椎体成形术和后凸成形术治疗脊柱转移性肿瘤

发布时间：2018-03-10 04:39

本文选题：经皮椎体成形术　切入点：经皮椎体后凸成形术　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:比较经皮椎体成形术(Percutaneous Vertebroplasty,PVP)和经皮椎体后凸成形术(Percutaneous Kyphoplasty,PKP)治疗脊柱转移瘤,分析其治疗效果。方法:2011年5月至2016年5月,对39例(77椎)脊柱转移瘤导致的病理性骨折行微创手术,其中包括PVP 14例(33椎),PKP25例(44椎);测量术前和术后即刻、术后1周、3月、6月、12月的疼痛视觉模拟评分法(Visual Analogue Score,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI);比较分析两组的术后住院时间、骨水泥使用量、手术出血量、病变椎体高度、Cobb角、骨水泥弥散、骨水泥渗漏、经济效用比值、生存时间。结果:全部患者均顺利完成手术,38例患者均在术后第一天疼痛得到缓解,1例术后出现疼痛加重;疼痛由术前(7.70±1.11)下降到术后(4.02±2.22),1周(3.50±1.92),3月(3.60±1.00),6个月(3.96±1.02),12月(4.34±1.25);ODI也显著下降,术前(74.42±8.97)%下降到术后(40.57±21.63)%,1周(37.50±10.45)%,3月(37.27±10.45)%,6月(38.60±8.42)%,12月(37.42±6.68)%。比较两组术后至出院时间、骨水泥注射量、术中出血量、椎体高度恢复均无显著性差别;PVP骨水泥渗漏率为42.42%(14/33椎),PKP为(27.27%,12/44椎),无一例出现骨水泥渗漏引起症状,通过经济效用比值发现,PVP比PKP性价比更高(P=0.02);且行两种手术的患者术后生存时间无明显差异(P=0.38)。结论:PVP和PKP治疗脊柱转移瘤均能很好的缓解病椎部位疼痛,提高肿瘤患者生活的质量。相比PVP而言,PKP更昂贵,两者均能部分恢复椎体中部和后缘高度,但不能改善后凸畸形。两者手术方式对患者生存寿命无差别。
[Abstract]:Objective: to compare the effect of percutaneous Vertebroplasty (PVP) and percutaneous kyphosis (PKP) in the treatment of spinal metastases. A minimally invasive operation was performed on 39 patients with spinal metastases resulting from spinal metastases, including 14 patients with PVP and 33 patients with PKP. Visual Analogue Scorevas (VAS) and Oswestry dysfunction index (Oswestry disability index) were evaluated 1 week after operation, March, June, December. The postoperative hospitalization time, bone cement usage, operative bleeding volume, the height of the lesion vertebral body and the dispersion of bone cement were compared between the two groups. Results: all the 38 patients with successful operation were relieved of pain on the first day after operation and 1 patient had severe pain after operation. The pain decreased from 7.70 卤1.11 before operation to 3.50 卤1.92 in 1 week after operation, 3.60 卤1.00 in March, 3.96 卤1.02 in 6 months, and 4.34 卤1.25m on December. It also decreased from 74.42 卤8.97% preoperatively to 40.57 卤21.6363 卤37.50 卤10.45 in 1 week, 37.27 卤10.45 in March, 38.60 卤8.422 in March, 37.42 卤6.6820 in #date8#, and 37.42 卤6.680.The time between discharge and discharge was 37.42 卤6.680.The blood loss was 37.50 卤10.45, 37.27 卤10.45, 38.60 卤8.422, 37.42 卤6.68 respectively. There was no significant difference in the recovery of vertebral body height. The leakage rate of PVP bone cement was 42.42% and the PKP of 14 / 33 was 27.272712 / 44 vertebrae. None of the cases had symptoms caused by cement leakage. According to the ratio of economic utility, it was found that the cost / performance ratio of PKP was higher than that of PKP, and there was no significant difference in postoperative survival time between the two types of patients. Conclusion the treatment of spinal metastases with PKP and PKP can relieve the pain of spinal metastases. It is more expensive than PVP to improve the quality of life of tumor patients. Both of them can partially recover the height of the middle and posterior edge of vertebral body, but can not improve kyphosis. There is no difference in the survival life between the two surgical methods.
【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】：R738

【参考文献】