中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (34): 7286-7292.doi: 10.12307/2025.493

• 组织工程骨材料 tissue-engineered bone • 上一篇    下一篇

椎体骨水泥强化联合短节段经皮骨水泥螺钉内固定治疗Ⅱ期Kümmell病

盛文博，刘丙立，李四波，敖荣广，禹宝庆   

  1. 上海中医药大学附属第七人民医院骨伤科，上海市   200120
  • 收稿日期:2024-07-15 接受日期:2024-09-05 出版日期:2025-12-08 发布日期:2025-01-17
  • 通讯作者: 禹宝庆，博士，主任医师，上海中医药大学附属第七人民医院骨伤科，上海市 200120
  • 作者简介:盛文博，男，1987年生，山东省莱阳市人，汉族，副主任医师，主要从事脊柱创伤方面的研究。
  • 基金资助:
    上海市浦东新区卫生健康委员会面上项目(PW2021A-67)，项目负责人：盛文博；上海市浦东新区卫生健康委员会学科带头人培养计划项目(PWRd2019-10)，项目负责人：李四波；浦东新区中医药传承创新发展示范试点项目[YC-2023-0601，中医高峰学科(中西医结合骨伤科)]，项目负责人：禹宝庆；2023年财政部国家中医药管理局医疗服务与保障能力提升补助资金重点科室项目《中西医协同重点科室建设(中西医结合骨伤科)》，项目负责人：禹宝庆

Cement-augmented short-segment percutaneous pedicle screw fixation for the stage II Kümmell’s disease

Sheng Wenbo, Liu Bingli, Li Sibo, Ao Rongguang, Yu Baoqing   

  1. Department of Orthopedics, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
  • Received:2024-07-15 Accepted:2024-09-05 Online:2025-12-08 Published:2025-01-17
  • Contact: Yu Baoqing, MD, Chief physician, Department of Orthopedics, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
  • About author:Sheng Wenbo, Associate chief physician, Department of Orthopedics, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
  • Supported by:
    Shanghai Pudong New Area Health Commission Project, No. PW2021A-67 (to SWB); Shanghai Pudong New Area Health Commission Discipline Leader Training Program, No. PWRd2019-10 (to LSB); Pudong New Area Traditional Chinese Medicine Inheritance Innovation Development Demonstration Pilot Project, No. [YC-2023-0601] (to YBQ); 2023 National Administration of Traditional Chinese Medicine of the Ministry of Finance Medical Service and Support Capacity Improvement Subsidy Fund (Part of Key Departments) Project "Construction of Key Departments of Collaborative Traditional Chinese and Western Medicine" (to YBQ) 

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摘要：


文题释义：

Kümmell病：也称为骨质疏松性椎体压缩骨折后缺血性坏死，或迟发性创伤后椎体塌陷，主要发生在中老年骨质疏松患者，最早由德国医生HERMAN KÜMMELL在1891年报道。Kümmell病患者一般有轻微的脊柱创伤史，然后在几周、几个月甚至几年的时间里保持基本无症状，最终发展为进展性的、疼痛性的后凸畸形。Kümmell病不同于常见的骨质疏松性椎体压缩性骨折，其发病机制主要为伤椎椎体缺血性坏死及假关节形成导致顽固性疼痛，保守治疗通常无效，需要手术干预。
椎体骨水泥强化：是一种微创手术技术，主要用于治疗椎体压缩性骨折，通过向受伤椎体内注入骨水泥(如聚甲基丙烯酸甲酯)达到强化椎体、缓解疼痛、恢复椎体高度和矫正后凸畸形的效果。椎体骨水泥强化术式包括经皮椎体成形与经皮椎体后凸成形，已被广泛用于Ⅰ期或Ⅱ期Kümmell病治疗。


背景：经皮椎体后凸成形治疗Ⅱ期Kümmell病常存在术后疼痛缓解不佳、骨水泥弥散差、相邻椎体骨折发生率较高等问题。有研究显示，伤椎骨水泥强化联合后路椎管减压短节段固定治疗伴神经症状的Kümmell病具有较好的疗效。

