上胸椎骨折经皮椎体成形术

发布时间：2018-08-22 19:55

【摘要】：目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗上胸椎骨折的可行性、安全性以及疗效。方法上胸椎VCFs20例(25椎体),男5例,女15例,年龄57-89岁(71.0±10.8岁)。T1 2个,T2 3个,T3 5个,T4 15个。俯卧位,静脉及局部麻醉,C型臂X线正侧位透视引导下穿刺手术,侧位透视时,2例双肩下沉体位,21例双肩上举位,2例“自由泳”体位。全部采用单侧椎弓根后外侧穿刺入路手术。记录手术时间、骨水泥注射量,术后及随访时复查X线片及CT了解骨水泥分布；记录疼痛的VAS评分、活动能力及功能障碍指数。比较术前1d与术后3d和末次随访时腰背疼痛程度、活动能力及功能障碍指数。结果所有患者顺利完成手术,18例获得随访。手术时间为39.74±10.6min(25-55mins).骨水泥注入量2.0-6.Omml(3.3±1.5m1)。随访时间5.5-18月(7.63±2.72月),3例(15%)发生骨水泥渗漏(1例硬膜外渗漏；1例椎间隙渗漏；1例椎旁软组织渗漏)但未引起临床症状；1例(5%)随访15天后再发上胸椎骨折(非邻近节段、非手术椎体),行PVP治疗后随访无再发骨折。未出现肋骨骨折、气胸、肺栓塞、血管神经损伤、脊髓损伤、感染等相关并发症。术前1d VAS 7.3 5±0.74.Mobility score 2.95±0.95、ODI 80.45±2.76。术后3d、1month、3月和末次随访时：VAS(分)分别为：2.40±0.68；2.20±0.69；2.19±0.45；1.90±0.39；Mobility score(分)分别为：1.95±0.76、1.72±0.75、1.55±0.50、1.50±0.51。ODI(%)分别是：40.50±3.76；34.22±10.82；32.20±5.97；30.30±5.55。术后3d、1月、3月和末次随访VAS、Mobility score、ODI与术前1d相比有显著性差异(P0.01)。结论经皮椎体成形术治疗上胸椎压缩性骨折安全、可行,有显著的止痛效果。根据上胸椎解剖毗邻关系特点,采用个体化的手术体位、良好的透视影像和单侧椎弓根后外侧入路穿刺有助于手术顺利完成。
[Abstract]:Objective to investigate the feasibility, safety and efficacy of percutaneous vertebroplasty in the treatment of upper thoracic vertebral fractures. Methods there were 25 cases (25 vertebrae) of upper thoracic vertebrae, male 5 cases, female 15 cases, age 57-89 years (71.0 卤10.8 years). In prone position, venous and local anaesthesia, the puncture was guided by positive and lateral fluoroscopy of C-arm X-ray. 2 cases of double shoulder sinking position were performed in lateral position, and 2 cases of "freestyle" position were performed on both shoulders of 21 cases. All patients underwent unilateral posterolateral pedicle approach. The time of operation, the amount of bone cement injection, the X-ray film and CT scan after operation and follow-up were recorded to understand the distribution of bone cement, the VAS score of pain, the activity ability and the index of dysfunction were recorded. The degree of lumbar and back pain, the activity ability and the index of dysfunction were compared between 1 day before operation and 3 days after operation. Results 18 patients were followed up successfully. The operative time was 39.74 卤10.6min (25-55mins). The amount of bone cement injected was 2.0-6.Omml (3.3 卤1.5m1). The follow-up time was 5.5-18 months (7.63 卤2.72 months) and 3 cases (15%) developed bone cement leakage (1 case of epidural leakage 1 case of peridural leakage and 1 case of soft tissue leakage of paravertebral space), but 1 case (5%) was followed up for 15 days without clinical symptoms. Non-operative vertebrae), no recurrent fractures were followed up after PVP treatment. There were no complications such as rib fracture, pneumothorax, pulmonary embolism, vascular and nerve injury, spinal cord injury, infection and so on. 1 day before operation, VAS was 7.35 卤0.74.Mobility score 2.95 卤0.95 卤0.95 卤0.95 卤80.45 卤2.76. On the 3rd day after operation, at 3 months and at the last follow-up, the score of the score was: 1: 2.40 卤0.68 卤2.20 卤0.69, 2.19 卤0.45, 1.90 卤0.39, Mobility score: 1. 95 卤0. 76U 1. 72 卤0. 751.55 卤0. 501.50 卤1. 50 卤0.51.ODI (%) were: 40.50 卤3. 7634.22 卤10. 82n 32.20 卤5. 972t 30.30 卤5. 555.The results showed that: 1 卤0. 765 卤0. 751.55 卤0. 501.50 卤0. 501.50 卤0. 501.50 卤5. 55%, respectively. At 3 days, 1 month, 3 months and the last follow-up, there was a significant difference between VASM mobility scoreography ODI and preoperative day 1 (P0.01). Conclusion Percutaneous vertebroplasty is safe and effective in the treatment of upper thoracic vertebral compression fracture. According to the characteristics of anatomical and adjoining relationship of upper thoracic vertebrae, individualized operation posture, good fluoroscopy and unilateral posterolateral pedicle approach are helpful for the successful completion of the operation.
【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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