纳米骨植入结合经皮微创固定治疗胸腰椎骨质疏松性骨折的临床研究

发布时间：2018-07-10 13:55

本文选题：纳米骨 + 经皮　；参考：《川北医学院》2015年硕士论文

【摘要】：目的:研究纳米骨植入结合经皮微创固定治疗胸腰椎骨质疏松性骨折的临床疗效,并与经皮椎体成型术治疗胸腰椎骨质疏松性骨折进行对比研究。方法:选取2012年3月至2014年6月48例胸腰椎骨质疏松性骨折,随机分为A、B组,其中A组为实验组,共20例,B组为对照组,共28例,A组的治疗方案为经伤椎椎弓根椎体内纳米骨植入同时经伤椎上下椎体微创椎弓根固定,B组的治疗方案为经伤椎椎弓根椎体内骨水泥注入,通过收集患者术前、术后、术后随访(随访时间为术后3月、6月、12月)临床资料,包括伤椎前缘高度、Cobb角变化、复查MRI术前术后对比了解相邻阶段椎间盘退变情况、病人疼痛改变。统计时采SPSS13.0统计软件建立数据库,分析时采用方法为伤椎高度改变、Cobb角变化、疼痛程度采用配对或非配对的t检验、方差分析(P0.05差异有统计学意义)。临床临床效果评价用Kruska1 Wallis检验。结果:1、实验组所有病例术后与术前椎体前缘高度相比有明显改变,与术前椎体前缘高度统计数据有明显差异(P0.05)。2、实验组所有病例术后与术前Cobb角相比较有获得明显改善,与术前Cobb角统计数据有明显差异(P0.05)。3、术后12月复查MRI,实验组和对照组在相邻节段椎间盘退变方面差异无统计学意义(P0.05)。4、实验组所有病例术前VAS评分与术后1周、3月、6月、12月VAS评分获得明显改变,其数据统计具有明显差异(P0.05)。5、实验组术后1年随访到20例,所有患者均行MRI检查,8例椎间盘出现退变,其余12例相邻节段椎间盘未出现明显加重的情况。6、对照组所有病例术前VAS评分与术后1周、3月、6月、12月VAS评分获得明显改善,术后与术前统计数据有明显差异(P0.05)。7、对照组术后1年随访到28例,所有28例患者均行MRI检查,与术前MRI检查相比较,有12例伤椎相邻阶段椎间盘出现退变明显加重情况。8、术后1周、3月、6月、12月复查影像学资料显示两组间在伤椎前缘高度改变、Cobb角改变方面比较有显著性差异(P0.05)。9、术前、术后1周、术后3月术后6月、术后12月两组VAS评分无显著差异(P0.05)。结论:纳米骨植入结合经皮微创固定与经伤椎椎弓根椎体内骨水泥置入相比较,同样具有创伤小、恢复快等优点,而且其在恢复椎体高度、改善Cobb角、防止椎体高度及Cobb角丢失方面具有明显的优势,是一种有效治疗胸腰椎骨质疏松性骨折方式。能否减缓邻近节段椎间盘退变需要大宗的病例以及中长期的随访。
[Abstract]:Objective: to study the clinical effect of nano-bone implantation combined with percutaneous minimally invasive fixation in the treatment of thoracolumbar osteoporotic fractures and compare it with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic fractures. Methods: from March 2012 to June 2014, 48 patients with osteoporotic fractures of thoracolumbar vertebrae were randomly divided into two groups: group A (experimental group) and group B (20 cases) as control group. A total of 28 patients in group A were treated by transpedicular bone implantation and minimally invasive pedicle fixation through the upper and lower vertebrae of the injured vertebrae. The patients were injected with bone cement in the pedicle of the injured vertebrae. The patients were collected before and after operation. All the patients were followed up for 3 months, 6 months and 12 months, including the changes of the anterior edge of the injured vertebrae and Cobb angle. SPSS 13.0 statistical software was used to establish the database. The method of analysis was used to change the Cobb angle of injured vertebra height, and the degree of pain was tested by paired or unpaired t-test. The variance analysis was significant (P0.05). The clinical efficacy was evaluated by Kruska1 Wallis test. Results all cases in the experimental group had significant changes after operation compared with the anterior height of the vertebral body before operation, and there was a significant difference between the statistical data of the height of the anterior edge of the vertebral body before operation (P0.05). All the cases in the experimental group were significantly improved compared with the preoperative Cobb angle after operation. There was significant difference between preoperative Cobb angle statistical data and preoperative Cobb angle statistical data (P0.05). 3 months after operation, there was no significant difference in adjacent segment disc degeneration between experimental group and control group (P0.05). The VAS score of all cases in experimental group was significantly higher than that in 1 week, 3 months and 6 months after operation. In December, VAS score was significantly changed, There was significant difference between the two groups (P0.05). The patients in the experimental group were followed up to 20 cases one year after operation. All the patients were examined by MRI in 8 cases with degeneration of intervertebral disc. In the control group, the VAS scores before operation and 1 week, 3 months, 6 months and 12 months after operation were significantly improved. There was a significant difference between postoperative and preoperative statistical data (P0.05). The control group was followed up to 28 cases one year after operation. All the 28 cases were examined by MRI, which was compared with that of preoperative MRI. There were 12 cases with severe degeneration of intervertebral disc in adjacent stage of injured vertebra. The imaging data of 1 week, 3 months, 6 months and 12 months after operation showed that there was a significant difference between the two groups in the change of anterior edge height of injured vertebrae and Cobb angle (P0.05). Before operation, 1 week after operation, there was a significant difference between the two groups in the change of anterior edge height and Cobb angle (P0.05). There was no significant difference in VAS score between the two groups 3 months after operation and 12 months after operation (P0.05). Conclusion: Nano-bone implantation combined with percutaneous minimally invasive fixation has the advantages of less trauma and faster recovery compared with bone cement implantation in the pedicle of injured vertebrae, and it can improve Cobb angle and restore the height of vertebral body. Prevention of vertebral height and Cobb angle loss has obvious advantages and is an effective treatment of thoracolumbar osteoporotic fracture. Mitigation of adjacent disc degeneration requires large numbers of cases and long-term follow-up.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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