目的：比较椎体骨水泥强化联合短节段经皮骨水泥螺钉内固定与经皮椎体后凸成形治疗Ⅱ期Kümmell病的效果。
方法：选择2020年1月至2023年1月上海中医药大学附属第七人民医院收治的Ⅱ期Kümmell病患者49例，其中男15例，女34例，根据治疗方式分为试验组(n=23)与对照组(n=26)，试验组患者接受椎体骨水泥强化联合短节段经皮骨水泥螺钉内固定手术，对照组患者接受经皮椎体后凸成形手术。记录术后并发症发生情况，对比两组患者术后1周、6周、12周、6个月、12个月的脊柱Cobb角与伤椎前缘高度比，术后1周、12个月的Oswestry功能障碍指数与腰椎目测类比评分。

结果与结论：①两组患者均完成术后12个月以上随访，对照组中有5例发生相邻椎体骨折、3例发生严重的脊柱后凸畸形，试验组中有1例出现术后切口并发症；②与术前相比，两组患者术后的脊柱Cobb角和伤椎前缘高度比均明显改善(P < 0.05)；试验组患者术后1周、6周、12周、6个月、12个月的脊柱Cobb角均低于对照组(P < 0.05)，术后1周、6周、12周、6个月、12个月的伤椎前缘高度比均高于对照组(P < 0.05)；③与术前相比，两组患者术后的Oswestry功能障碍指数与腰椎目测类比评分均明显改善(P < 0.05)；试验组患者术后1周、12个月的Oswestry功能障碍指数与腰椎目测类比评分均低于对照组(P < 0.05)；④结果表明，与经皮椎体后凸成形治疗相比，椎体骨水泥强化联合短节段经皮骨水泥螺钉内固定治疗Ⅱ期Kümmell病可以更好地恢复患椎高度、维持伤椎形态、改善脊柱功能、减轻腰部疼痛。

https://orcid.org/0000-0002-9316-3540 (盛文博) 

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: Kümmell病, 短节段内固定, 椎体骨水泥强化, 椎体后凸成形, 骨水泥螺钉, 工程化骨材料

Abstract: BACKGROUND: Stage II Kümmell’s disease has traditionally been treated with percutaneous kyphoplasty, but this approach is associated with a high incidence of complications such as poor postoperative pain relief, suboptimal cement dispersion, and adjacent vertebral fractures. Studies have shown that cement augmentation of the injured vertebra combined with posterior spinal canal decompression and short-segment fixation has a good effect on the treatment of Kümmell’s disease with neurological symptoms. 
OBJECTIVE: To compare the outcomes of cement-augmented short-segment percutaneous pedicle screw fixation with those of percutaneous kyphoplasty for the treatment of stage II Kümmell’s disease.
METHODS: From January 2020 to January 2023, a total of 49 patients with stage II Kümmell’s disease from Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine were included in this study, with 15 males and 34 females. According to the treatment method, the patients were divided into the trial group (n=23) and the control group (n=26). The patients in the trial group received cement-augmented short-segment percutaneous pedicle screw fixation, and the patients in the control group received percutaneous kyphoplasty. The postoperative complications were recorded, and the spinal Cobb angle and the ratio of the anterior edge height of the injured vertebra were compared between the two groups at 1, 6, 12 weeks, 6, and 12 months after surgery. The Oswestry disability index and lumbar visual analog score were compared at 1 week and 12 months after surgery. 
RESULTS AND CONCLUSION: (1) All patients in the two groups were followed up for more than 12 months after surgery. Five patients in the control group had adjacent vertebral fractures, three patients had severe kyphosis, and one patient in the trial group had postoperative incision complications. (2) Compared with preoperative data, the spinal Cobb angle and the ratio of the anterior edge height of the injured vertebra in both groups were significantly improved after surgery (P < 0.05). The spinal Cobb angle of the trial group was lower than that of the control group at 1, 6, 12 weeks, 6, and 12 months after surgery (P < 0.05), and the ratio of the anterior edge height of the injured vertebra in the trial group was higher than that of the control group at 1, 6, 12 weeks, 6, and 12 months after surgery (P < 0.05). (3) Compared with preoperative data, the Oswestry disability index and lumbar visual analog scale score of the two groups were significantly improved after surgery (P < 0.05). The Oswestry disability index and lumbar visual analog scale score of the trial group were lower than those of the control group at 1 week and 12 months after surgery (P < 0.05). (4) The results show that compared with percutaneous kyphoplasty, cement-augmented short-segment percutaneous pedicle screw fixation for stage II Kümmell’s disease can better restore the height of the affected vertebra, maintain the shape of the affected vertebra, improve spinal function, and alleviate lumbar pain.

Key words: Kümmell’s disease, short-segment internal fixation, vertebral body cement augmentation, kyphoplasty, bone cement screw, engineered bone material

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