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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (6): 25-32.doi: 10.6040/j.issn.1671-7554.0.2021.0052

• 骨质疏松症新进展专题 • 上一篇    下一篇

Kümmell's病的危险因素和诊治研究进展

司海朋*(),张文灿,李乐,周鑫   

  1. 山东大学齐鲁医院骨科，山东 济南 250012
  • 收稿日期:2021-01-14 出版日期:2021-06-10 发布日期:2021-06-10
  • 通讯作者: 司海朋 E-mail:18560082571@163.com
  • 作者简介:司海朋，医学博士后，山东大学齐鲁医院骨科主任医师，教授，博士研究生导师。擅长各类脊椎退行性疾病(腰椎间盘突出症、颈椎病、腰椎滑脱、腰椎管狭窄症、胸椎管狭窄症等)的阶梯治疗(保守→微创→手术)，并在国内较早开始椎间盘镜下腰椎纤维环缝合修补术。对上颈椎和胸椎手术有创新性研究。对老年骨质疏松相关疾病有丰富的手术经验和规范的抗骨松治疗经验。目前主要学术任职：山东省老年医学会基层医疗工作委员会主任委员，山东省老年医学会骨科委员会骨松学组组长，山东省康复医学会骨松分会青年委员会副主任委员，山东省康复医学腰背痛分会基层医疗工作委员会主任委员，中华医学会骨科分会微创学组青年委员，中国医药教育协会骨质疾病专业委员会委员，中国老年学骨质疏松分会创新与转化专委会委员，中国研究型医院学会神经再生与修复专业委员会委员，山东省医师协会骨质疏松与骨矿盐学会委员，山东省医学会数字医学分会神经再生与修复专业委员会委员。科研方向：聚焦脊柱外科疾病、骨质疏松及医工交叉结合领域，开展骨科新材料及三维有限元分析，影像人工智能分析等研究；已承担中国博士后科学基金1项，山东省自然科学基金委员会青年基金项目1项，山东大学医养健康产业项目基金1项，山东大学横向课题4项，山东大学教学项目3项，累计科研经费260多万元。发表多篇脊柱外科临床、基础及医工交叉论文，其中SCI收录15篇，通讯作者3篇，第一作者5篇

Research advances on risk factors, diagnosis and treatment of Kümmell's disease

Haipeng SI*(),Wencan ZHANG,Le LI,Xin ZHOU   

  1. Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2021-01-14 Online:2021-06-10 Published:2021-06-10
  • Contact: Haipeng SI E-mail:18560082571@163.com

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摘要：

Kümmell's病是一种在严重骨质疏松症基础上发生的迟发性椎体压缩性骨折，不予重视或治疗不当会造成脊柱后凸畸形以及严重神经症状，给患者生活质量带来巨大打击，并造成沉重的家庭负担。随着人口老龄化和医疗水平的提高，Kümmell's病的发病率和诊断率逐年提升。关于Kümmell's病的诊治新技术层出不穷。从Kümmell's病的历史发展、危险因素、发病机制、诊断、临床分期、治疗选择等6个方面进行阐述，旨在为临床医师提供指导。

关键词: Kümmell's病, 危险因素, 临床分期, 治疗, 综述

Abstract:

Kümmell's disease is post-traumatic delayed vertebral compression fracture that occurs on the basis of severe osteoporosis. Failure to pay attention or improper treatment may cause kyphosis and severe neurological symptoms, which will have a huge blow on patients' quality of life and cause a heavy family burden. With the aging of population and improvement of medical standards, the incidence and diagnosis rate of Kümmell's disease have been increasing. New technologies of diagnosis and treatment are also emerging. This article summarizes the development, risk factors, pathogenesis, diagnosis, clinical stage, treatment options of Kümmell's disease so as to provide guidance for clinicians.

Key words: Kümmell's disease, Risk factors, Clinical stage, Treatment, Review

中图分类号: 

  • R574

表1

Kümmell's病的Li分期"

分期 伤椎椎体情况 MRI表现 临床表现
Ⅰ期 椎体完整或者椎体前柱轻度压缩，椎体前缘高度丢失小于20% T1像低信号，T2像高信号和轻微的椎体裂隙。 腰背痛或者胸壁痛，但有的患者可能没有症状。
Ⅱ期 椎体动态活动或者椎体前缘高度丢失大于20%，椎体后壁完整。 T1像低信号，T2像均匀或者不均匀的高信号和椎体裂隙。 腰背痛、胸壁痛、神经损伤、后凸畸形
Ⅲ期 椎体动态活动和椎体严重塌陷，椎体后缘皮质破裂 T1像低信号，T2像均匀或者不均匀的高信号和椎体裂隙，椎体后壁骨折块压迫脊髓。 腰背痛、胸壁痛、后凸畸形，神经受损的症状表现为肋间神经痛，坐骨神经痛，股神经痛，脊髓压迫致瘫痪等。
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