本文選題：骨質(zhì)疏松 + 椎體壓縮骨折�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討骨質(zhì)疏松導(dǎo)致的椎體壓縮骨折不愈合的臨床特點(diǎn)及骨質(zhì)疏松椎體壓縮骨折不愈合的影像學(xué)分期對手術(shù)治療方法的指導(dǎo)作用。方法本研究納入自2009年1月至2015年12月青島大學(xué)附屬醫(yī)院收治的骨質(zhì)疏松椎體壓縮骨折不愈合的患者共53例,其中男性5例,女性48例,年齡50-86歲(平均70.2歲)。所有患者均具有完整的臨床及影像學(xué)資料。通過回顧性分析所有患者的臨床及影像學(xué)資料,總結(jié)骨質(zhì)疏松椎體壓縮骨折不愈合的影像學(xué)特點(diǎn),并根據(jù)不同的影像學(xué)特點(diǎn)對所有患者進(jìn)行分期,確定不同手術(shù)方案。測量并統(tǒng)計(jì)術(shù)前、術(shù)后及末次隨訪時(shí)病變椎體前后緣高度、椎體楔形變角度、椎體Cobb角的變化及VAS評分并進(jìn)行統(tǒng)計(jì)學(xué)分析評價(jià)手術(shù)治療效果。結(jié)果本研究中共有53個(gè)病變椎體發(fā)生不愈合,病變椎體主要集中在T12、L1水平(共39椎,占73.6%),椎體內(nèi)可見真空裂隙征共21例(39.6%),椎體內(nèi)可見液體信號者共26例(49.1%),椎體內(nèi)無真空裂隙征及液體征但可見骨折線硬化者共6例(11.3%),開口征陽性者共8例(15.1%)。椎體壓縮骨折不愈合累及上終板者共37例,累及上終板及下終板者共12例,累及下終板者4例。病變椎體臨近椎間盤有真空現(xiàn)象者14例,其中1例椎間盤真空與骨折椎體裂隙相通。根據(jù)Li等關(guān)于骨質(zhì)疏松椎體壓縮性骨折不愈合的分型將所有病變椎體進(jìn)行分期,其中Ⅰ期11例,Ⅱ期16例,Ⅲ期26例。所有Ⅰ期、Ⅱ期患者均行PVP或PKP治療,其中13例行PVP治療,14例行PKP手術(shù);Ⅲ期患者由于病變累及椎體后壁,動力位像可見脊柱不穩(wěn),行開放手術(shù)治療。所有患者手術(shù)順利,術(shù)后未出現(xiàn)神經(jīng)癥狀加重。5例行PVP及PKP的患者出現(xiàn)骨水泥泄露,其中PVP組3例,PKP組2例,3例向椎體前方泄露,2例向椎間隙泄露,末次隨訪未見骨水泥移位。所有行PVP、PKP及開放手術(shù)治療的患者,術(shù)前VAS評分、椎體前緣高度、椎體楔形角度及Cobb角與術(shù)后三天相比有統(tǒng)計(jì)學(xué)差異,術(shù)前椎體后緣高度與術(shù)后三天相比差異無統(tǒng)計(jì)學(xué)意義,術(shù)后三天與末次隨訪時(shí)上述指標(biāo)差異無統(tǒng)計(jì)學(xué)意義,行PVP或PKP手術(shù)治療的患者在VAS評分、骨折椎體前后緣高度、椎體楔形角度及Cobb角改善方面無明顯差異,開放組所需手術(shù)時(shí)間明顯長于PVP及PKP組。結(jié)論骨質(zhì)疏松椎體壓縮骨折不愈合主要發(fā)生在胸腰段結(jié)合處(T12、L1),影像學(xué)常見真空裂隙征、液體征及硬化的骨折線,對于確診椎體壓縮骨折不愈合具有很好的指導(dǎo)意義。Li等對椎體壓縮骨折不愈合分型對選擇手術(shù)方案具有很好的臨床指導(dǎo)作用,Ⅰ及Ⅱ期患者采取PVP或PKP手術(shù)可取得滿意的手術(shù)效果,但是術(shù)中存在骨水泥泄漏的風(fēng)險(xiǎn),需要在臨床實(shí)踐中引起重視。Ⅲ期患者術(shù)前常存在脊柱不穩(wěn)甚至神經(jīng)損害癥狀,多數(shù)需要進(jìn)行固定融合。
[Abstract]:Objective to investigate the clinical features of nonunion of vertebral compression fractures caused by osteoporosis and the guiding effect of imaging stages of nonunion of osteoporotic vertebral compression fractures on surgical treatment. Methods from January 2009 to December 2015, 53 cases of osteoporotic vertebral compression fracture nonunion were admitted to the affiliated Hospital of Qingdao University, including 5 males and 48 females, aged 50-86 years (mean 70.2 years). All patients had complete clinical and imaging data. The clinical and imaging data of all patients were analyzed retrospectively, and the imaging features of nonunion of osteoporotic vertebral compression fracture were summarized. According to the different imaging characteristics, all patients were divided into stages and different operative schemes were determined. The anterior and posterior height of the lesion vertebral body, the angle of vertebral wedge change, the changes of vertebral Cobb angle and the VAS score were measured and counted before, after and at the last follow-up. The effect of operation was evaluated statistically. Results in this study, 53 diseased vertebrae had nonunion, and the diseased vertebrae were mainly located at T12L 1 level (39 vertebrae). There were 21 cases with vacuum fissure sign in vertebral body, 26 cases with fluid signal in vertebral body, 6 cases with no vacuum fissure sign and liquid sign but 6 cases with osseous sclerosis, and 8 cases with positive opening sign. There were 37 cases of nonunion of vertebral body compression fracture involving upper endplate, 12 cases of upper endplate and inferior endplate, and 4 cases of lower endplate. There were 14 cases with vacuum in the adjacent intervertebral disc, in which 1 case was connected with fracture fracture. According to Li et al.'s classification of nonunion of osteoporotic vertebral body compression fracture, all the lesions were divided into stages, including 11 cases of stage 鈪，

本文編號：1812685