远程遥控骨水泥推注系统辅助经皮椎体后凸成形术治疗后壁破裂型骨质疏松性椎体骨折

发布时间：2018-03-14 02:34

  本文选题：骨质疏松性椎体骨折　切入点：远程遥控骨水泥推注系统　出处：《中国修复重建外科杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的通过与术中间断手推注骨水泥进行比较,评估远程遥控骨水泥推注系统(remote controlled injection manipulator system,RCIM)辅助经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗后壁破裂型骨质疏松性椎体骨折的效果。方法回顾分析2010年9月—2016年1月收治并符合选择标准的48例行PKP治疗的单节段后壁破裂型骨质疏松性胸腰椎骨折老年患者临床资料,根据术中骨水泥推注方式分为2组:对照组22例采用手推杆间断推注骨水泥,试验组26例采用RCIM辅助推注骨水泥。两组患者性别、年龄、病程、致伤原因、累及椎体、骨密度T值、疼痛持续时间及术前疼痛视觉模拟评分(VAS)、伤椎前缘相对高度、伤椎后凸Cobb角等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录两组术中骨水泥灌注期时间、医患双方接受辐射剂量、骨水泥注入量;采用VAS评分、伤椎后凸Cobb角、伤椎前缘相对高度、骨水泥弥散面积比值、骨水泥渗漏率评价疗效。结果两组患者均获随访,随访时间6个月。术后均无骨水泥毒性反应,无脊髓、神经损伤,无感染、血管栓塞等并发症发生。两组骨水泥注入量及术者接受辐射剂量比较差异无统计学意义(P0.05),但试验组骨水泥灌注期时间、骨水泥弥散面积比值及患者接受辐射剂量显著少于对照组(P0.05)。对照组和试验组分别有6例(27.27%)和2例(7.69%)出现骨水泥渗漏,比较差异有统计学意义(χ~2=4.850,P=0.029);两组均无经后壁向椎管内渗漏。两组术后3 d及6个月VAS评分、伤椎前缘相对高度和伤椎后凸Cobb角均较术前显著改善(P0.05);两组间以上指标比较差异均无统计学意义(P0.05)。结论 RCIM辅助PKP治疗后壁破裂型骨质疏松性椎体骨折可获得满意临床效果,缩短了灌注期时间,可有效减少患者接受辐射剂量,降低骨水泥渗漏发生率。
[Abstract]:Objective to compare bone cement with intermittent manual injection during operation. To evaluate the effect of remote controlled injection manipulator system (RCIM-assisted percutaneous kyphoplastysia PKK) in the treatment of posterior wall ruptured osteoporotic vertebral fracture. Methods from September 2010 to January 2016, we retrospectively analyzed the effect of percutaneous kyphoplast kyphoplasty in the treatment of osteoporotic vertebral fracture of posterior wall rupture. Clinical data of 48 elderly patients with single segmental posterior wall ruptured osteoporotic thoracolumbar fracture treated with PKP were selected. According to the intraoperative method of bone cement injection, the patients in the control group were divided into two groups: the control group (22 cases) received intermittent injection of bone cement by hand push rod, and the experimental group (26 cases) were treated with RCIM assisted injection of bone cement, the sex, age, course of disease, cause of injury, and vertebral body involvement in the two groups. T value of bone mineral density, duration of pain, visual analogue score of pain before operation, relative height of anterior edge of injured vertebrae, Cobb angle of kyphosis were compared. The difference was not statistically significant (P 0.05), which was comparable. The time of bone cement perfusion in the two groups was recorded, the dose of radiation and the amount of bone cement injected were recorded, the VAS score was used to evaluate the Cobb angle of kyphosis and the relative height of the anterior edge of the injured vertebrae. Results the patients in both groups were followed up for 6 months. There was no toxic reaction of bone cement, no spinal cord, no nerve injury, no infection, no spinal cord injury and no infection. Complications such as vascular embolism occurred. There was no significant difference between the two groups in bone cement injection and radiation dose, but the time of bone cement perfusion in the experimental group was not significantly different from that in the control group. Bone cement diffusion area ratio and radiation dose in patients were significantly lower than those in control group (P 0.05). Bone cement leakage was found in 6 cases in the control group and in 2 cases in the test group (P = 27.27) and 2 cases in the control group (n = 2). The difference was statistically significant (蠂 ~ (2 +) 4.850). There was no posterior wall leakage in the two groups. The VAS score was 3 days and 6 months after operation in the two groups. The relative height of the anterior edge of the injured vertebrae and the Cobb angle of the injured vertebral kyphosis were significantly improved compared with those before operation, and there was no significant difference in the above indexes between the two groups. Conclusion RCIM assisted with PKP can obtain satisfactory clinical results in the treatment of posterior wall ruptured osteoporotic vertebral fracture. The time of perfusion can be shortened, the radiation dose can be reduced effectively, and the incidence of cement leakage can be reduced.
【作者单位】： 来宾市人民医院脊柱外科;
【分类号】：R580;R687.3
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