PKP治疗中上胸椎骨质疏松性重度压缩骨折的临床疗效

发布时间：2018-03-01 07:00

本文关键词： 椎体后凸成形术骨质疏松性椎体压缩骨折中上胸椎椎弓根入路骨水泥渗漏　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨经皮椎体后凸成形术(PKP)治疗中上胸椎(T6以上)骨质疏松性重度压缩骨折(SVCF)的安全性和疗效。方法:回顾性分析2013年1月~2016年3月我院采用PKP治疗的30例中上胸椎重度骨质疏松性骨折,男10例,女20例,年龄61~87岁,平均72岁。椎体分布:T3 2例、T4 4例、T5 11例、T6 17例。受累节段椎体平均压缩率为59%(40.5%~82.6%)。应用统计学方法比较手术前后的胸背痛视觉模拟评分(VAS)、功能障碍指数(ODI)、活动能力(四级评分法)、椎体压缩率和后凸角的恢复情况。结果:所有患者顺利完成手术,其中23例采用双侧椎弓根入路,7例采用单侧椎弓根外入路。随访6~39月,平均18.5月。术后1天、1月和末次随访时VAS、ODI、活动能力评分与术前比较差异有统计学意义(P0.05)。手术前后椎体的后凸角和压缩率也均改善,差异有统计学意义(P0.05)。术中11例(32%)发生骨水泥渗漏(1例硬膜外渗漏,4例椎间隙渗漏,8例椎旁软组织渗漏),均未引起临床症状。未出现肺栓塞、肋骨或椎弓根骨折、气胸等相关并发症。2例(6%)随访半年后再发椎体骨折(非邻近节段、非手术椎体)。结论:PKP治疗中上胸椎重度骨质疏松性骨折可以有效缓解胸背痛和提高活动能力,并能一定程度恢复受累节段椎体高度和后凸角,在合适的体位和手术入路下,该手术安全且疗效显著。
[Abstract]:Objective: to evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) in the treatment of severe osteoporotic compression fracture of the upper thoracic vertebrae (T6). Methods: from January 2013 to March 2016, 30 patients treated with PKP in our hospital were retrospectively analyzed. A case of severe osteoporotic fracture of the upper thoracic vertebra, There were 10 males and 20 females, aged 61 to 87 years, The average age was 72 years old. The vertebral body distribution was 2 cases of T 3, 4 cases of T 4 and 11 cases of T 5 and 6 cases of T 6.The average compression ratio of involved vertebral body was 59% 40.5% and 82.6%. The visual analogue score of chest and back pain before and after operation was compared by statistical method, the index of dysfunction was ODI, and the ability of movement was obtained. Fourth grade method, vertebral compression ratio and kyphosis recovery. Results: all patients successfully completed the operation, Among them, 23 cases were treated with bilateral pedicle approach and 7 cases were treated with unilateral pedicle approach. On the first day after operation, on January and at the last follow-up, there was a statistically significant difference in activity score between before and after operation (P 0.05). The kyphosis angle and compression ratio of vertebral body were also improved before and after operation. The difference was statistically significant (P 0.05). There were 11 cases of bone cement leakage and 1 case of epidural leakage. 4 cases of vertebral space leakage and 8 cases of paraspinal soft tissue leakage did not cause clinical symptoms. There was no pulmonary embolism, rib or pedicle fracture. 2 cases of pneumothorax and other related complications were followed up for half a year. (non-adjacent segment, non-operative vertebral body). Conclusion the treatment of severe osteoporotic fracture of middle and upper thoracic vertebrae with PKP can effectively relieve chest and back pain and improve mobility. It can restore the height and kyphoid angle of the involved segment to a certain extent. The operation is safe and effective under proper posture and operative approach.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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