椎体成形术治疗骨质疏松性椎体压缩骨折的临床及生物力学研究

发布时间：2018-04-23 14:11

本文选题：回顾性研究 + 骨质疏松症　；参考：《南方医科大学》2017年博士论文

【摘要】：研究背景骨质疏松性椎体压缩骨折是骨质疏松症患者常见的骨折类型,椎体成形术(PVP)因其良好的止痛效果而广泛用于治疗骨质疏松性椎体压缩骨折。目前PVP采用单侧还是双侧椎弓根入路还有争议,主要原因是单侧椎弓根入路PVP的临床疗效及安全性受到质疑。随着PVP的临床使用,术后其他椎体再发骨折的报道逐渐增加,尤其是邻近椎体骨折;但也有报道术后邻近椎体骨折发生率并不高。目前PVP术后再发椎体骨折的相关风险因素、生物力学机制尚无明确结论。研究方法:1、单侧与双侧经椎弓根入路PVP治疗骨质疏松性椎体压缩骨折临床疗效比较:回顾分析南方医院收治的单节段骨质疏松性椎体压缩骨折患者,根据手术入路不同分为单侧椎弓根入路组和双侧椎弓根入路组,比较两组患者的临床疗效、手术时间、骨水泥灌注量、骨水泥渗漏率、骨折椎体高度恢复程度及后凸矫正度数等。2、椎体成形术治疗Kummell's病的临床研究:回顾南方医院收治并经椎体成形术治疗的Kummell's病患者,比较患者的临床疗效、手术时间、骨水泥灌注量、骨水泥渗漏率、骨折椎体高度恢复程度及后凸矫正度数等。3、椎体成形术后再发椎体骨折相关危险因素分析:回顾分析南方医院收治的经椎体成形术治疗的骨质疏松椎体压缩骨折患者相关临床资料,探讨PVP术后再发椎体骨折的相关危险因素。4、椎体成形术后邻近椎体生物力学研究:取人体防腐胸腰段标本,包埋、固定。于腰1椎体建立骨折模型,在不同状态下测定整体刚度、邻近椎体及椎间盘的应变。实验结果:1、单侧与双侧经椎弓根入路PVP治疗骨质疏松性椎体压缩骨折临床疗效比较:单侧组患者手术时间(36.4±6.0min)少于双侧组(52.9±6.8min),骨水泥注入量(3.7± 1.1ml)较双侧组(4.3± 1.1ml)少,差异均有统计学意义(P0.05)。两组患者术后椎体前缘压缩改善程度、椎体中央压缩改善程度及后凸cobb角矫正度数比较差异均无统计学意义(P0.05)。两组患者术后24 h、3个月及12个月VAS评分均明显低于术前,差异有统计学意义(P0.05),但两组患者之间术后24h、3个月及12个月VAS评分比较差异均无统计学意义(P0.05)。虽然单侧组患者骨水泥渗漏率(28.9%)较双侧组(46.4%)低,但二者比较无差异(P0.05)。2、椎体成形术治疗Kummell's病的临床研究:单侧组患者手术时间明显短于双侧组(P0.05),两组间骨水泥注入量、渗漏率、术后椎体前缘压缩改善程度、椎体中央压缩改善程度及后凸矫正度数、随访VAS评分差异均无统计学意义(P0.05)。两组术后24 h、术后3个月及末次随访时VAS评分均明显低于术前,差异均有统计学意义(P0.05)。3、椎体成形术后再发椎体骨折相关危险因素分析:共182患者符合纳入标准,其中男性27人、女性155人,平均年龄69.7岁;随访时间24～50个月(平均26.4个月),共21名患者出现再发椎体骨折,发生率为11.5%。单因素及多因素回归分析发现:患者性别,年龄,骨密度,骨水泥注入量,椎间隙骨水泥渗漏,术前骨折椎体后凸角度,术前骨折椎体前缘、中央压缩程度,术后骨折椎体前缘、中央的恢复程度,术后骨折椎体后凸矫正度数等因素与术后再发骨折无显著相关性(P0.05);仅体重指数、骨折椎体数目与术后再发骨折有显著相关性(P0.05)。4、生理载荷下椎体成形术后邻近椎体生物力学研究:腰1椎体平均注入骨水泥量为4.4ml(3.8～5.0ml)。注射骨水泥后刚度(201±65N/mm)较骨折后明显提高(96±24N/mm,P0.05),但仍低于骨折前的刚度(242±67 N/mm,P0.05)。注射骨水泥后邻近上位椎体的应变较骨折前相比无明显差异(P0.05),而邻近下位椎体的应变较骨折前明显增加(P0.05)。结论:1、单侧与双侧椎弓根入路穿刺椎体成形术(PVP)均可取得相当的临床效果。2、椎体成形术治疗Kummell's病时,单侧穿刺可取得与双侧穿刺类似的临床效果。3、骨折椎体数目、体重指数是PVP术后出现再发骨折的危险因素。4、PVP不能将节段刚度恢复至正常水平,但改变了下位椎体的载荷分享。
[Abstract]:Background osteoporotic vertebral compression fracture is a common fracture type of osteoporotic patients. Vertebroplasty (PVP) is widely used for the treatment of osteoporotic vertebral compression fractures because of its good analgesic effect. Currently, unilateral or bilateral pedicle pedicle approach is still disputed with PVP, the main reason is the unilateral pedicle approach of PVP. The effect and safety of the bed are questioned. With the clinical use of PVP, reports of other vertebral fractures are increasing, especially adjacent vertebral fractures, but there are also reports that the incidence of adjacent vertebral fractures is not high. There is no clear conclusion of the related risk factors for the recurrence of vertebral fractures after PVP. Method: 1, comparison of the clinical efficacy of unilateral and bilateral transpedicular approach PVP in the treatment of osteoporotic vertebral compression fractures: retrospective analysis of single segment osteoporotic vertebral compression fractures treated in southern hospitals, and the surgical approaches were divided into unilateral pedicle approach group and bilateral pedicle pedicle approach group, and compared the clinical efficacy of the two groups. Operation time, bone cement perfusion, bone cement leakage, degree of vertebral height recovery and kyphosis correction degree, etc..2, vertebroplasty for the treatment of Kummell's's disease: a retrospective study of patients with Kummell's disease treated in the southern hospital and treated with vertebroplasty, compared with the patient's clinical efficacy, operation time, cement perfusion, bone cement .3, analysis of risk factors for vertebral fracture after vertebroplasty: retrospective analysis of related clinical data of patients with osteoporotic vertebral compression fractures treated by vertebroplasty in the southern hospital, and to explore the risk factors associated with recurrent vertebral fractures after PVP,.4 Biomechanical study of adjacent vertebral body after vertebroplasty: take the body anticorrosive thoracolumbar specimens, embedded and fixed. Establish the fracture model in the lumbar 1 vertebral body, determine the overall stiffness, adjacent vertebra and intervertebral discs under different conditions. Experimental results: 1, unilateral and bilateral vertebral