经皮椎体成形术与保守方法治疗骨质疏松性椎体压缩骨折的临床疗效比较

发布时间：2018-05-15 12:29

本文选题：椎体成形术 + 椎体压缩骨折　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:比较分析经皮椎体成形术(percutaneous vertebroplasty,PVP)与保守方法治疗有症状的骨质疏松性椎体压缩骨折(OVCF)的临床疗效分析。方法:回顾性分析2013年02月至2014年02月在福建省泉州市第一医院骨科因骨质疏松性脊柱骨折接受治疗的143例患者的临床资料。根据治疗方法分为PVP组和保守组。对患者进行入院时、手术后(1-3天)、手术后3个月、手术后6个月、手术后1年的疗效评估,每个时间点的评估均采用视觉模拟评分量表(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry Disability index,ODI)2种方法。随访1年,比较分析两组随访结果并作统计学分析。结果:1共有143例患者符合纳入标准,剔除死亡及失访患者13例,共120患者完成1年随访。其中保守组75例,PVP组55例。在PVP组患者中有1例发生骨水泥椎间隙渗漏,无明显临床症状。2 VAS评分:保守组的VAS评分入院时、术后(1-3天)、术后3个月、术后6个月、术后1年分别为(7.51±1.21)、(6.24±1.20)、(3.53±1.20)、(2.79±1.09)、(2.28±0.97)。保守组入院时和术后(1-3天)的VAS评分与术后3个月、术后6个月、术后1年的VAS评分差异有统计学意义(P0.05)。PVP组的VAS评分入院时、术后(1-3天)、术后3个月、术后6个月、术后1年分别为(7.40±1.03)、(3.56±0.96)、(2.69±1.14)、(2.58±0.94)、(2.40±1.10)。PVP组术后(1-3天)、术后3个月、术后6个月、术后1年的VAS评分,较入院时VAS评分差异存在统计学意义(P0.05)。入院时两组间的VAS评分差异无统计学意义(P0.05)。在术后(1-3天)、和术后3个月随访中的VAS评分,两组存在差异存在统计学意义(P0.05);两组在术后6个月和术后1年随访中的VAS评分差异均无统计学意义(P0.05)。3 ODI指数:保守组的ODI指数入院时、术后(1-3天)、术后3个月、术后6个月、术后1年分别为(75.23±6.80)、(73.96±6.39)、(47.88±5.77)、(41.00±6.43)、(31.23±6.86)。保守组入院时和术后(1-3天)的ODI指数与术后3个月、术后6个月、术后1年的ODI指数差异有统计学意义(P0.05)。PVP组的ODI指数入院时、术后(1-3天)、术后3个月、术后6个月、术后1年分别为(73.01±7.34)、((48.77±5.99)、(43.92±5.17)、(39.60±6.51)、(32.32±7.67)。PVP组术后(1-3天)、术后3个月、术后6个月、术后1年的ODI指数,较入院时ODI指数差异存在统计学意义(P0.05)。入院时两组间的ODI指数差异无统计学意义(P0.05)。在术后(1-3天)、和术后3个月随访中的ODI指数,两组存在差异存在统计学意义(P0.05);两组在术后6个月和术后1年随访中的ODI指数差异均无统计学意义(P0.05)。4本研究结果表明:PVP治疗组在术后3个月内的随访VAS评分、ODI指数明显低于保守组,差异存在统计学意义(P0.05)。结论:PVP治疗和保守方法两种方法均可以有效的治疗OVCF。但PVP治疗OVCF患者,具有创伤小、操作简便、手术时间短等特,能够早期快速有效减轻患者痛苦、增加椎体骨强度、提高椎体稳定性,从而使患者早期恢复活动功能,提高生活质量,减少并发症的发生和病死率。
[Abstract]:Objective: to compare and analyze the clinical effects of percutaneous vertebroplasty (PVP) and conservative method in the treatment of symptomatic osteoporotic vertebral compression fractures (OVCFCs). Methods: the clinical data of 143 cases of osteoporotic spinal fractures treated in the Department of Orthopaedics, Quanzhou first Hospital, Fujian Province from February 2013 to February 2014 were retrospectively analyzed. According to the treatment method, the patients were divided into PVP group and conservative group. On admission, 1 to 3 days after operation, 3 months after operation, 6 months after operation and 1 year after operation, the patients were evaluated by visual analogue scale (VASL) and Oswestry dysfunction index (Oswestry Disability index ODI). Follow-up 1 year, the two groups were compared the results of follow-up and statistical analysis. Results one hundred and thirty three patients met the inclusion criteria, 13 patients were excluded from death and lost visits, and 120 patients were followed up for one year. There were 75 cases in conservative group and 55 cases in PVP group. In the PVP group, there was one case with bone cement leakage with no obvious clinical symptoms. The VAS score of the conservative group was 1 to 3 days after admission, 3 months after operation, 6 months after operation, and 1 year after operation. The scores of VAS in conservative group were 7.51 卤1.21, 3.53 卤1.20, 2.79 卤1.09 and 2.28 卤0.97, respectively. The VAS score of the conservative group was significantly different from that of 3 months after operation, 6 months after operation and 1 year after operation. There were significant differences in VAS score of the conservative group on admission, 1-3 days after