过伸体位复位法结合PVP与PKP治疗骨质疏松椎体压缩骨折的临床疗效比较

发布时间：2018-06-27 16:08

本文选题：过伸体位复位法 + PVP　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:基于中医正骨复位理念,结合椎体成形术,比较过伸体位复位法结合经皮椎体成形术(percutaneous vertebroplasty,PVP)与经皮椎体球囊扩张后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果,观察其临床疗效、临床可行性及安全性,为OVCF的治疗提供可靠的理论支撑和相应的临床参考,试图为OVCF的患者寻求经济最优化、利益最大化的治疗措施。方法:选取2015年10月至2016年8月在广州中医药大学附属骨伤科医院和广州中医药大学第三附属医院两个院区的单节段胸腰段骨质疏松性椎体压缩性骨折的患者,用随机信封抽签的方法将符合实验纳入标准的70例患者分为试验组和对照组,每组各35例患者,试验组给予过伸体位复位法加PVP手术干预治疗,对照组则是选用PKP手术干预治疗,观察并记录两组患者的手术时间、住院天数、住院费用、骨水泥注入量、VAS评分、ODI指数、椎体前缘高度、椎体前缘高度恢复率、Cobb角、手术并发症和术后继发二次骨折,并对两组所有患者进行为期6m的随访。对不同时间点的组间和组内的各指标的差异进行统计学分析,比较两组治疗OVCF的疗效。结果:1)两组患者均顺利完成手术,术中未见骨水泥过敏,术后未见伤口感染、静脉栓塞等严重并发症。2)两组患者手术时间、住院天数、骨水泥注入量,经统计学分析,差异无统计学意义(P0.05)。3)试验组患者的住院费用为2.43±0.36万元,对照组的住院费用为3.74±0.22万元,经统计学分析,两组住院费用差异具有统计学意义(P0.05),认为试验组的住院费用低于对照组。4)试验组患者出现8例骨水泥渗漏,渗漏率为22.86%;对照组患者出现2例骨水泥渗漏,渗漏率为5.71%;两组患者渗漏率经统计学分析,差异具有统计学意义(P0.05),认为试验组的骨水泥渗漏率高于对照组。5)VAS和ODI评分方面,试验组和对照组分别在术前、术后1d、术后3m、术后6m进行组间比较时,差异不具有统计学意义(P0.05),两组患者不同时间点VAS和ODI评分改善组间比较不显著;而试验组和对照组分别在术后1d、术后3m、术后6m与术前进行组内比较时,差异具有统计学意义(P0.05),两组患者术前、术后相比,VAS和ODI评分改善显著,认为两种治疗方案均可以缓解患者疼痛、提高生活质量。6)椎体前缘高度、椎体前缘高度恢复率和Cobb角方面,试验组和对照组分别在术前、术后1d、术后3m、术后6m进行组间比较时,差异不具有统计学意义(P0.05),两组患者不同时间点椎体前缘高度、椎体前缘高度恢复率和Cobb角改善组间比较不显著;而试验组和对照组分别在术后1d、术后3m、术后6m与术前进行组内比较时,差异具有统计学意义(P0.05),两组患者术前、术后相比,椎体前缘高度、椎体前缘高度恢复率和Cobb角改善显著。7)对两组患者进行6m随访周期,两组患者均未见继发二次骨折。结论:过伸体位复位法结合PVP与PKP治疗OVCF患者时,疼痛改善和矫正后凸畸形效果相当。过伸体位复位法结合PVP既弥补了 PVP既往手术矫正后凸畸形不足的缺陷,又同样可以快速缓解患者疼痛、提高生活质量,达到和PKP 一样的手术疗效,且与PKP相比,费用更廉价,值得临床推广运用。
[Abstract]:Objective: to treat osteoporotic vertebral compression fracture (osteoporotic vertebral compression FR) with percutaneous vertebroplasty (PVP) and percutaneous vertebroplasty (PVP) and percutaneous vertebroplasty (percutaneous kyphoplasty, PKP) for the treatment of osteoporotic vertebral compression fracture (osteoporotic vertebral compression FR), based on the concept of orthopedics reduction and vertebroplasty with percutaneous vertebroplasty. Acture, OVCF) clinical effect, observe its clinical efficacy, clinical feasibility and safety, provide reliable theoretical support and corresponding clinical reference for the treatment of OVCF, try to seek economic optimization and maximization of treatment for OVCF patients. Methods: select the affiliated orthopedics department of Guangzhou University of Chinese Medicine from October 2015 to August 2016. Patients with single segment thoracolumbar osteoporotic vertebral compression fractures in two hospitals, Third Affiliated Hospitals of Guangzhou University of Chinese Medicine, were divided into experimental group and control group by random envelope drawing method. 70 patients in each group were divided into 35 patients in each group. The experimental group was given the hyperextension position reduction and PVP operation. In the control group, the control group was treated with PKP operation, and observed and recorded the operation time of two groups of patients, hospital days, hospitalization expenses, bone cement injection, VAS score, ODI index, height of vertebral front edge, height recovery rate of vertebral front edge, Cobb angle, operation complication and secondary two fractures after operation, and all patients in two groups were 6M The difference between the groups and the groups in different time points was statistically analyzed, and the curative effect of the two groups in the treatment of OVCF was compared. Results: 1) the two groups were successfully completed the operation, no bone cement allergy, no