垫枕练功法配合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的临床对比研究

发布时间：2018-04-18 18:57

本文选题：骨质疏松性椎体压缩性骨折 + 垫枕练功法　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:对比研究垫枕练功法配合经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的中短期疗效及并发症,为临床选择经济、安全、有效的OVCF的治疗方法提供一定的依据。方法:回顾性分析2014年10月~2016年3月西南医科大学附属中医医院骨伤科收治的57例OVCF患者,按治疗方法分成A、B两组,A组26例采用垫枕练功法配合PVP治疗,B组31例采用PKP治疗。所有患者入院时、术前及术后3天、1月、3月、6月、12月进行疼痛视觉模拟评分(Visual Analogue Scale VAS),定期拍摄X片,测算患者入院时、术前及术后3天、1月、3月、6月、12月的伤椎椎体高度丢失率及后凸Cobb角,术中观察记录骨水泥渗漏情况,术后随访患者伤椎邻近椎体骨折情况,统计分析两组的一般资料、术后的一般情况、组内不同治疗时间点以及组间相同治疗时间点各研究指标的变化情况。结果:1.一般资料比较:两组年龄、性别、病程、伤椎压缩程度比较无统计学差异(P㧐0.05),研究具有可比性。2、术后一般情况比较:A组骨水泥注入量、手术时间、住院费用明显低于B组,差异有统计学意义(P㩳0.01);住院时间A组明显长于B组,差异有统计学意义(P㩳0.01)。3.vas评分比较:两组入院时比较无统计学差异(p㧐0.05);两组术后各时间点与术前及入院时比较vas评分均明显降低(p㩳0.01);术后各时间点组间比较vas评分无统计学差异(p㧐0.05)。4.椎体高度丢失率比较:两组入院时比较无统计学差异(p㧐0.05);a组术前与入院时比较椎体高度丢失率明显改善(p㩳0.01),a组术前及术后各时间点之间比较无统计学差异(p㧐0.05);b组入院时与术前比较无统计学差异(p㧐0.05),术后各时间点与术前比较椎体高度丢失率有明显改善(p㩳0.01),b组术后1月、3月、6月、12月与术后3天比较伤椎高度有一定的再次丢失(p㩳0.01),b组术后1月、3月、6月、12月之间两两比较无统计学差异(p㧐0.05)。5.后凸cobb角比较:两组入院时比较无统计学差异(p㧐0.05);a组术前与入院时比较cobb角有明显改善(p㩳0.01),a组术前及术后各时间点之间比较无统计学差异(p㧐0.05);b组入院时与术前比较无统计学差异(p㧐0.05),术后各时间点较术前cobb角有明显改善(p㩳0.01),b组术后1月、3月、6月、12月与术后3天比较cobb角有一定的继发增大(p㩳0.01),b组术后1月、3月、6月、12月之间两两比较无统计学差异(p㧐0.05)。6.骨水泥渗漏率比较:a组为12.50%(4/32),b组为17.95%(7/39),两组比较无统计学差异(p㧐0.05)。7.术后邻椎骨折发生率比较:a组为11.54%(3/26),b组为16.13%(5/31),两组比较无统计学差异(p㧐0.05)。结论:垫枕练功法配合pvp与pkp治疗ovcf均能有效地缓解疼痛、恢复伤椎高度、矫正后凸畸形,垫枕练功法配合pvp较pkp的优势在于治疗费用低、手术时间短、术后椎体高度及后凸cobb角无明显继发性改变,垫枕练功法配合PVP是治疗OVCF的一种经济、安全、有效的治疗方法。
[Abstract]:Objective: to compare the short and medium term effects and complications of pillow exercise combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture.Effective treatment of OVCF provides some basis.Methods: from October 2014 to March 2016, 57 patients with OVCF in the Department of Orthopedics and Trauma, affiliated traditional Chinese Medicine Hospital of Southwest Medical University, were analyzed retrospectively. According to the treatment method, the patients in group A were divided into two groups: group A (n = 26) treated with pillow exercises combined with PVP, group B (n = 31) were treated with PKP.Visual Analogue Scale vas (VAS) were assessed before admission, 3 days, 1 month, 3 months, 6 months and 12 months after admission.Three days, one month, three months, six months and twelve months after operation, the rate of loss of vertebral body height and the Cobb angle of kyphosis were observed and recorded during operation. The patients were followed up after operation. The general data of the two groups were statistically analyzed.The changes of the indexes of different treatment time points and the same treatment time points after operation.The result is 1: 1.Comparison of general data: there was no significant difference in age, sex, course of disease, degree of compression of injured vertebrae between two groups (P < 0.05). The study was comparable .2.The general situation after operation was significantly lower than that of group B in terms of the amount of bone cement injected, the time of operation, and the cost of hospitalization.The difference was statistically significant (P < 0.01), the length of hospitalization in group A was longer than that in group B.The difference was statistically significant (P < 0.01). 3. Vas scores: there was no significant difference between the two groups on admission, the vas scores at each time point after operation were significantly lower than those before operation and on admission, and there was no significant difference in vas scores between the two groups at different time points after operation.Comparison of vertebral height loss rate: there was no statistical difference between the two groups on admission. There was no significant difference in the loss rate of vertebral height between the two groups before and after admission. There was no significant difference between the two groups at the time points before and after operation.There was no significant difference between before and after operation. The loss rate of vertebral height at each time point after operation was significantly improved compared with that before operation. In group B, there was a certain loss of vertebral height in 1 month, 3 months, 6 months, 12 months and 3 days after operation.There was no statistical difference between January, March, June and December.Comparison of kyphosis cobb angle: there was no statistical difference between the two groups on admission. There was no significant difference in cobb angle between the two groups before and after admission. There was no statistical difference between the two groups at the time points before and after operation.Compared with the preoperative cobb angle, there was no significant difference in the postoperative cobb angle between the two groups (P 0.05, P 0.05, P 0.05, P 0.05), and there was no significant difference between the two groups (p 0.05U. 6) in comparison with the preoperative cobb angle in 1 month, 3 months, 6 months, 12 months and 3 days after operation.The ratio of bone cement leakage was 12.50% in group A and 17.95% in group B (17.95%). There was no statistical difference between the two groups.The incidence of postoperative vertebral fracture was 11.54% in group A and 16.13% in group B (16.13%). There was no significant difference between the two groups in the incidence of vertebral fracture. There was no statistical difference between the two groups.Conclusion: pillow exercises combined with pvp and pkp can effectively relieve pain, recover the height of injured vertebrae and correct kyphosis deformity. The advantage of pillow exercise combined with pvp is that the treatment cost is lower and the operation time is short.There were no obvious secondary changes in vertebral height and kyphosis cobb angle after operation. Pillow exercise combined with PVP was an economical, safe and effective treatment for OVCF.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】