麻醉状态下的中医手法联合PKP治疗中重度OVCF的临床观察

发布时间：2018-06-24 06:59

本文选题：中医手法闭合复位 + 中重度OVCF　；参考：《湖北中医药大学》2015年硕士论文

【摘要】：目的本文研究采用回顾性分析的方法,对术前麻醉状态下的中医手法闭合复位联合PKP与单纯PKP治疗中重度OVCF的临床疗效进行比较研究,对中医手法闭合复位联合PKP治疗中重度OVCF的临床疗效进行观察。方法回顾性分析2012年3月至2015年3月武汉市中西医结合医院骨脊柱专科收住院手术治疗的128例中重度OVCF患者,其中研究组术前麻醉状态下先予中医手法闭合复位,再行PKP手术治疗,对照组采用单纯PKP治疗,观察两组患者的临床症状改善情况、骨水泥的注入量及渗漏情况、治疗前后腰背部疼痛VAS评分、治疗前后脊柱节段后凸Cobb角、治疗前后病椎椎体前缘、中间以及后缘的高度,综合评价麻醉状态下中医手法闭合复位联合PKP治疗中重度OVCF的临床疗效。结果1.对于术中骨水泥的用量方面的比较:研究组在术前麻醉状态下中医手法闭合复位后再行PKP手术治疗能够增加骨水泥平均注入量,同对照组相相比较,两组骨水泥的平均注入量的差别存在统计学上的意义(p0.05)。2.对于骨水泥渗漏情况方面的比较:两组病人的骨水泥的渗漏情况治疗前后相比差别不存在统计学上的意义(p0.05)。3.治疗前后的VAS评分比较:两组病人的疼痛治疗3日后均能得到明显地缓解,研究组治疗3日后VAS评分同对照组治疗3日后VAS评分相比差异不存在统计学上的意义(p0.05);两组患者在治疗3月后较治疗3日后疼痛进一步减轻,两组患者之间在治疗3月后的VAS疼痛评分相比较差异不存在统计学上的意义(p0.05)。4.治疗前后的脊柱后凸Cobb角比较:在病人的脊柱后凸畸形矫正方面,两组病人自身治疗前后相比,差异存在统计学上的意义(p0.05),两组治疗均能不同程度地缓解病人的脊柱后凸畸形。在矫正病人的脊柱后凸畸形程度方面,两组病人之间治疗3日后的脊柱后凸Cobb角相比,差异存在统计学上的意义(p0.05),研究组明显优于对照组;两组病人之间治疗3月后的脊柱后凸Cobb相比差异存在统计学上的意义(p0.05),研究组同样优于对照组。5.治疗前后的病椎椎体前缘、中间及后缘高度的比较:在恢复病椎椎体前缘、中间高度方面,两组病人自身治疗前后相比,差异存在统计学上的意义(p0.05),两组治疗均能不同程度地恢复病椎椎体前缘和中间高度;在恢复病椎椎体后缘高度方面,研究组病人自身治疗前后相比,差异存在统计学上的意义(p0.05),对照组病人自身治疗前后相比,差异不存在统计学上的意义(p0.05),研究组能不同程度地恢复病椎椎体的后缘高度。两组患者之间治疗3日后的病椎椎体前缘、中间高度分别相比,差别存在统计学上的意义(p0.05),研究组优于对照组;两组患者之间治疗3月后的病椎椎体前缘、中间的高度分别相比,差异存在统计学上的意义(p0.05),研究组同样优于对照组。结论术前麻醉状态下的中医手法闭合复位联合PKP治疗中重度OVCF可以显著地改善病人的疼痛,能够最大限度地矫正病人的脊柱后凸畸形,集合了现代医学微创技术与中医传统手法的优势,可以最大限度地使病椎椎体高度恢复到骨折前水平,具有显著改善病人疼痛、矫正病人的脊柱后凸畸形并且恢复维持病人的脊柱正常生理弧度等优点,值得在临床实践中加以推广。
[Abstract]:Objective to study the clinical efficacy of closed reduction combined with PKP and simple PKP in the treatment of moderate and severe OVCF under preoperative anesthesia, and to observe the clinical efficacy of traditional Chinese medicine closed reduction combined with PKP in the treatment of moderate and severe OVCF. Methods a retrospective analysis from March 2012 to 2015 was conducted. In March, 128 cases of moderate to severe OVCF patients were treated by hospital bone and spine surgery in Wuhan integrated traditional Chinese and Western medicine hospital. The study group was treated with closed reduction of traditional Chinese medicine before operation and PKP operation, and the control group was treated with simple PKP treatment. The improvement of clinical symptoms, the injection amount of bone cement and the leakage of the bone cement were observed. The VAS score of back and back pain before and after treatment, the Cobb angle of spinal segment kyphosis before and after treatment, the height of the anterior, middle and posterior edge of the vertebral body before and after treatment, and evaluate the clinical efficacy of closed reduction of traditional Chinese medicine combined with PKP in the treatment of moderate and severe OVCF under anesthesia. Results 1. comparison of the dosage of bone cement in the operation: the study group was in the study group The average injection of bone cement could be increased after the closed reduction of traditional Chinese medicine and PKP operation under the anesthesia state before operation. Compared with the control group, the difference of the average injection of two groups of cement was statistically significant (P0.05) the comparison of the leakage of bone cement by.2.: the treatment of the leakage of bone cement in the two groups of patients There was no statistical significance (P0.05) before and after treatment (P0.05).3. treatment before and after treatment: