PVP、PKP术后非手术椎体再发骨折的相关因素分析
发布时间：2018-08-07 11:53
【摘要】：目的：本文探讨经皮椎体成形术(percutaneous vertibroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)术后非手术椎体再发骨折的发生率及相关的危险因素。旨在对其相关因素进一步剖析,并比较邻近节段与非邻近节段椎体再骨折的异同,为临床提供参考,同时研究补肾活血中药对于预防新发椎体骨折的作用,指导临床用药。方法：本研究回顾采纳了2009年1月～2013年12月广州中医药大学第二附属医院(广东省中医院)收治的发生于胸腰段椎体的压缩性骨折并行单节段PVP/PKP治疗的患者的基本信息、病例、手术及影像学等资料。根据术后是否再发非手术节段的椎体骨折,分为骨折组及非骨折组；再根据再发骨折的椎体节段分为相邻椎体组及远隔椎体组。通过对所有患者年龄、性别、骨水泥注入量、椎体局部后凸纠正角度、手术方式(PVP/PKP)、手术椎体节段、有否骨水泥外渗、围手术期有否行抗骨质疏松治疗、有否予补肾活血中药等的统计和计算,计数资料采用χ2检验,计量资料采用独立样本t检验,并将有统计学意义(P0.05)的指标纳入多因素Logistic回归分析,得出术后非手术椎体再发骨折的相关危险因素。数据用SPSS 19.0统计软件处理分析,以P0.05为差异有统计学意义,PO.01为差异有明显统计学意义。结果：本研究共纳入行PVP/PKP术的患者452例,随访时间12-62个月。平均29.82±11.94个月,其中女性359例,男性93例,年龄49-93岁,平均74.98±8.42岁,其中71～80岁所占比例最高(45%)。行PVP术211例,行PKP术241例。发生骨水泥外渗116例,占25.7%。骨水泥注入量1.2-7.2ml,平均3.56±0.95ml。术前原椎体局部后凸Cobb's角-31.70°-48.73°,平均11.08°±11.73°,术后伤椎局部后凸Cobb's角-30.86°～40.53°,平均6.11°±11.31°。伤椎局部后凸Cobb's角纠正角度-3.08。-14.85°,平均4.97°±2.35°。围手术期予行抗骨质疏松治疗的397例,占87.8%,予补肾活血中药口服的333例,占73.7%。术后发生非手术椎体再发骨折共64例,包括男性12例,女性52例,发病率14.2%,再发骨折时间1-53个月,平均14.56±11.46个月。未发生骨折的共388例患者。骨折组与非骨折组在性别、年龄、随访时间、术前伤椎局部后凸角、手术方式(PVP/PKP)、手术椎体节段、骨水泥注入量等方面比较,差异无统计学意义(P0.05)。骨折组在骨水泥外渗发生率方面明显高于非骨折组(P0.01),而非骨折组在围手术期,抗骨质疏松药物及补肾活血中药的使用率方面明显高于骨折组。二组在术后伤椎局部后凸Cobb's角纠正角度方面差异存在统计学意义(P0.05),骨折组大于非骨折组。多因素分析结果显示发生骨水泥外渗、术后未予抗骨质疏松治疗及补肾活血中药口服、伤椎局部后凸Cobb's角纠正过度是术后再发椎体骨折的危险因素。骨折组中,相邻椎体组与远隔椎体组在发生率、性别、年龄、再发骨折时间、术前伤椎局部后凸角、手术方式(PVP/PKP)、骨水泥注入量、骨水泥外渗、抗骨质疏松药物及补肾活血中药的使用率等方面比较,差异无统计学意义(P0.05)。相邻椎体组在局部后凸Cobb's角纠正角度方面大于远隔椎体组,二者存在统计学差异(P0.05)。两种手术方式相比,行PKP术的患者伤椎局部后凸Cobb's角纠正较行PVP术的患者明显,而在骨水泥外渗的发生及再发骨折时间方面,两种手术方式差异无统计学差异。结论：造成PVP、PKP术后非手术椎体再发骨折的危险因素有很多,本研究结果显示,发生骨水泥外渗、伤椎局部后凸Cobb's角纠正过度、围手术期无行抗骨质疏松治疗等均明显提高其发生率。另外术后围手术期予补肾活血中药可降低术后非手术椎体的再发骨折率。为了更好地预防非手术椎体再发骨折。医生应掌握其相关的危险因素,术中避免骨水泥外渗的发生,对于伤椎局部后凸角的纠正不必过于强调,围手术期注意抗骨质疏松药物的治疗。此外,应重视中医药在其中的运用,可予补肾活血中药预防再发椎体骨折,中西医结合治疗,以提高医疗质量。
[Abstract]:Objective: To investigate the incidence and risk factors of non operative vertebral fractures after percutaneous vertebroplasty (percutaneous vertibroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP), to further analyze the related factors and to compare the re fractures between adjacent segments and non adjacent segments. The effect of tonifying kidney and activating blood Chinese medicine on prevention of new vertebral fracture and guiding clinical use. Methods: This study reviewed and adopted the compression fracture parallel to the thoracolumbar vertebral body from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Traditional Chinese Medical Hospital) from January 2009 to December 2013. Basic information, case, surgery, and imaging data for patients with segmental PVP/PKP treatment. The vertebral fractures were divided into fracture groups and non fracture groups according to the postoperative vertebral fractures of non operative segments, and the vertebral segments of the recurrent fractures were divided into adjacent vertebra group and distant vertebra group. The age, sex, and cement injection of all patients were measured. The correction angle of vertebral local kyphosis, operation mode (PVP/PKP), vertebral segment, bone cement extravasation, anti osteoporosis treatment during the perioperative period, statistics and calculation of tonifying kidney and activating blood, using chi 2 test, measuring data using independent sample t test, and incorporating statistical significance (P0.05) index into Multiple factor Logistic regression analysis, the related risk factors of non operative vertebral fracture after operation were obtained. The data were analyzed with SPSS 19 statistical software, and the difference of P0.05 was statistically significant. The difference of PO.01 was statistically significant. Results: 452 cases of PVP/PKP were enrolled in this study, and the follow-up time was 12-62 months. The average was 29.8. 2 + 11.94 months, of which 359 Cases of women, 93 males, 49-93 years old, average 74.98 + 8.42 years, among which the proportion of 71~80 years was the highest (45%). 