PKP治療骨質(zhì)疏松性椎體骨折骨不愈合的臨床研究
發(fā)布時間：2018-10-04 20:33
【摘要】：目的:分析經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體骨折(Osteoporotic Vertebral Fracture,OVF)骨不愈合的臨床療效,探討PKP治療OVF骨不愈合中防止骨水泥滲漏的有效方法,對OVF骨不愈合的臨床特點及影像學表現(xiàn)做進一步總結(jié)。方法:回顧性分析我院2012年8月至2014年3月采用PKP技術(shù)治療的骨質(zhì)疏松性椎體骨折病人。排除既往存在脊柱手術(shù)病史,合并腫瘤病史及存在脊髓或神經(jīng)壓迫的情況,根據(jù)OVF骨不愈合的診斷依據(jù)共有27例28椎進入本研究,男性5例,女性22例,平均年齡69.70±9.26歲。所有病人術(shù)前均行X線片、CT及MRI檢查。術(shù)中采用骨水泥“封堵”、分次灌注等椎體后凸成形術(shù)關(guān)鍵技術(shù)治療,術(shù)后予正側(cè)位X線片,必要時CT檢查。于術(shù)前、術(shù)后及末次隨訪時測量椎體前緣高度、椎體中間高度及局部后凸角,記錄疼痛視覺模擬評分(Visual Analogue Scale,VAS)和Oswestry功能障礙指數(shù)評分(Oswestry Disability Index,ODI),同時記錄骨水泥用量、骨水泥滲漏情況及末次隨訪時骨水泥的填充情況。比較手術(shù)前、后及末次隨訪時椎體前緣高度、椎體中間高度、Cobb角、VAS評分及ODI評分變化情況。結(jié)果:27例病人均以特殊的腰背痛就診,表現(xiàn)為站立時劇烈疼痛,平臥時幾乎消失;術(shù)前X線片或CT上有裂隙征、邊緣硬化現(xiàn)象,MRI檢查見T2加權(quán)像上為高信號或低信號,T1加權(quán)像上為低信號,脂肪抑制像為界限清楚的高信號。所有病人使用椎體后凸成形術(shù)中的關(guān)鍵技術(shù)均順利完成手術(shù)。術(shù)后28椎體中僅有2椎發(fā)生骨水泥滲漏,均無癥狀。27例病人平均隨訪16.11±5.19月(3至23個月),末次隨訪時病人椎體內(nèi)骨水泥填充良好,無松動或脫出。本組病人椎體前緣、椎體中間高度由術(shù)前53.01±21.10、57.61±18.59分別恢復(fù)至術(shù)后77.70±12.92、75.61±13.68(P0.05),末次隨訪時分別為75.25±12.17、74.00±14.97,末次與術(shù)后比較無統(tǒng)計學差異性(P0.05);Cobb角、VAS評分及ODI分別由術(shù)前的17.75±14.38、8.48±0.64、84.61±5.39分別下降至術(shù)后9.86±12.16、2.33±0.62、32.48±6.04,有顯著差異性(P0.05),末次隨訪時上述指標與術(shù)后比較不具統(tǒng)計學意義。結(jié)論:OVF骨不愈合好發(fā)胸腰段,平臥時疼痛消失,站立或坐位時疼痛加重,影像學可見椎體內(nèi)裂隙、真空及假關(guān)節(jié)活動征象。使用椎體后凸成形術(shù)中的關(guān)鍵操作技術(shù)治療骨質(zhì)疏松性椎體骨折骨不愈合療效顯著,且能有效降低骨水泥滲漏的發(fā)生。
[Abstract]:Objective: to analyze the clinical effect of percutaneous kyphoplasty in the treatment of (Osteoporotic Vertebral Fracture,OVF) bone nonunion of osteoporotic vertebral fracture, and to explore the effective method of preventing bone cement leakage in the treatment of OVF nonunion by PKP. The clinical features and imaging findings of OVF bone nonunion were further summarized. Methods: the patients with osteoporotic vertebral fracture treated with PKP from August 2012 to March 2014 were analyzed retrospectively. According to the diagnosis basis of OVF bone nonunion, 27 cases 28 vertebrae entered this study. There were 5 males and 22 females with an average age of 69.70 鹵9.26 years. All patients were examined by CT and MRI before operation. The key techniques of kyphoplasty, such as bone cement occlusion and perfusion, were used during the operation. X-ray films were performed on the lateral and positive position after operation, and CT was performed when necessary. The anterior height, middle height and local kyphoid angle of the vertebral body were measured before, after and at the last follow-up. The pain visual analogue score (Visual Analogue Scale,VAS) and the Oswestry dysfunction index (Oswestry Disability Index,ODI) were recorded. The amount of bone cement was also recorded. The leakage of bone cement and the filling of bone cement at the last follow-up. Before, after and at the last follow-up, the changes of the anterior height of the vertebral body, the height of the middle vertebral body and the ODI score were compared. Results all of the 27 patients were treated with special low back pain, which was characterized by severe pain in standing and almost disappeared in supine, and had fissure sign on X-ray film or CT before operation. Edge-sclerosis MRI showed that T 2 weighted images showed high signal intensity or low signal intensity on T 1 weighted images, and fat suppression images showed high signal intensity on T 1 weighted images and fat suppression images on T 1 weighted images. All patients successfully completed the operation using the key techniques of kyphoplasty. Cement leakage occurred in only 2 of the 28 vertebrae postoperatively. The average follow-up of 27 patients was 16.11 鹵5.19 months (3 to 23 months). At the last follow-up, the cement filling in the vertebral body was good, no loosening or prolapse. The anterior edge of the vertebrae in this group, The median height of the vertebral body recovered from 53.01 鹵21.10 鹵57.61 鹵18.59 before operation to 77.70 鹵12.92 鹵75.61 鹵13.68 after operation (P0.05), and at the last follow-up was 75.25 鹵12.1774.00 鹵14.97, respectively. There was no significant difference between the last time and postoperative (P0.05). The scores of Cobb angle VAS and ODI decreased from 17.75 鹵14.38 鹵8.48 鹵0.644.61 鹵5.39 to 9.86 鹵12.16 鹵2.33 鹵0.62n 32.48 鹵6.04, respectively (P0.05). At the last follow-up, the above indexes were not statistically significant compared with postoperative. Conclusion the thoracolumbar segment of OVF bone is nonunion, the pain is disappeared in supine, the pain is aggravated in standing or sitting position, the sign of vertebral body fissure, vacuum and pseudarthrosis can be seen on imaging. The key techniques of kyphoplasty in the treatment of bone nonunion of osteoporotic vertebral fracture are significant and can effectively reduce the occurrence of bone cement leakage.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
