单侧横突入路椎体成形术联合体位复位治疗严重腰椎骨质疏松性压缩骨折的疗效观察

发布时间：2018-08-25 20:04

【摘要】：目的：探讨单侧横突入路椎体成形术(percutaneous vertebroplasty, PVP)联合体位复位治疗严重腰椎骨质疏松性压缩骨折(osteoporotic vertebral compression fracture, OVCF)的临床疗效。方法：回顾性分析2012年3月-2014年7月我科收治的45例严重腰椎骨质疏松性压缩骨折,共45个椎体,均给予单侧横突入路椎体成形术联合体位复位治疗,其中男11例,女34例；年龄60-93岁,平均74.38岁。比较患者术前、术后3天及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS), Oswestry功能障碍指数(Oswestry disability index, ODI),伤椎Cobb角及椎体前缘、中份高度,评价其临床疗效。结果：顺利完成所有患病椎体的手术,手术时间29.84±7.73分钟,骨水泥量5.1±0.97 ml,骨水泥渗漏发生率15.6%(共7例),无相关临床症状及体征,39例患者获得满意随访,失访6例,失访率13.3%,随访时间6-30个月,平均18.2个月,术后3天VAS评分为2.28±0.89分,ODI指数为33.95±4.44%,Cobb角为8.13±1.69°,伤椎前缘及中份高度分别为24.82±2.52mm、22.77±2.06mm;末次随访时VAS评分为1.73±0.76分,ODI指数为21.33±4.83%,Cobb角为8.44±1.650,伤椎前缘及中份高度分别为23.92±2.34mm、22.07±2.18mm,术前、术后3天及末次随访时VAS评分及ODI指数两相比较均有统计学差异(P0.05)；术后伤椎Cobb角、椎体前缘及中份高度较术前恢复明显(P0.05),末次随访时伤椎Cobb角及椎体前缘、中份高度较术后3天无明显改变(P0.05)。结论：单侧横突入路椎体成形术联合体位复位能有效的缓解严重腰椎骨质疏松性压缩骨折引起的疼痛,恢复并维持伤椎的椎体高度,纠正腰椎后凸Cobb角,重建矢状面平衡,明显提高生活质量,是一种有效、安全、简单、经济的手术方式。
[Abstract]:Objective: to investigate the clinical effect of unilateral transverse process vertebroplasty (percutaneous vertebroplasty, PVP) combined with reduction in the treatment of severe osteoporotic compression fracture of lumbar vertebrae (osteoporotic vertebral compression fracture, OVCF). Methods: from March 2012 to July 2014, 45 cases of severe osteoporotic compression fractures of the lumbar vertebrae were analyzed retrospectively. All 45 vertebrae were treated with unilateral transverse-process vertebroplasty combined reduction, including 11 males and 34 females. The average age was 74.38 years. To compare the pain visual analogue score (visual analogue scale,VAS), Oswestry) before operation, 3 days after operation and at the last follow-up, (visual analogue scale,VAS), Oswestry dysfunction index (Oswestry disability index, ODI),) was used to evaluate the clinical efficacy of the patients with Cobb angle of vertebrae and the anterior and middle height of vertebral body. Results: the operation time was 29.84 卤7.73 minutes, and the cement leakage rate was 15.6% (7 cases) with 5. 1 卤0. 97 ml, bone cement leakage. 39 patients with no related clinical symptoms and signs were followed up satisfactorily and 6 cases were lost. The rate of missing visit was 13.3.The follow-up time was 6-30 months (mean 18.2 months). On the 3rd day after operation, the VAS score was 2.28 卤0.89 and the ODI index was 33.95 卤4.44. The Cobb angle was 8.13 卤1.69 掳, the anterior and middle height of the injured vertebrae were 24.82 卤2.52 mm and 22.77 卤2.06 mm respectively, the VAS score was 1.73 卤0.76 at the last follow-up, and the ODI index of the Cobb angle was 8.44 卤1.650, the anterior and middle height of the injured vertebra were 23.92 卤2.34 mm and 22.07 卤2.18 mm, respectively. There were significant differences in VAS score and ODI index between 3 days and the last follow-up (P0.05), the Cobb angle, anterior and median height of the injured vertebrae recovered significantly (P0.05), the Cobb angle and the anterior edge of the injured vertebra at the last follow-up were significantly higher than those before the operation (P0.05). There was no significant change in median height 3 days after operation (P0.05). Conclusion: unilateral transverse process approach combined with vertebroplasty can effectively relieve the pain caused by severe osteoporotic compression fracture, restore and maintain the height of the injured vertebra, correct the Cobb angle of lumbar kyphosis, and reconstruct the sagittal balance. It is an effective, safe, simple and economical way to improve the quality of life.
【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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