单、双侧入路PKP治疗骨质疏松性椎体压缩骨折的疗效比较

发布时间：2018-05-10 13:56

本文选题：骨质疏松性胸腰椎压缩骨折 + 经皮球囊扩张椎体后凸成形术　；参考：《湖北中医药大学》2013年硕士论文

【摘要】：目的：骨质疏松症(Osteoporosis)是指骨矿物质成分和骨质等比例地不断减低，临床上以骨皮质变薄、骨小梁数量减少为病理特点，骨质脆性增加而容易并发骨折的一种全身骨代谢障碍性疾病。腰背部疼痛是其最常见的临床症状，，疼痛部位多在脊柱或脊柱两侧，卧床休息疼痛症状可以有所缓解，但是当腰部承受负重时，疼痛加重。骨折是骨质疏松症最为常见也是最严重的并发症，尤其以胸腰椎压缩性骨折（OVCF）为多见，骨折发生后，常出现脊柱和（或）脊柱两侧的弥漫性疼痛，脊柱的后凸畸形及功能障碍，严重影响着患者的健康状况及生活质量[1，2]。伴随着医疗技术的不断发展，经皮穿刺球囊扩张椎体后凸成形术（PKP）已逐渐成为目前治疗OVCF的首选方法，其微创的手术方法及显著的止痛效果被患者广泛接受，并使其在临床上迅速开展。许多专家学者就单、双侧入路的选择方面，以及不同的穿刺方式，对患者的疼痛缓解，脊柱功能和椎体后凸畸形的恢复，以及骨水泥用量，手术时间，骨水泥渗漏等方面，各有各的看法，未形成比较统一的认识，笔者通过对单侧与双侧入路PKP治疗OVCF的临床观察,分析两种手术操作方法的差异。资料与方法:回顾性分析笔者在湖北省中医院骨科实习期间(2010.10-2012.12)收治的采取PKP技术治疗的OVCF患者55例(女性35例,男性20例),年龄在56-92岁,平均年龄76.4岁，按手术方式的不同,随机分为单侧入路PKP组和双侧入路PKP组.其中单侧入路PKP组25例,共33个椎体；双侧入路PKP组30例,共30个椎体,比较两组在疼痛模拟症状VAS评分、椎体后凸角度（cobb角）、脊柱功能障碍指数（ODI）、手术时间、术中骨水泥用量、骨水泥渗漏等方面的差异。结果: 1.疼痛模拟症状VAS评分单侧入路PKP组:术前24小时VAS评分为(7.73±1.35)分，术后24小时VAS评分为(3.12±1.49)分，术后1月VAS评分为(3.03±1.48)分;手术前后比较VAS评分有统计学意义（p0.01），术后24小时与术后1月VAS评分比较无统计学意义（p0.05）。双侧入路PKP组:术前24小时为(7.63±1.43)分，术后24小时为(2.33±0.99)分,术后1月为(2.10±0.19)分,手术前后比较有统计学意义（p0.01），术后24小时与术后一月比较无统计学意义（p0.05）。 2.脊柱功能障碍评分单侧入路PKP组术后Oswestry评分为(11.52±1.49)。双侧入路PKP组术后Oswestry评分为(11.27±1.98)。两组功能障碍指数比较无统计学意义（t=0.567，p0.05）。 3.手术时间长短单侧入路PKP组手术时间为(50.82±6.17)分钟。双侧入路PKP组手术时间为(60.93±5.65)分钟。两组手术操作时间比较有统计学意义（t=6.762，p0.01）。 4.术中骨水泥用量单侧入路PKP组术中骨水泥用量为(2.96±0.92)毫升。双侧入路PKP组术中骨水泥用量为(3.79±0.98)毫升。两组术中骨水泥用量比较有统计学意义（t=3.490，p0.01）。 5.椎体后凸角度单侧入路PKP组术前为(16.36±4.05)°，术后24小时为(13.52±2.75)°，术后1月为(13.57±2.71)°。手术前后比较有统计学意义（p0.01），术后24小时与术后1月比较无统计学意义（p0.05）。双侧入路PKP组术前为(15.89±3.72)°，术后24小时为(13.63±2.73)°，术后1月为(13.65±2.72)°。手术前后比较有统计学意义（p0.05），术后24小时与术后1月比较无统计学意义（p0.05）。两组间手术前后比较无统计学意义（p0.05）。 6.骨水泥渗漏单侧入路PKP组33例中，发生渗漏3例，发生率为9.09%。双侧入路PKP组30例中，发生渗漏1例，发生率为3.33%。两组灌注剂渗漏情况比较有统计学意义（X2=0.88，p0.05）。结论:行单侧或双侧入路PKP手术都能有效缓解OVCF引起的疼痛症状，一定程度地恢复脊柱的后凸畸形，可有效改善患者的脊柱的功能，以及明显缓解骨折带来的疼痛症状，但单侧入路PKP组可以明显缩短手术时间、减少骨水泥用量；双侧入路PKP组骨水泥渗漏率稍偏低;两组各有各的优缺点，所以临床上需要仔细斟酌，根据不同的患者选择合理的穿刺方式。
[Abstract]:Objective: Osteoporosis (Osteoporosis) is a kind of systemic bone metabolic disorder, which is the most common clinical symptom, the pain site of the back is the most common bone mineral composition and bone and so on, with the thinner cortical bone, the reduction of the bone trabecular number as the pathological characteristic, the bone brittleness increases and the fracture is easy to be complicated. The rest of the spine and spine can be relieved on both sides of the spine, but the pain can be relieved in bed rest, but the pain increases when the waist is weighed. Fracture is the most common and most serious complication of osteoporosis, especially in the thoracic and lumbar compression fracture (OVCF), and the diffuse pain on the sides of the spine and / or spine often occurs after the fracture. The kyphosis and dysfunction of the spine seriously affect the health of the patients and the quality of life ([1,2].) with the continuous development of medical technology. Percutaneous balloon kyphoplasty (PKP) has gradually become the first choice for the treatment of OVCF, and its minimally invasive hand method and significant analgesic effect are widely accepted by the patient. Many experts and scholars have different views on the choice of the unilateral approach, the choice of bilateral approach, the relief of the pain of the patients, the recovery of spinal function and kyphosis, the dosage of bone cement, the time of operation, the leakage of bone cement and so on. Through the clinical observation of unilateral and bilateral PKP in the treatment of OVCF, the difference of the two operative methods was analyzed.
