PKP治疗老年骨质疏松性椎体压缩骨折骨水泥注射量与止痛效果研究

发布时间：2018-04-05 00:31

本文选题：PKP　切入点：骨质疏松性椎体压缩骨折　出处：《吉林大学》2017年硕士论文

【摘要】：目的:探讨PKP治疗老年骨质疏松性椎体压缩骨折骨水泥注射剂量与止痛效果的相关性。方法:选取2015年10月至2016年9月期间收入我院治疗的具有完整影像学资料并符合PKP手术适应症的老年骨质疏松性椎体压缩骨折的病人90例(140个椎体)作为研究对象,病人年龄范围为65岁-81岁,累及椎体范围为T10-L3。依据术中给予的不同骨水泥剂量将所有患者分为A组(小剂量骨水泥1-3ml),20例患者(20个椎体);B组(常规剂量骨水泥3-6ml),65例患者(115个椎体);C组(大剂量骨水泥6ml),5例患者(5个椎体)。按术中C臂透视监测下观察记录的骨水泥注射部位分成三组,A组(注射部位位于椎体的上1/3处),10例患者(10个椎体);B组(位于椎体正中),50例患者(100个椎体);C组(位于椎体骨折线处),30例病人(30个椎体)。根据术后胸腰椎正侧位X线片骨水泥的弥散程度分为两组,A组(骨水泥未过椎体正中线),30例患者(65个椎体);B组(过正中线),60例患者(75个椎体)。7例病人(10个椎体)发生骨水泥泄漏。记录并观察比较各组患者术前、术后1天、术后1月的VAS评分。结果:90例患者(140个椎体)手术均取得成功,未出现严重并发症,7例出现骨水泥泄露,无临床症状,疼痛完全缓解。对于骨水泥注射剂量,A组(小剂量骨水泥1-3ml)、B组(常规剂量骨水泥3-6ml)、C组(大剂量骨水泥6ml)三组在分别在术后1天、术后1月比较VAS评分无统计学差异(P0.05);各组术后1天、术后1月与术前比较VAS评分均有明显下降(P0.05)。对于骨水泥注射部位,A组(注射部位位于椎体上1/3处)、B组(注射部位位于椎体正中)、C组(注射部位位于椎体骨折线处)三组在术后1天、术后1月分别比较VAS评分无统计学差异(P0.05)。对于骨水泥弥散程度,A组(骨水泥弥散程度未过椎体中间线)、B组(骨水泥弥散程度过椎体中间线)三组在术后1天、术后1月比较VAS评分无统计学差异(P0.05)。结论:PKP能有效缓解老年骨质疏松性椎体压缩骨折引发的疼痛,近期止痛效果显著,但注射不同剂量的骨水泥对于患者的止痛效果无明显差异。PKP术中注射骨水泥的部位、骨水泥弥散程度对于术后止痛效果无明显影响。
[Abstract]:Objective: to investigate the correlation between the injection dose of bone cement and analgesic effect in the treatment of senile osteoporotic vertebral compression fracture with PKP.Methods: from October 2015 to September 2016, 90 patients (140 vertebrae) with complete imaging data and PKP surgical indications were selected.The age range of the patients was 65 to 81 years old and the range of vertebral involvement was T10-L 3.All the patients were divided into two groups according to different dosage of bone cement during operation: group A (20 patients with low dose bone cement 1-3ml) (group B: 20 patients with bone cement) (group B: 65 patients with normal dose of bone cement 3-6ml) (group C: 115 patients (group C: 5 patients with large dose of bone cement 6ml).According to intraoperative C-arm fluoroscopic monitoring, bone cement injection sites recorded in group A were divided into three groups: group A (the injection site was located at the upper 1 / 3 of the vertebral body) in 10 patients (group B) (50 patients were located in the midbody of the vertebral body) (group C, 100 vertebrae).Thirty patients (30 vertebrae) were treated with vertebral fracture line.According to the degree of diffusion of bone cement in thoracolumbar lateral X-ray films after operation, two groups were divided into two groups: group A (30 patients with bone cement not above the midline of vertebral body) (group B: 65 vertebrae) (60 patients with midline suture (75 vertebrae), 7 patients (10 vertebrae))A bone cement leak occurred.VAS scores were recorded and compared before operation, 1 day after operation and 1 month after operation.Results 90 cases (140 vertebrae) were successfully operated without serious complications, 7 cases with bone cement leakage, no clinical symptoms and complete relief of pain.There was no significant difference in VAS score between group A (low dose bone cement 1-3 ml) and group B (normal dose of bone cement 3-6 ml) and group C (large dose of bone cement 6 ml) at 1 day after operation and 1 month after operation (P 0.05), and there was no significant difference between the three groups on the first day after operation, and at 1 day after operation, there was no significant difference in VAS score between the three groups (P < 0.05).The VAS scores decreased significantly after 1 month compared with those before operation (P 0.05).For the bone cement injection site, group A (the injection site was at 1 / 3 of the vertebral body) and group B (the injection site was located in the middle of the vertebral body) group C (the injection site was located at the fracture line of the vertebral body), the three groups were treated 1 day after operation.There was no significant difference in VAS score at 1 month after operation (P 0.05).There was no significant difference in VAS score between group A and group A (the degree of bone cement dispersion was not above the midline of vertebrae) in group B (the degree of bone cement diffusion was over the midline of vertebral body) on the first day after operation (P 0.05).ConclusionWow-PKP can effectively relieve pain caused by osteoporotic vertebral compression fracture in the elderly, and the short-term analgesic effect is remarkable, but there is no significant difference in analgesic effect with different doses of bone cement injection.The extent of bone cement dispersion had no significant effect on postoperative pain relief.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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