211 cases of PVP were performed, 241 cases were performed by PKP. Cement extravasation occurred in 116 cases, accounting for 25.7%. bone cement injection amount 1.2-7.2ml, average 3.56 + 0.95ml. preoperative vertebral local kyphosis Cobb's angle -31.70 degree -48.73 degrees, averaging 11 .08 degree + 11.73 degrees, the local kyphosis Cobb's angle of the injured vertebra was -30.86 degree to 40.53 degree, mean 6.11 degree 11.31 degree. The local kyphosis Cobb's angle of the injured vertebra was corrected to -3.08.-14.85 degrees, averaging 4.97 + 2.35 degrees. 397 cases of anti osteoporosis treatment were performed in perioperative period, accounting for 87.8%. There were 64 cases of fracture, including 12 men, 52 women, 14.2%, 1-53 months of fracture, an average of 14.56 + 11.46 months. There were 388 patients without fracture. The fracture group and non fracture group were in sex, age, follow-up time, local posterior convex angle, PVP/PKP, vertebral segment, bone cement injection, and so on. There was no statistical difference between the two groups (P0.05). The incidence of bone cement extravasation in fracture group was significantly higher than that in non fracture group (P0.01), but in the non fracture group, the use of anti osteoporosis drugs and tonifying kidney and activating blood Chinese medicine was significantly higher than that in the fracture group. The difference between the two groups in the correction angle of the local kyphosis Cobb's angle after the operation was different. In statistical significance (P0.05), the fracture group was larger than the non fracture group. The results of multiple factors analysis showed that the bone cement exoskosoosis occurred, the treatment of osteoporosis and the oral administration of tonifying kidney and activating blood were not taken after the operation. The local kyphosis Cobb's angle correction was the risk factor for the fracture of the vertebral body after the operation. There was no significant difference in the rate of birth, sex, age, recurrent fracture time, local posterior convex angle of the vertebral body, operation mode (PVP/PKP), bone cement injection, bone cement extravasation, the use of anti osteoporosis drugs and traditional Chinese medicine for invigorating kidney and activating blood (P0.05). The correction angle of the adjacent vertebra group in the local kyphosis Cobb's angle was greater than that of the distant vertebra. There was a statistical difference between the two groups (P0.05). Compared with the two surgical methods, the local kyphosis Cobb's angle correction of the injured vertebrae in the patients with PKP was more obvious than that of the patients with PVP, but there was no difference between the two kinds of surgical methods in the occurrence of bone cement exoskosis and the time of re fracture. Conclusion: cause PVP, the non operative vertebral body redevelopment after PKP operation. There are many risk factors of fracture. The results of this study show that the occurrence of bone cement extravasation, the correction of the local kyphosis Cobb's angle of the injured vertebra excessively, and the absence of anti osteoporosis in the perioperative period all obviously improve the incidence of the fracture. Non operative vertebral fractures. Doctors should master the related risk factors, avoid the occurrence of bone cement extravasation during the operation, do not emphasize the correction of the local posterior convex angle of the injured vertebra, and pay attention to the treatment of anti osteoporosis drugs in the perioperative period. In addition, we should pay attention to the use of traditional Chinese medicine in the operation, and can prevent the redevelopment of vertebra bone with Chinese traditional Chinese medicine for invigorating kidney and blood. Combination of traditional Chinese and Western medicine treatment, in order to improve the quality of medical treatment.