本文編號：2251787
[Abstract]:Objective: to analyze the clinical effect of percutaneous kyphoplasty in the treatment of (Osteoporotic Vertebral Fracture,OVF) bone nonunion of osteoporotic vertebral fracture, and to explore the effective method of preventing bone cement leakage in the treatment of OVF nonunion by PKP. The clinical features and imaging findings of OVF bone nonunion were further summarized. Methods: the patients with osteoporotic vertebral fracture treated with PKP from August 2012 to March 2014 were analyzed retrospectively. According to the diagnosis basis of OVF bone nonunion, 27 cases 28 vertebrae entered this study. There were 5 males and 22 females with an average age of 69.70 鹵9.26 years. All patients were examined by CT and MRI before operation. The key techniques of kyphoplasty, such as bone cement occlusion and perfusion, were used during the operation. X-ray films were performed on the lateral and positive position after operation, and CT was performed when necessary. The anterior height, middle height and local kyphoid angle of the vertebral body were measured before, after and at the last follow-up. The pain visual analogue score (Visual Analogue Scale,VAS) and the Oswestry dysfunction index (Oswestry Disability Index,ODI) were recorded. The amount of bone cement was also recorded. The leakage of bone cement and the filling of bone cement at the last follow-up. Before, after and at the last follow-up, the changes of the anterior height of the vertebral body, the height of the middle vertebral body and the ODI score were compared. Results all of the 27 patients were treated with special low back pain, which was characterized by severe pain in standing and almost disappeared in supine, and had fissure sign on X-ray film or CT before operation. Edge-sclerosis MRI showed that T 2 weighted images showed high signal intensity or low signal intensity on T 1 weighted images, and fat suppression images showed high signal intensity on T 1 weighted images and fat suppression images on T 1 weighted images. All patients successfully completed the operation using the key techniques of kyphoplasty. Cement leakage occurred in only 2 of the 28 vertebrae postoperatively. The average follow-up of 27 patients was 16.11 鹵5.19 months (3 to 23 months). At the last follow-up, the cement filling in the vertebral body was good, no loosening or prolapse. The anterior edge of the vertebrae in this group, The median height of the vertebral body recovered from 53.01 鹵21.10 鹵57.61 鹵18.59 before operation to 77.70 鹵12.92 鹵75.61 鹵13.68 after operation (P0.05), and at the last follow-up was 75.25 鹵12.1774.00 鹵14.97, respectively. There was no significant difference between the last time and postoperative (P0.05). The scores of Cobb angle VAS and ODI decreased from 17.75 鹵14.38 鹵8.48 鹵0.644.61 鹵5.39 to 9.86 鹵12.16 鹵2.33 鹵0.62n 32.48 鹵6.04, respectively (P0.05). At the last follow-up, the above indexes were not statistically significant compared with postoperative. Conclusion the thoracolumbar segment of OVF bone is nonunion, the pain is disappeared in supine, the pain is aggravated in standing or sitting position, the sign of vertebral body fissure, vacuum and pseudarthrosis can be seen on imaging. The key techniques of kyphoplasty in the treatment of bone nonunion of osteoporotic vertebral fracture are significant and can effectively reduce the occurrence of bone cement leakage.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
【參考文獻】
相關(guān)期刊論文 前1條
1 楊惠林,顧曉暉,陳亮,陸儉,毛海青,孟斌,牛國旗,趙劉軍,唐天駟;后凸成形術(shù)治療骨質(zhì)疏松性脊柱骨折的選擇性與個體化[J];中國醫(yī)學科學院學報;2005年02期
，本文編號：2251787
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