单针穿刺副突定位椎体成形术治疗老年骨质疏松性腰椎压缩性骨折

发布时间：2018-03-13 05:27

本文选题：副突定位　切入点：单针穿刺　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨副突定位单针穿刺行椎体成形术在治疗老年骨质疏松性腰椎体压缩性骨折（OVCF）的可行性、临床疗效及诊断与治疗要点。方法：通过使用单针穿刺副突定位椎体成形术治疗老年骨质疏松性腰椎压缩性骨折68例患者，其中76个伤椎，并进行回顾性分析，观察患者术前、术后即刻、术后1周，术后3个月、6个月时的VAS评分、改良Macnab评分，进行统计学比较及分析。结果：所有患者均顺利完成手术，术后较术前症状改善明显，，疼痛缓解，恢复正常生活，单个椎体手术时间为25-40min，平均35min；注射骨水泥量为3.0-6.0ml，平均4.6ml，术后患者疼痛明显减轻或消失，恢复正常生活。患者术后即刻VAS评分为3.1±0.7，术后1周为1.8±0.7，术后3个月为1.5±0.6，术后6个月为1.6±0.6，所有OVCF患者术前术后对比具有统计学意义（P＜0.05)，术后1周与术后3个月、6个月的结果对比没有显著的统计学差异（P＞0.05)。术后改良Macnab评定优良率在术后即刻、术后1周、术后3个月及术后6个月达到97%。所有病例没有穿刺失败、感染、肺栓塞发生，在68例患者中有3例病例出现骨水泥渗漏，但没有临床症状，未发生骨水泥椎管内渗漏，没有临床症状。结论：单针穿刺副突定位椎体成形术治疗老年骨质疏松性腰椎压缩性骨折，通过将穿刺点继续向外侧移位，使穿刺终点更容易接近或越过中线，能够在单针穿刺下获得更好的骨水泥弥散，减少手术风险、手术时间及治疗费用，并获得良好疗效，值得临床推广应用。
[Abstract]:Objective: to investigate the feasibility, clinical effect, diagnosis and treatment of osseous lumbar vertebral compression fracture (OVCFC) in elderly patients with paracentesis and single needle vertebroplasty. Methods: Sixty-eight elderly patients with osteoporotic lumbar vertebrae compression fracture were treated with single needle puncture and accessory process positioning vertebroplasty, 76 of which were injured vertebrae. The patients were observed before, immediately after operation and 1 week after operation. The VAS score and modified Macnab score at 3 and 6 months after operation were compared and analyzed statistically. Results: all the patients completed the operation successfully, the postoperative symptoms were improved obviously, the pain was relieved, and the normal life was restored. The operation time of single vertebral body was 25-40 min (mean 35 min), the amount of bone cement injected was 3.0-6.0 ml (mean 4.6 ml), the pain of the patients was relieved or disappeared after operation. The scores of VAS were 3.1 卤0.7, 1.8 卤0.7, 1.5 卤0.6 and 1.6 卤0.6 at the first week, 3 months and 6 months after operation respectively. There was significant difference between all OVCF patients before and after operation (P < 0.05), 1 week after operation and 3 months and 6 months after operation. There was no significant difference in the results between the two groups (P > 0.05). The excellent and good rate of modified Macnab was evaluated immediately after operation. At 1 week, 3 months and 6 months after operation, 97 cases were involved. No puncture failure, infection, pulmonary embolism occurred in all cases. Bone cement leakage was found in 3 out of 68 patients, but no clinical symptoms were found. There was no osseous leakage in the spinal canal and no clinical symptoms. Conclusion: the treatment of senile osteoporotic lumbar vertebrae compression fracture with single needle puncture accessory process positioning vertebroplasty can make the puncture point more easily approaching or crossing the midline by moving the puncture point to the lateral side. It can obtain better bone cement dispersion under single needle puncture, reduce the operation risk, operation time and treatment cost, and obtain good curative effect. It is worth popularizing and applying in clinic.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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