two groups of patients with pain treatment could be significantly relieved after 3 days. After 3 days, the study group had no statistically significant difference in VAS score compared with the control group after 3 days of treatment (P0.05); the two groups were compared after the treatment of March. After 3 days of treatment, the pain was further reduced. There was no statistically significant difference in the VAS pain score between the two groups after the March treatment (P0.05) the comparison of the kyphosis Cobb angle before and after the.4. treatment: in the correction of the kyphosis in the patients, the difference was statistically significant between the two groups before and after their own treatment (P0 .05), the two groups were able to alleviate the patients' spinal kyphosis in varying degrees. In the correction of the degree of kyphosis in the patients, there was a statistically significant difference between the two groups of patients after 3 days of treatment of the kyphosis (P0.05), and the study group was obviously superior to the control group; the two groups were treated with spinal kyphosis after March. Cobb compared with the difference of statistical significance (P0.05), the study group was also better than the control group before and after.5. treatment of the vertebral vertebra anterior edge, the middle and the posterior margin of the height of the comparison: in the recovery of the vertebral vertebral anterior margin, the middle height, the two groups of patients before and after the treatment, the difference is statistically significant (P0.05), the two groups of treatment can be different The anterior and middle height of vertebra vertebral body was restored to the extent of the disease. In the recovery of the height of the posterior margin of the vertebral body, there was a statistically significant difference between the patients before and after the treatment of the patients before and after their own treatment (P0.05). The difference was not statistically significant (P0.05) in the control group before and after their own treatment (P0.05), and the study group could recover the vertebral vertebral body in varying degrees. The height of the back edge of the two groups of patients after 3 days of treatment of the vertebral vertebral body edge, the middle height, the difference was statistically significant (P0.05), the study group was better than the control group; the two groups of patients after March, the height of the vertebral vertebral body, the height of the middle of the difference was statistically significant (P0.05), the same group Conclusion the closed reduction of traditional Chinese medicine combined with PKP for the treatment of moderate and severe OVCF can significantly improve the patient's pain, and can correct the patients' spinal kyphosis to the maximum extent, and set the advantages of modern medical minimally invasive technique and traditional Chinese medicine, which can maximize the height of the vertebral body. Back to the pre fracture level, it has the advantages of significantly improving the patient's pain, correcting the patients' spinal kyphosis and restoring the normal physiological radian of the spinal column. It is worth popularizing in clinical practice.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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