wound infection, venous embolism and other severe.2), the operation time, the number of days of hospitalization, and the bone cement were found in the two groups. According to statistical analysis, the difference was not statistically significant (P0.05).3) the hospitalization expenses of the patients in the experimental group were 2.43 + 3 thousand and 600 yuan, and the hospitalization expenses of the control group were 3.74 + 2 thousand and 200 yuan. The statistical analysis showed that the two groups of hospitalization expenses were statistically significant (P0.05), and the hospitalization expenses of the experimental group were lower than the control group.4) and the patients in the test group appeared 8. The leakage rate of bone cement was 22.86%, 2 cases of bone cement leakage occurred in the control group and the leakage rate was 5.71%. The leakage rate of the two groups was statistically significant (P0.05). The leakage rate of the bone cement in the experimental group was higher than that of the control group.5) VAS and ODI scores, the experimental group and the control group were respectively 1D and postoperative. After 3M, the difference was not statistically significant (P0.05), and there was no significant difference between the two groups at different time points of VAS and ODI. The difference between the experimental group and the control group was statistically significant (P0.05) in the postoperative 1D, postoperative 3M, postoperative 6m and preoperative group (P0.05), and the two groups were preoperatively and postoperatively. VAS and ODI scores were improved significantly. It was considered that the two treatments could relieve the pain of the patients, improve the quality of life (.6), the height of the vertebral body, the recovery rate of the anterior edge of the vertebral body and the angle of Cobb. The difference between the experimental group and the control group was not statistically significant (P0.05), and the difference was not statistically significant (P0.05), the difference between the group and the control group before the operation of 1D, postoperative 3M, and postoperative 6m (P0.05). The height of the anterior edge of the vertebral body at different time points, the height recovery rate of the anterior edge of the vertebral body and the improvement of the Cobb angle were not significant, but the difference was statistically significant between the experimental group and the control group at 1D, 3M after operation, and the comparison between the 6m and the preoperative group (P0.05). The two groups were compared with the height of the vertebral anterior margin and the height of the anterior edge of the vertebral body. The recovery rate and Cobb angle improved significantly.7) two groups of patients were followed up with 6m follow-up period, and no two secondary fractures were found in the two groups. Conclusion: the hyperextension position reduction combined with PVP and PKP in the treatment of OVCF patients, the pain improvement and the correction of kyphotic deformity are equal. The hyperextension position reduction combined with PVP not only compensates for the previous postoperative corrective kyphotic deformity of PVP. Foot defects can also quickly relieve the pain, improve the quality of life, and achieve the same effect as the PKP, and compared with PKP, the cost is cheaper, it is worthy of clinical application.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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