發(fā)布時間：2018-03-01 07:00

  本文關(guān)鍵詞： 椎體后凸成形術(shù) 骨質(zhì)疏松性椎體壓縮骨折 中上胸椎 椎弓根入路 骨水泥滲漏　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討經(jīng)皮椎體后凸成形術(shù)(PKP)治療中上胸椎(T6以上)骨質(zhì)疏松性重度壓縮骨折(SVCF)的安全性和療效。方法:回顧性分析2013年1月~2016年3月我院采用PKP治療的30例中上胸椎重度骨質(zhì)疏松性骨折,男10例,女20例,年齡61~87歲,平均72歲。椎體分布:T3 2例、T4 4例、T5 11例、T6 17例。受累節(jié)段椎體平均壓縮率為59%(40.5%~82.6%)。應(yīng)用統(tǒng)計學(xué)方法比較手術(shù)前后的胸背痛視覺模擬評分(VAS)、功能障礙指數(shù)(ODI)、活動能力(四級評分法)、椎體壓縮率和后凸角的恢復(fù)情況。結(jié)果:所有患者順利完成手術(shù),其中23例采用雙側(cè)椎弓根入路,7例采用單側(cè)椎弓根外入路。隨訪6~39月,平均18.5月。術(shù)后1天、1月和末次隨訪時VAS、ODI、活動能力評分與術(shù)前比較差異有統(tǒng)計學(xué)意義(P0.05)。手術(shù)前后椎體的后凸角和壓縮率也均改善,差異有統(tǒng)計學(xué)意義(P0.05)。術(shù)中11例(32%)發(fā)生骨水泥滲漏(1例硬膜外滲漏,4例椎間隙滲漏,8例椎旁軟組織滲漏),均未引起臨床癥狀。未出現(xiàn)肺栓塞、肋骨或椎弓根骨折、氣胸等相關(guān)并發(fā)癥。2例(6%)隨訪半年后再發(fā)椎體骨折(非鄰近節(jié)段、非手術(shù)椎體)。結(jié)論:PKP治療中上胸椎重度骨質(zhì)疏松性骨折可以有效緩解胸背痛和提高活動能力,并能一定程度恢復(fù)受累節(jié)段椎體高度和后凸角,在合適的體位和手術(shù)入路下,該手術(shù)安全且療效顯著。
[Abstract]:Objective: to evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) in the treatment of severe osteoporotic compression fracture of the upper thoracic vertebrae (T6). Methods: from January 2013 to March 2016, 30 patients treated with PKP in our hospital were retrospectively analyzed. A case of severe osteoporotic fracture of the upper thoracic vertebra, There were 10 males and 20 females, aged 61 to 87 years, The average age was 72 years old. The vertebral body distribution was 2 cases of T 3, 4 cases of T 4 and 11 cases of T 5 and 6 cases of T 6.The average compression ratio of involved vertebral body was 59% 40.5% and 82.6%. The visual analogue score of chest and back pain before and after operation was compared by statistical method, the index of dysfunction was ODI, and the ability of movement was obtained. Fourth grade method, vertebral compression ratio and kyphosis recovery. Results: all patients successfully completed the operation, Among them, 23 cases were treated with bilateral pedicle approach and 7 cases were treated with unilateral pedicle approach. On the first day after operation, on January and at the last follow-up, there was a statistically significant difference in activity score between before and after operation (P 0.05). The kyphosis angle and compression ratio of vertebral body were also improved before and after operation. The difference was statistically significant (P 0.05). There were 11 cases of bone cement leakage and 1 case of epidural leakage. 4 cases of vertebral space leakage and 8 cases of paraspinal soft tissue leakage did not cause clinical symptoms. There was no pulmonary embolism, rib or pedicle fracture. 2 cases of pneumothorax and other related complications were followed up for half a year. (non-adjacent segment, non-operative vertebral body). Conclusion the treatment of severe osteoporotic fracture of middle and upper thoracic vertebrae with PKP can effectively relieve chest and back pain and improve mobility. It can restore the height and kyphoid angle of the involved segment to a certain extent. The operation is safe and effective under proper posture and operative approach.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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