骨质疏松椎体压缩骨折不愈合影像学特点及手术治疗方案选择

发布时间：2018-04-27 22:51

  本文选题：骨质疏松 + 椎体压缩骨折　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的探讨骨质疏松导致的椎体压缩骨折不愈合的临床特点及骨质疏松椎体压缩骨折不愈合的影像学分期对手术治疗方法的指导作用。方法本研究纳入自2009年1月至2015年12月青岛大学附属医院收治的骨质疏松椎体压缩骨折不愈合的患者共53例,其中男性5例,女性48例,年龄50-86岁(平均70.2岁)。所有患者均具有完整的临床及影像学资料。通过回顾性分析所有患者的临床及影像学资料,总结骨质疏松椎体压缩骨折不愈合的影像学特点,并根据不同的影像学特点对所有患者进行分期,确定不同手术方案。测量并统计术前、术后及末次随访时病变椎体前后缘高度、椎体楔形变角度、椎体Cobb角的变化及VAS评分并进行统计学分析评价手术治疗效果。结果本研究中共有53个病变椎体发生不愈合,病变椎体主要集中在T12、L1水平(共39椎,占73.6%),椎体内可见真空裂隙征共21例(39.6%),椎体内可见液体信号者共26例(49.1%),椎体内无真空裂隙征及液体征但可见骨折线硬化者共6例(11.3%),开口征阳性者共8例(15.1%)。椎体压缩骨折不愈合累及上终板者共37例,累及上终板及下终板者共12例,累及下终板者4例。病变椎体临近椎间盘有真空现象者14例,其中1例椎间盘真空与骨折椎体裂隙相通。根据Li等关于骨质疏松椎体压缩性骨折不愈合的分型将所有病变椎体进行分期,其中Ⅰ期11例,Ⅱ期16例,Ⅲ期26例。所有Ⅰ期、Ⅱ期患者均行PVP或PKP治疗,其中13例行PVP治疗,14例行PKP手术;Ⅲ期患者由于病变累及椎体后壁,动力位像可见脊柱不稳,行开放手术治疗。所有患者手术顺利,术后未出现神经症状加重。5例行PVP及PKP的患者出现骨水泥泄露,其中PVP组3例,PKP组2例,3例向椎体前方泄露,2例向椎间隙泄露,末次随访未见骨水泥移位。所有行PVP、PKP及开放手术治疗的患者,术前VAS评分、椎体前缘高度、椎体楔形角度及Cobb角与术后三天相比有统计学差异,术前椎体后缘高度与术后三天相比差异无统计学意义,术后三天与末次随访时上述指标差异无统计学意义,行PVP或PKP手术治疗的患者在VAS评分、骨折椎体前后缘高度、椎体楔形角度及Cobb角改善方面无明显差异,开放组所需手术时间明显长于PVP及PKP组。结论骨质疏松椎体压缩骨折不愈合主要发生在胸腰段结合处(T12、L1),影像学常见真空裂隙征、液体征及硬化的骨折线,对于确诊椎体压缩骨折不愈合具有很好的指导意义。Li等对椎体压缩骨折不愈合分型对选择手术方案具有很好的临床指导作用,Ⅰ及Ⅱ期患者采取PVP或PKP手术可取得满意的手术效果,但是术中存在骨水泥泄漏的风险,需要在临床实践中引起重视。Ⅲ期患者术前常存在脊柱不稳甚至神经损害症状,多数需要进行固定融合。
[Abstract]:Objective to investigate the clinical features of nonunion of vertebral compression fractures caused by osteoporosis and the guiding effect of imaging stages of nonunion of osteoporotic vertebral compression fractures on surgical treatment. Methods from January 2009 to December 2015, 53 cases of osteoporotic vertebral compression fracture nonunion were admitted to the affiliated Hospital of Qingdao University, including 5 males and 48 females, aged 50-86 years (mean 70.2 years). All patients had complete clinical and imaging data. The clinical and imaging data of all patients were analyzed retrospectively, and the imaging features of nonunion of osteoporotic vertebral compression fracture were summarized. According to the different imaging characteristics, all patients were divided into stages and different operative schemes were determined. The anterior and posterior height of the lesion vertebral body, the angle of vertebral wedge change, the changes of vertebral Cobb angle and the VAS score were measured and counted before, after and at the last follow-up. The effect of operation was evaluated statistically. Results in this study, 53 diseased vertebrae had nonunion, and the diseased vertebrae were mainly located at T12L 1 level (39 vertebrae). There were 21 cases with vacuum fissure sign in vertebral body, 26 cases with fluid signal in vertebral body, 6 cases with no vacuum fissure sign and liquid sign but 6 cases with osseous sclerosis, and 8 cases with positive opening sign. There were 37 cases of nonunion of vertebral body compression fracture involving upper endplate, 12 cases of upper endplate and inferior endplate, and 4 cases of lower endplate. There were 14 cases with vacuum in the adjacent intervertebral disc, in which 1 case was connected with fracture fracture. According to Li et al.'s classification of nonunion of osteoporotic vertebral body compression fracture, all the lesions were divided into stages, including 11 cases of stage 鈪，

本文编号：1812685