目的 探讨创伤后椎体迟发性骨坏死(Kummell病)的早期预防及治疗.方法 将100例有骨质疏松、外伤后表现为腰背痛的患者,按照随机数字表法,随机分为两组,对照组50例:佩带腰围1个月加塞来昔布0.2 g,qd×7 d;实验组50例:绝对卧床1个月加塞来昔布0.2 g,qd×7 d.分别于受伤时,伤后1个月摄腰椎正、侧位X线片和CT,观察椎体内真空现象.对Kummell病患者采用经皮椎体成形术(PKP)进行治疗,术后疗效采用视觉模拟评分系统(VAS)评价.结果 对照组有10例伤后1个月时X线片出现椎体压缩骨折伴椎体内真空现象(位于椎体中央上终板部位),患病率为20%.实验组有2例于伤后1个月时X线片出现椎体压缩骨折及椎体内真空现象,患病率为4%.创伤后Kummell病患病率对照组明显高于实验组(P<0.01).12例Kummell病患者,VAS评分术前为4.5～7.0(6.14±0.16)分,术后为6.5～9.1(8.23±0.18)分,差异有统计学意义(P<0.01).结论 骨质疏松患者外伤后影像学无明显异常者,早期绝对卧床1个月对预防创伤后Kummell病有积极作用.PKP可有效缓解Kummell病疼痛.%Objective To study early prevention and treatment for delayed post-traumatic osteonecrosis of the vertebral body( Kummell disease ).Methods 100 cases of osteoporosis patients who had a slight trauma were divided into two groups : control group,50 cases, were given Celecoxib 0.2 g, once a day, 7 days all together and Belt waistline one month; experimental group, 50 cases, were given Celecoxih 0.2 g,once a day, 7 days all together and strict bed rest one month.All cases were checked by X rays in times of trauma and one month later and CT in times of one month later trauma.Obeservation of the cleft in the vertebral body was performed.All Kummell diseases were treated by PKP and the effective of operative PKP was evaluated by Visual analogue scale system.Results 10 cases of control groups experienced the cleft in the vertehral body, the incidence was 20％ , and there were 2 case of control groups experienced the cleft in the vertebral body, the incidence was 4％.The difference between two groups was significant( P ＜ 0.01 ).There were 12 cases who were diagnosed Kummell disease, with preoperative VAS : 4.5 ～ 7.0 ( 6.14 ±0.16 ) ,postoperative VAS: 6.5 ～9.1( 8.23 ±0.18 ), the difference was significant ( P ＜ 0.01 ).Conclusions Osteoporosis patients who had a slight trauma with normal X ray, strict bed rest one month can be beneficial to prevent delayed post-traumatic Kummell disease.PKP can effectively relieve the pains in Kummell disease.
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