operation, 3 months after operation and 6 months after operation, and there was a significant difference in VAS score between 3 months and 6 months after operation in the conservative group at admission, 3 months after operation, 6 months after operation, and 1 to 3 days after operation. At 1 year after operation, the VAS scores in the group of 3.56 卤0.96 and 2.69 卤1.14 were 2.58 卤0.94 and 2.40 卤2.40 卤1.10).PVP, respectively. The VAS scores of 3 months, 6 months and 1 year after operation were significantly higher than those at admission (P 0.05). There was no significant difference in VAS score between the two groups at admission (P 0.05). VAS scores were measured at 1 to 3 days after operation and 3 months after operation. There were significant differences in VAS scores between the two groups at 6 months after operation and 1 year after operation, and there was no significant difference in VAS scores between the two groups. The index of ODI in the conservative group was 1-3 days after admission, 3 months after operation, 6 months after operation, 3 days after admission, 6 months after operation, 3 days after admission, 3 months after operation, 6 months after operation, and 1 to 3 days after operation in the conservative group. At one year after operation, 75.23 卤6.80 were 73.96 卤6.39, 47.88 卤5.77, 41.00 卤6.43, 31.23 卤6.86, respectively. The ODI index of conservative group was significantly different from that of 3 months after operation, 6 months after operation and 1 year after operation. There were significant differences in ODI index between 3 days after admission, 3 months after operation, 6 months after operation, and 1 to 3 days after operation, and 6 months after operation in the conservative group at admission, 3 months after operation and 6 months after operation, and 1 to 3 days after admission, 3 months after operation and 6 months after operation. At one year after operation, the ODI index in the group of 39.60 卤6.51 and 32.32 卤7.67).PVP was 73.01 卤7.34, 48.77 卤5.99, 39.60 卤6.51 and 32.32 卤7.67).PVP, respectively, and the ODI index of 3 months, 6 months and 1 year after operation was significantly higher than that at admission (P 0.05). There was no significant difference in ODI index between the two groups at admission (P 0.05). The ODI index was measured at 1-3 days after operation and 3 months after operation. There was no significant difference in ODI index between the two groups in 6 months after operation and 1 year after operation. The results of this study showed that the follow-up VAS score of the treatment group at 3 months after operation was similar to that of the control group. The number was significantly lower than that in the conservative group. The difference was statistically significant (P 0.05). Conclusion both the treatment of PVP and the conservative method can effectively treat OVCF. However, the treatment of OVCF by PVP has the advantages of small trauma, simple operation and short operation time. It can reduce the pain of patients quickly and effectively, increase the bone strength of vertebral body, improve the stability of vertebral body, and make the patients recover the function of movement in the early stage. Improve the quality of life, reduce the incidence of complications and mortality.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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