经皮椎体成形及后凸成形术对邻近椎间盘影响的观察

发布时间：2018-08-08 16:44

【摘要】：目的探讨经皮椎体成形术(percutaneous vertebroplasty, PVP)及经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)治疗胸腰椎压缩性骨折后,手术对邻近椎间盘退变(intervertebral disc degeneration, IDD)的影响。方法回顾性分析我院采用PVP或PKP治疗胸腰段骨质疏松性压缩性骨折患者49例,其中男性17例,女性32例,年龄59～91岁,手术椎体65个,节段T8-L5。术后随访14～38个月。①以手术椎体相邻椎间盘为手术组,以自身非手术椎体邻近椎间盘为对照组。②手术组的椎间盘中以骨水泥对称分布于椎体中线两侧为对称组,非对称分布于椎体中线两侧为侧偏组。③以骨水泥接触软骨终板中央1/2面积区域为中央组,以骨水泥未接触中央区域为周围组。以MRI T2WI正中矢状位图像为基础对椎间盘进行Pfirrmann分级。所有数据进行归纳、汇总,应用SAS 8.0统计软件分析,对自身配对等级资料进行Wilcoxon符号秩和检验,对计数资料进行Wilcoxon秩和检验。结果纳入研究的椎间盘共230个。①手术组124个,对照组106个。手术组与对照组Pfirrmann等级增加有显著性差异(P0.0001),前者高于后者。②对称组56个与侧偏组68个。对称组与侧偏组椎间盘Pfirrmann等级增加无显著性差异(P=0.926)。③中央组75个与周围组35个。中央组与周围组椎间盘Pfirrmann等级增加有显著性差异(P=0.025),前者高于后者。结论PVP或PKP术可加速邻近椎间盘的退变,其影响程度与手术椎体中骨水泥是否对称分布无关,与骨水泥是否接触软骨终板中央区域有关。
[Abstract]:Objective to investigate the effect of percutaneous vertebroplasty (percutaneous vertebroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP) on degenerative (intervertebral disc degeneration, IDD) in patients with thoracolumbar vertebral compression fracture. Methods 49 cases of thoracolumbar osteoporotic compression fracture treated with PVP or PKP were retrospectively analyzed, including 17 males and 32 females, aged 5991 years, 65 vertebrae and T8-L5. The patients were followed up for 14 ~ 38 months. 1 the adjacent intervertebral disc of the surgical vertebral body was taken as the operation group, and the intervertebral disc adjacent to the non-operative vertebral body was taken as the control group. 2. The intervertebral discs in the surgical group were symmetrically distributed on both sides of the midline of the vertebral body by bone cement symmetry. Asymmetrically distributed on both sides of the midline of vertebral body was the lateral deviation group .3 the central area of bone cement contact cartilage endplate was 1 / 2 area as the central group, and the bone cement non-contact central area was the surrounding group. On the basis of MRI T2WI median sagittal image, Pfirrmann classification of intervertebral disc was carried out. All the data are summed up and analyzed by SAS 8.0 statistical software. The self-matched rank data are tested by Wilcoxon sign rank sum test, and the count data are tested by Wilcoxon rank sum test. Results there were 124 intervertebral discs in 230 .1 operative groups and 106 in control group. There was significant difference in Pfirrmann grade between the operation group and the control group (P0.0001), the former was higher than that of the latter group (56 cases) and the lateral deviation group (68 cases). There was no significant difference in Pfirrmann grade between symmetrical group and lateral deviation group (P0. 926). 3 75 in central group and 35 in peripheral group. There was a significant difference in Pfirrmann grade between central group and peripheral group (P0. 025), the former was higher than the latter. Conclusion PVP or PKP can accelerate the degeneration of adjacent intervertebral disc, and its influence is not related to the symmetrical distribution of bone cement in the vertebral body, but to the central region of the cartilage endplate.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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