经皮穿刺椎体内植骨成形术治疗胸腰椎骨折的临床研究

发布时间：2018-03-01 10:15

本文关键词： 经皮穿刺椎体成形术经椎弓根植骨胸腰椎骨折　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨经皮穿刺椎体内植骨成形术治疗无神经损伤的胸腰椎压缩骨折的临床疗效。方法:本研究通过收集2014年12月至2016年2月因胸腰椎压缩骨折在我院骨科住院并行经皮穿刺椎体内植骨成形术治疗的患者共36例,其中男性21例,女性15例,平均年龄43.5±9.3(19-64)岁。神经功能按Frankel分级均为E级。骨折节段:T12合并L11例,T116例,T1210例,L112例,L26例,L31例。骨折类型:均为单纯压缩骨折。术前计算好植骨需要量,术中记录手术时间、出血量及植骨量,分别于术前、术后3 d、术后3个月、术后6个月、术后1年对患者进行随访,获得疼痛程度、X线片和CT或MRI资料。得到本组患者各随访时间点的VAS评分值、伤椎椎体前缘高度百分比(AVH%)及后凸畸形角度(Cobb'角)数据,并做统计学对比分析,评估临床效果。结果:本组患者均获得良好随访,平均随访时间14个月(12-20个月),手术时间平均为55min,术中平均出血量12ml,平均植骨量8.7±1.2 g(8-10g)。疼痛程度改善情况:VAS评分术后3天从术前7.3±0.9下降至2.8±0.6,3月时为2.0±0.5,6月时为1.4±0.5,1年时为1.1±0.5。伤椎前缘高度和后凸畸形角度(Cobb'角)方面,伤椎椎体前缘高度百分比(AVH%)术后3天从术前62.8%±3.4%恢复至90.4%±3.0%,3个月时为88.1%±2.9%,6个月时为87.3%±2.9%,1年时为87.0%±2.9%。后凸畸形角度(Cobb'角)术后3天从18.6±2.5°下降至3.5±0.6°,3个月时为4.8±0.9°,6个月时为5.1±0.9°,1年时为5.4±0.9°。所有患者均获得良好的骨性愈合,未出现神经功能受损,无顽固性腰背痛残留,无进行性后凸畸形加重等并发症发生。结论:对于无神经损伤胸腰椎压缩骨折的患者,经皮穿刺椎体内植骨成形术可有效恢复伤椎的结构完整性和稳定性,早期能有效缓解伤椎疼痛,减轻患者卧床及康复锻炼时的痛苦,椎体内充分的打压植骨在恢复并维持椎体高度的同时避免了“蛋壳样”椎体的发生,进而减少了进行性后凸畸形加重、顽固性腰背痛等并发症的发生。经皮穿刺椎体内植骨成形术具有创伤小、安全性高、并发症少等优点,是一种安全、有效的微创手术治疗方法。
[Abstract]:Objective: to investigate the clinical effect of percutaneous vertebroplasty in the treatment of thoracolumbar compression fractures without nerve injury. Methods: from December 2014 to February 2016, this study was carried out in orthopedic department of our hospital by collecting thoracolumbar compression fractures from December 2014 to February 2016. A total of 36 patients were hospitalized and treated with percutaneous vertebroplasty. Among them, 21 cases were male, 15 cases were female, mean age was 43.5 卤9.3 卤19-64 years old. The neurological function was grade E according to Frankel grade. The time of operation, the amount of blood loss and the amount of bone graft were recorded during the operation. The patients were followed up before, 3 days, 3 months, 6 months and 1 year after operation, respectively. X-ray films and CT or MRI data of pain degree were obtained. The data of VAS score, anterior height percentage of injured vertebrae and angle of kyphosis deformity were obtained, and the data were compared and analyzed statistically. Results: all the patients were followed up well. The mean follow-up time was 14 months to 20 months, the average operative time was 55 minutes, the average amount of blood loss during operation was 12 ml, the average bone graft volume was 8.7 卤1.2 g / L and the mean bone graft volume was 8. 8 卤0. 6 g / L. The improvement of pain degree decreased from 7. 3 卤0. 9 before operation to 2. 8 卤0. 6 at 3 days after operation, 2. 0 卤0. 5 on March, 1.4 卤0. 5 on June, and 1 year after operation. 1. 1 卤0. 5. Anterior height of injured vertebrae and angle of kyphosis. The percentage of anterior height of injured vertebrae recovered from 62.8% 卤3.4% to 90.4% 卤3.0, 88.1% 卤2.9 at 3 months, 87.3% 卤2.9 at 6 months, 87.0% 卤2.9 at 1 year). The angle of kyphosis decreased from 18.6 卤2.5 掳to 3.5 卤0.6 掳, 4.8 卤0.9 掳at 3 months, 5.1 卤0.9 掳at 6 months, and 5.1 卤0.9 掳at 1 year. 5.4 卤0.9 掳. Good bone healing was achieved in all patients. There were no complications such as no neurological impairment, no residual intractable low back pain, no exacerbation of progressive kyphosis, etc. Conclusion: for patients with compression fracture of thoracolumbar vertebrae without nerve injury, Percutaneous transluminal osteoplasty can effectively restore the structural integrity and stability of the injured vertebrae, relieve the pain of the injured vertebrae in the early stage, and relieve the pain of the patients during bed rest and rehabilitation exercise. Adequate compression of the vertebrae and bone graft can restore and maintain the height of the vertebrae while avoiding the occurrence of "eggshell like" vertebrae, thereby reducing the exacerbation of progressive kyphosis. Percutaneous vertebroplasty has the advantages of small trauma, high safety and less complications, so it is a safe and effective minimally invasive surgical treatment.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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