arch root approach PVP treatment of osteoporotic vertebral compression fracture clinical treatment Comparison: the operation time of the unilateral group (36.4 + 6.0min) was less than that of the bilateral group (52.9 6.8min), the amount of bone cement injection (3.7 + 1.1ml) was less than that of the bilateral group (4.3 + 1.1ml), and the difference was statistically significant (P0.05). The improvement degree of the anterior compression of the vertebral body in the two groups, the improvement degree of the central compression of the vertebral body and the correction degree of the kyphosis Cobb angle were all different There was no statistical significance (P0.05). The score of 24 h, 3 months and 12 months after operation in the two groups was significantly lower than that before the operation, the difference was statistically significant (P0.05), but there was no statistical difference between the two groups after 24h, 3 months and 12 months (P0.05). Although the rate of bone cement leakage (28.9%) in the unilateral group was lower than that of the bilateral group (46.4%). But there was no difference (P0.05).2, the clinical study of vertebroplasty in the treatment of Kummell's disease: the operation time of the unilateral group was significantly shorter than that of the bilateral group (P0.05), the amount of bone cement injection, the leakage rate, the improvement degree of the compression of the vertebral anterior margin after the operation, the degree of central compression modification and the kyphotic correction of the vertebral body, and the difference of the follow-up of VAS scores were not statistically significant. Study significance (P0.05). The two group 24 h after operation, 3 months and the last follow-up, the VAS scores were significantly lower than before the operation, the difference was statistically significant (P0.05).3, after vertebroplasty, the risk factors of re vertebral fracture: a total of 182 patients were in accordance with the inclusion criteria, including 27 men, 155 women, average age of 69.7 years, and 24~50 follow-up time. The incidence of recurrent vertebral fractures was found in 21 patients (average 26.4 months). The incidence was 11.5%. single factor and multiple factor regression analysis. The patients' sex, age, bone mineral density, bone cement injection, intervertebral bone cement leakage, anterior vertebral vertebral kyphosis angle, preoperation bone fracture front edge, central compression degree, fracture vertebral anterior margin after operation, center of vertebral fracture, Central There was no significant correlation between the degree of recovery and the degree of correction of posterior vertebral kyphosis after the operation (P0.05). Only body mass index, the number of fractured vertebral bodies had a significant correlation with the postoperative recurrent fracture (P0.05).4. Under physiological load, the biomechanical study of the adjacent vertebral body after vertebroplasty: the average amount of bone cement injected in the lumbar 1 vertebral body was 4.4ml (3) .8 ~ 5.0ml). The stiffness (201 + 65N/mm) after the injection of bone cement was significantly higher than that of the fracture (96 + 24N/mm, P0.05), but still lower than that before the fracture (242 + 67 N/mm, P0.05). The strain adjacent to the upper vertebral body after injection of bone cement had no significant difference compared with that before the fracture (P0.05), and the strain of adjacent lower vertebral body was significantly higher than that before the fracture (P0.05). Conclusion: 1 One side and bilateral pedicle pedicle puncture vertebroplasty (PVP) can achieve a considerable clinical effect of.2. When vertebroplasty is used to treat Kummell's disease, unilateral puncture can achieve a similar clinical effect to bilateral puncture.3, the number of fractured vertebrae, body mass index (BMI) is a risk factor for recurrent fractures after PVP, and PVP can not restore segmental stiffness. To normal level, but the load sharing of the lower vertebrae was changed.

【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R687.3

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