Materials and methods: a retrospective analysis of 55 cases of OVCF patients (35 women, 20 males) treated by PKP in the Department of orthopedics of Hubei Provincial Traditional Chinese Medical Hospital (2010.10-2012.12), aged 56-92 years old, with an average age of 76.4 years, were divided into unilateral approach PKP group and bilateral approach PKP group according to the different surgical methods. There were 25 cases in group PKP, with 33 vertebral bodies, 30 cases in group PKP with bilateral approach, and 30 vertebral bodies. The difference between the two groups in the pain simulated symptom VAS score, the kyphosis angle (Cobb angle), the spine dysfunction index (ODI), the operation time, the amount of bone cement during the operation and the leakage of bone cement were compared.
Result:
1. pain analogue symptom VAS score
Unilateral approach PKP group: 24 hours before operation VAS score (7.73 + 1.35), 24 hours VAS score (3.12 + 1.49), and January VAS score (3.03 + 1.48); before and after operation, VAS scores were statistically significant (P0.01), 24 hours after operation and postoperative VAS score after operation (P0.05). Bilateral approach PKP group: 24 hours preoperative (24 hours before operation) The score of 7.63 + 1.43), 24 hours after operation (2.33 + 0.99), (2.10 + 0.19) after operation, was statistically significant (P0.01) before and after operation (P0.05), and there was no statistical significance (P0.05) compared with the postoperative month after operation.
2. spinal dysfunction score
The Oswestry score of PKP group after unilateral approach was (11.52 + 1.49). The Oswestry score in group PKP after bilateral approach was (11.27 + 1.98). The two group dysfunction index was not statistically significant (t=0.567, P0.05).
3. the length of operation time
The operation time of the unilateral approach in group PKP was (50.82 + 6.17) minutes. The operation time of PKP group on bilateral approach was (60.93 + 5.65) minutes. The operation time of the two groups was statistically significant (t=6.762, P0.01).
The dosage of bone cement during the 4. operation
The amount of bone cement in the unilateral PKP group was (2.96 + 0.92) ml. The dosage of bone cement in group PKP was (3.79 + 0.98) milliliters in the bilateral approach. The two groups of bone cement in the two groups were statistically significant (t=3.490, P0.01).
5. vertebral kyphosis angle
The unilateral approach was (16.36 + 4.05) before operation (16.36 + 4.05), 24 hours after operation (13.52 + 2.75) degrees and (13.57 + 2.71) degrees in January. There was statistical significance before and after operation (P0.01). There was no statistical significance (P0.05) for 24 hours after operation (15.89 + 3.72) before operation in group PKP, and (13.63 + 2.73) degrees (13.63 + 2.73) after operation, and (1) after surgery in January. 3.65 + 2.72). There were statistical significance before and after operation (P0.05). There was no significant difference between the 24 hours after operation and January after operation (P0.05). There was no statistical significance before and after operation between the two groups (P0.05).
6. bone cement leakage
Among 33 cases of unilateral approach PKP group, 3 cases had leaking, the incidence of which was 30 cases in group PKP of 9.09%. bilateral approach, 1 cases had leakage, and the rate of occurrence rate of 3.33%. two group was statistically significant (X2=0.88, P0.05).
Conclusion: PKP operation with unilateral or bilateral approach can effectively relieve the symptoms of pain caused by OVCF and restore the kyphosis of the spine to a certain extent. It can effectively improve the function of the spinal column and obviously relieve the pain symptoms caused by the fracture, but the unilateral approach PKP group can obviously shorten the operation time and reduce the amount of bone cement; bilateral entry can be used. The leakage rate of bone cement in group PKP was slightly lower. The two groups had their own advantages and disadvantages, so they need careful consideration in clinical practice and choose reasonable puncture methods according to different patients.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R687.3

【共引文献】