ye-feng,HU Xu-qi,HU Min-jie,PAN Xue-kang.Treatment of stage Ⅱ-Ⅲ Kümmell disease with robot-assisted bone cement-augmented pedicle screw fixation[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(5):465~472
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