【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】：2015
【分类号】：R687.3
本文编号：2169938
[Abstract]:Objective: To investigate the incidence and risk factors of non operative vertebral fractures after percutaneous vertebroplasty (percutaneous vertibroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP), to further analyze the related factors and to compare the re fractures between adjacent segments and non adjacent segments. The effect of tonifying kidney and activating blood Chinese medicine on prevention of new vertebral fracture and guiding clinical use. Methods: This study reviewed and adopted the compression fracture parallel to the thoracolumbar vertebral body from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Traditional Chinese Medical Hospital) from January 2009 to December 2013. Basic information, case, surgery, and imaging data for patients with segmental PVP/PKP treatment. The vertebral fractures were divided into fracture groups and non fracture groups according to the postoperative vertebral fractures of non operative segments, and the vertebral segments of the recurrent fractures were divided into adjacent vertebra group and distant vertebra group. The age, sex, and cement injection of all patients were measured. The correction angle of vertebral local kyphosis, operation mode (PVP/PKP), vertebral segment, bone cement extravasation, anti osteoporosis treatment during the perioperative period, statistics and calculation of tonifying kidney and activating blood, using chi 2 test, measuring data using independent sample t test, and incorporating statistical significance (P0.05) index into Multiple factor Logistic regression analysis, the related risk factors of non operative vertebral fracture after operation were obtained. The data were analyzed with SPSS 19 statistical software, and the difference of P0.05 was statistically significant. The difference of PO.01 was statistically significant. Results: 452 cases of PVP/PKP were enrolled in this study, and the follow-up time was 12-62 months. The average was 29.8. 2 + 11.94 months, of which 359 Cases of women, 93 males, 49-93 years old, average 74.98 + 8.42 years, among which the proportion of 71~80 years was the highest (45%). 211 cases of PVP were performed, 241 cases were performed by PKP. Cement extravasation occurred in 116 cases, accounting for 25.7%. bone cement injection amount 1.2-7.2ml, average 3.56 + 0.95ml. preoperative vertebral local kyphosis Cobb's angle -31.70 degree -48.73 degrees, averaging 11 .08 degree + 11.73 degrees, the local kyphosis Cobb's angle of the injured vertebra was -30.86 degree to 40.53 degree, mean 6.11 degree 11.31 degree. The local kyphosis Cobb's angle of the injured vertebra was corrected to -3.08.-14.85 degrees, averaging 4.97 + 2.35 degrees. 397 cases of anti osteoporosis treatment were performed in perioperative period, accounting for 87.8%. There were 64 cases of fracture, including 12 men, 52 women, 14.2%, 1-53 months of fracture, an average of 14.56 + 11.46 months. There were 388 patients without fracture. The fracture group and non fracture group were in sex, age, follow-up time, local posterior convex angle, PVP/PKP, vertebral segment, bone cement injection, and so on. There was no statistical difference between the two groups (P0.05). The incidence of bone cement extravasation in fracture group was significantly higher than that in non fracture group (P0.01), but in the non fracture group, the use of anti osteoporosis drugs and tonifying kidney and activating blood Chinese medicine was significantly higher than that in the fracture group. The difference between the two groups in the correction angle of the local kyphosis Cobb's angle after the operation was different. In statistical significance (P0.05), the fracture group was larger than the non fracture group. The results of multiple factors analysis showed that the bone cement exoskosoosis occurred, the treatment of osteoporosis and the oral administration of tonifying kidney and activating blood were not taken after the operation. The local kyphosis Cobb's angle correction was the risk factor for the fracture of the vertebral body after the operation. There was no significant difference in the rate of birth, sex, age, recurrent fracture time, local posterior convex angle of the vertebral body, operation mode (PVP/PKP), bone cement injection, bone cement extravasation, the use of anti osteoporosis drugs and traditional Chinese medicine for invigorating kidney and activating blood (P0.05). The correction angle of the adjacent vertebra group in the local kyphosis Cobb's angle was greater than that of the distant vertebra. There was a statistical difference between the two groups (P0.05). Compared with the two surgical methods, the local kyphosis Cobb's angle correction of the injured vertebrae in the patients with PKP was more obvious than that of the patients with PVP, but there was no difference between the two kinds of surgical methods in the occurrence of bone cement exoskosis and the time of re fracture. Conclusion: cause PVP, the non operative vertebral body redevelopment after PKP operation. There are many risk factors of fracture. The results of this study show that the occurrence of bone cement extravasation, the correction of the local kyphosis Cobb's angle of the injured vertebra excessively, and the absence of anti osteoporosis in the perioperative period all obviously improve the incidence of the fracture. Non operative vertebral fractures. Doctors should master the related risk factors, avoid the occurrence of bone cement extravasation during the operation, do not emphasize the correction of the local posterior convex angle of the injured vertebra, and pay attention to the treatment of anti osteoporosis drugs in the perioperative period. In addition, we should pay attention to the use of traditional Chinese medicine in the operation, and can prevent the redevelopment of vertebra bone with Chinese traditional Chinese medicine for invigorating kidney and blood. Combination of traditional Chinese and Western medicine treatment, in order to improve the quality of medical treatment.
【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】：2015
【分类号】：R687.3
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