骨质疏松性压缩骨折经皮穿刺椎体成形术后再骨折的相关危险因素分析

发布时间：2018-05-25 01:07

本文选题：骨质疏松性压缩骨折 + 经皮穿刺椎体成形术　；参考：《山东中医药大学》2015年硕士论文

【摘要】：目的:通过分析比较老年骨质疏松性脊椎压缩性骨折(osteoporosis vertebral compression fracture,OVCF)行经皮穿刺椎体成形术(Percutaneous Vertebroplasty,PVP)治疗后有或无发生再次骨折患者的相关资料,来探讨术后再骨折的发生机制及危险因素,以期降低其发生率,提高椎体成形术的进一步发展,从而提高临床疗效。方法:选取2013年04到2014年07月山东中医药大学脊柱骨科同一治疗组收治的骨质疏松性脊椎压缩骨折患者,共81例,其中男性16例,女性65例,年龄50~94岁,平均(73.56±8.73)岁,伤椎总数129个,其中胸椎58个,腰椎71个。采用回顾性研究的分析方法,根据临床资料及随访结果按术后是否发生再次骨折分为A组(非再骨折组)和B组(再骨折组),记录患者年龄、性别、原发骨折数目、骨折椎体部位、骨密度等一般资料,记录手术中骨水泥注入量、是否发生椎间隙渗漏、椎体高度恢复率、后凸角恢复角度、不同时间段VAS(视觉模拟评分)等手术相关因素,对以上因素进行统计学分析。结果:所有患者均成功完成手术,没有出现脊髓损伤及肺栓塞等严重并发症。有18例22个椎体出现非手术椎体再骨折,比率约为22%,间隔时间为1~24个月,平均(8.33±1.25)个月。骨水泥椎间渗透12例,为0.09%,渗漏后无临床症状发生。年龄、性别、骨折部位、椎体高度恢复率、后凸角恢复角度等因素在A组和B组之间差异无统计学意义(P0.05);术前及术后1周VAS评分在A组、B组组内比较有统计学意义(P0.05),终末随访VAS评分在两组间对比有统计学意义(P0.05),原发椎体数目、骨水泥注入量在A组和B组间有统计学意义(P0.05);骨密度在A组和B组间有显著统计学意义(P0.01)。结论:骨质疏松性压缩骨折患者行PVP治疗能取得良好的临床效果,再骨折好发于术后8个月内,低骨密度、原发椎体数目、骨水泥注入量是诱发再骨折的危险因素。
[Abstract]:Objective: to analyze and compare the data of patients with or without secondary fracture after percutaneous vertebroplasty and percutaneous vertebroplasty for osteoporotic vertebral compression fracture (OVCF) in elderly patients with osteoporotic vertebral compression fracture. To explore the mechanism and risk factors of postoperative refracture, in order to reduce its incidence, improve the further development of vertebroplasty, so as to improve the clinical efficacy. Methods: 81 patients with osteoporotic vertebral compression fractures were selected from the same treatment group in Department of Spine Orthopedics, Shandong University of traditional Chinese Medicine from 04 to July 2014, including 16 males and 65 females, aged 50 to 94 years, with an average age of 73.56 卤8.73 years. The total number of injured vertebrae was 129, including 58 thoracic vertebrae and 71 lumbar vertebrae. According to the clinical data and follow-up results, the patients were divided into two groups: group A (non-refracture group) and group B (refracture group). The patients' age, sex and number of primary fractures were recorded. The fracture vertebral body position, bone mineral density and other general data, recorded the amount of bone cement injection, whether the leakage of intervertebral space occurred, the recovery rate of vertebral body height, the angle of kyphosis recovery, the VAS (visual analogue score) in different time period, and so on. The above factors were analyzed statistically. Results: all patients successfully completed the operation without severe complications such as spinal cord injury and pulmonary embolism. Non-operative vertebral refracture occurred in 22 vertebrae of 18 cases, the ratio was about 22. The interval was from 124 months to 24 months, with an average of 8.33 卤1.25 months. There were 12 cases of bone cement intervertebral osmosis (0.09%). Age, sex, fracture site, vertebral height recovery rate, The recovery angle of kyphosis angle had no significant difference between group A and group B (P 0.05), and the VAS score was significantly higher in group A than that in group B 1 week after operation (P 0.05). The final follow-up VAS score was statistically significant between the two groups. P0.05, number of primary vertebrae, There was significant difference in bone cement injection between group A and group B (P 0.05) and bone mineral density (BMD) in group A and group B (P 0.01). Conclusion: PVP can obtain good clinical effect in patients with osteoporotic compression fracture. The risk factors of refracture are low BMD, number of primary vertebral body and cement injection.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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