光电导航引导个体化穿刺椎体后凸成形术治疗胸腰椎骨质疏松性骨折的临床观察

发布时间：2018-01-26 22:04

本文关键词： 导航 PKP 胸腰椎骨折个体化　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨光电导航引导个体化穿刺椎体后凸成形术(Percutaneous kyphoplasty,PKP)治疗胸腰椎骨质疏松性骨折(Osteoporosis vertebral compression fracture,OVCF)的安全性和有效性。方法:自贡市第四人民医院骨科2012年11月~2014年09月采用PKP治疗OVCF63例,共82个椎体。其中男12例,女51例。年龄61~86岁,平均年龄71.2岁。根据导航方式分为两组:试验组为光电导航引导个体化穿刺PKP共32例43个椎体,男6例,女26例,年龄62-85岁,平均年龄71.7岁;对照组为常规C型臂X线机透视下穿刺PKP共31例39个椎体,男6例,女25例,年龄61-86岁,平均年龄70.8岁。两组患者性别、年龄、病因、VAS评分、患椎分布等一般资料比较,差异均无统计学意义(P0.05),具有可比性。两组手术前后进行VAS评分,术中记录单侧穿刺成功数、X线暴露次数、穿刺次数及手术时间,术后在X线片和CT上观察椎弓根穿破、骨水泥渗漏情况,术后记录血管、神经、脑脊液漏等其他并发症,并进行统计学比较。结果:术后试验组椎弓根穿破0例、骨水泥渗漏1例,对照组椎弓根穿破2例、骨水泥渗漏5例,两组均无血管、神经、脑脊液漏等其他并发症发生。术后24h后试验组VAS评分与对照组比较,差异无统计学意义(P0.05);组内与术前比较,差异有统计学意义(P0.05)。术中试验组X线暴露次数、穿刺次数明显少于对照组(P0.05),而两组手术时间比较,差异无统计学意义(P0.05)。术中试验组单侧穿刺成功率明显高于对照组(P0.05)。术后试验组椎弓根穿破、骨水泥渗漏、血管、神经及脑脊液漏等并发症发生率明显低于对照组(P0.05)。结论:光电导航引导个体化穿刺PKP治疗OVCF中,单侧穿刺即可达到传统方法双侧穿刺的效果;手术时间与对照组无明显差异,并没有增加术者的工作量和患者的耐受时间,因此本方法有较好的临床效果。光电导航引导个体化穿刺术中,单侧穿刺成功率高、穿刺次数少,与对照组比较穿刺准确性明显提高;而术中X线暴露次数少,椎弓根穿破率、骨水泥渗漏率低,没有血管、神经、脑脊液漏等其他并发症,因此本方法安全性较高。光电导航系统对穿刺外倾角度的把握更精确,可依据导航屏幕上光标延长线的距离来判断,减少了C型臂X线机导航常依靠术者手感、经验以及患者体位变化所带来的误差。
[Abstract]:Objective: to investigate the percutaneous kyphoplasty guided by photo-electronic navigation through individualized lumbar kyphoplasty. Vertebral compression fracture in the treatment of osteoporotic fracture of thoracolumbar vertebrae. Methods: from November 2012 to September 2014, patients with OVCF63 were treated with PKP in orthopedic department of 4th people's Hospital of Zigong. There were 82 vertebrae, including 12 males and 51 females, aged 61 to 86 years. The average age was 71.2 years. According to the navigation mode, the experimental group was divided into two groups: the experimental group consisted of 32 patients (6 males and 26 females, aged 62-85 years) with PKP guided by photo-electronic navigation. The average age was 71.7 years; The control group consisted of 31 patients (6 males and 25 females, aged 61-86 years, with an average age of 70.8 years) who were punctured with PKP under conventional C-arm fluoroscopy. Compared with the general data of etiology and vertebral distribution, the difference was not statistically significant (P 0.05). The VAS score was performed before and after operation in both groups, and the number of successful unilateral puncture was recorded during the operation. X-ray exposure, puncture times and operation time, X-ray film and CT observation of pedicle perforation, bone cement leakage, postoperative records of blood vessels, nerves, cerebrospinal fluid leakage and other complications. Results: there were 0 cases of pedicle perforation, 1 case of bone cement leakage, 2 cases of pedicle perforation and 5 cases of bone cement leakage in the control group. There were no blood vessels and nerves in both groups. Other complications such as cerebrospinal fluid leakage occurred. 24 hours after operation, there was no significant difference in VAS score between the experimental group and the control group (P 0.05). The number of X-ray exposure and puncture times in the experimental group was significantly lower than that in the control group (P 0.05), and the operative time was compared between the two groups. The success rate of unilateral puncture in the test group was significantly higher than that in the control group (P 0.05). The pedicle perforation, bone cement leakage and blood vessel in the experimental group were significantly higher than those in the control group. The incidence of neurologic and cerebrospinal fluid leakage was significantly lower than that of the control group (P 0.05). Conclusion: photoelectric navigation guided individualized puncture PKP in the treatment of OVCF. Unilateral puncture can achieve the effect of bilateral puncture. There was no significant difference between the operation time and the control group, and did not increase the workload of the operator and patient tolerance time, so this method has a better clinical effect. The success rate of unilateral puncture was high and the frequency of puncture was less. Compared with the control group, the accuracy of puncture was improved obviously. But the number of X-ray exposure during the operation, pedicle puncture rate, bone cement leakage rate is low, there are no blood vessels, nerves, cerebrospinal fluid leakage and other complications. Therefore, the security of this method is high. The photoelectric navigation system is more accurate to grasp the angle of external inclination, can be judged according to the distance of the cursor extension line on the navigation screen, reducing the C-arm X-ray machine navigation often rely on the hand of the warlock. Errors caused by experience and changes in patient posture.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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