PKP治疗骨质疏松性椎体骨折骨不愈合的临床研究
发布时间：2018-10-04 20:33
【摘要】：目的:分析经皮椎体后凸成形术治疗骨质疏松性椎体骨折(Osteoporotic Vertebral Fracture,OVF)骨不愈合的临床疗效,探讨PKP治疗OVF骨不愈合中防止骨水泥渗漏的有效方法,对OVF骨不愈合的临床特点及影像学表现做进一步总结。方法:回顾性分析我院2012年8月至2014年3月采用PKP技术治疗的骨质疏松性椎体骨折病人。排除既往存在脊柱手术病史,合并肿瘤病史及存在脊髓或神经压迫的情况,根据OVF骨不愈合的诊断依据共有27例28椎进入本研究,男性5例,女性22例,平均年龄69.70±9.26岁。所有病人术前均行X线片、CT及MRI检查。术中采用骨水泥“封堵”、分次灌注等椎体后凸成形术关键技术治疗,术后予正侧位X线片,必要时CT检查。于术前、术后及末次随访时测量椎体前缘高度、椎体中间高度及局部后凸角,记录疼痛视觉模拟评分(Visual Analogue Scale,VAS)和Oswestry功能障碍指数评分(Oswestry Disability Index,ODI),同时记录骨水泥用量、骨水泥渗漏情况及末次随访时骨水泥的填充情况。比较手术前、后及末次随访时椎体前缘高度、椎体中间高度、Cobb角、VAS评分及ODI评分变化情况。结果:27例病人均以特殊的腰背痛就诊,表现为站立时剧烈疼痛,平卧时几乎消失;术前X线片或CT上有裂隙征、边缘硬化现象,MRI检查见T2加权像上为高信号或低信号,T1加权像上为低信号,脂肪抑制像为界限清楚的高信号。所有病人使用椎体后凸成形术中的关键技术均顺利完成手术。术后28椎体中仅有2椎发生骨水泥渗漏,均无症状。27例病人平均随访16.11±5.19月(3至23个月),末次随访时病人椎体内骨水泥填充良好,无松动或脱出。本组病人椎体前缘、椎体中间高度由术前53.01±21.10、57.61±18.59分别恢复至术后77.70±12.92、75.61±13.68(P0.05),末次随访时分别为75.25±12.17、74.00±14.97,末次与术后比较无统计学差异性(P0.05);Cobb角、VAS评分及ODI分别由术前的17.75±14.38、8.48±0.64、84.61±5.39分别下降至术后9.86±12.16、2.33±0.62、32.48±6.04,有显著差异性(P0.05),末次随访时上述指标与术后比较不具统计学意义。结论:OVF骨不愈合好发胸腰段,平卧时疼痛消失,站立或坐位时疼痛加重,影像学可见椎体内裂隙、真空及假关节活动征象。使用椎体后凸成形术中的关键操作技术治疗骨质疏松性椎体骨折骨不愈合疗效显著,且能有效降低骨水泥渗漏的发生。
[Abstract]:Objective: to analyze the clinical effect of percutaneous kyphoplasty in the treatment of (Osteoporotic Vertebral Fracture,OVF) bone nonunion of osteoporotic vertebral fracture, and to explore the effective method of preventing bone cement leakage in the treatment of OVF nonunion by PKP. The clinical features and imaging findings of OVF bone nonunion were further summarized. Methods: the patients with osteoporotic vertebral fracture treated with PKP from August 2012 to March 2014 were analyzed retrospectively. According to the diagnosis basis of OVF bone nonunion, 27 cases 28 vertebrae entered this study. There were 5 males and 22 females with an average age of 69.70 卤9.26 years. All patients were examined by CT and MRI before operation. The key techniques of kyphoplasty, such as bone cement occlusion and perfusion, were used during the operation. X-ray films were performed on the lateral and positive position after operation, and CT was performed when necessary. The anterior height, middle height and local kyphoid angle of the vertebral body were measured before, after and at the last follow-up. The pain visual analogue score (Visual Analogue Scale,VAS) and the Oswestry dysfunction index (Oswestry Disability Index,ODI) were recorded. The amount of bone cement was also recorded. The leakage of bone cement and the filling of bone cement at the last follow-up. Before, after and at the last follow-up, the changes of the anterior height of the vertebral body, the height of the middle vertebral body and the ODI score were compared. Results all of the 27 patients were treated with special low back pain, which was characterized by severe pain in standing and almost disappeared in supine, and had fissure sign on X-ray film or CT before operation. Edge-sclerosis MRI showed that T 2 weighted images showed high signal intensity or low signal intensity on T 1 weighted images, and fat suppression images showed high signal intensity on T 1 weighted images and fat suppression images on T 1 weighted images. All patients successfully completed the operation using the key techniques of kyphoplasty. Cement leakage occurred in only 2 of the 28 vertebrae postoperatively. The average follow-up of 27 patients was 16.11 卤5.19 months (3 to 23 months). At the last follow-up, the cement filling in the vertebral body was good, no loosening or prolapse. The anterior edge of the vertebrae in this group, The median height of the vertebral body recovered from 53.01 卤21.10 卤57.61 卤18.59 before operation to 77.70 卤12.92 卤75.61 卤13.68 after operation (P0.05), and at the last follow-up was 75.25 卤12.1774.00 卤14.97, respectively. There was no significant difference between the last time and postoperative (P0.05). The scores of Cobb angle VAS and ODI decreased from 17.75 卤14.38 卤8.48 卤0.644.61 卤5.39 to 9.86 卤12.16 卤2.33 卤0.62n 32.48 卤6.04, respectively (P0.05). At the last follow-up, the above indexes were not statistically significant compared with postoperative. Conclusion the thoracolumbar segment of OVF bone is nonunion, the pain is disappeared in supine, the pain is aggravated in standing or sitting position, the sign of vertebral body fissure, vacuum and pseudarthrosis can be seen on imaging. The key techniques of kyphoplasty in the treatment of bone nonunion of osteoporotic vertebral fracture are significant and can effectively reduce the occurrence of bone cement leakage.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2251787
[Abstract]:Objective: to analyze the clinical effect of percutaneous kyphoplasty in the treatment of (Osteoporotic Vertebral Fracture,OVF) bone nonunion of osteoporotic vertebral fracture, and to explore the effective method of preventing bone cement leakage in the treatment of OVF nonunion by PKP. The clinical features and imaging findings of OVF bone nonunion were further summarized. Methods: the patients with osteoporotic vertebral fracture treated with PKP from August 2012 to March 2014 were analyzed retrospectively. According to the diagnosis basis of OVF bone nonunion, 27 cases 28 vertebrae entered this study. There were 5 males and 22 females with an average age of 69.70 卤9.26 years. All patients were examined by CT and MRI before operation. The key techniques of kyphoplasty, such as bone cement occlusion and perfusion, were used during the operation. X-ray films were performed on the lateral and positive position after operation, and CT was performed when necessary. The anterior height, middle height and local kyphoid angle of the vertebral body were measured before, after and at the last follow-up. The pain visual analogue score (Visual Analogue Scale,VAS) and the Oswestry dysfunction index (Oswestry Disability Index,ODI) were recorded. The amount of bone cement was also recorded. The leakage of bone cement and the filling of bone cement at the last follow-up. Before, after and at the last follow-up, the changes of the anterior height of the vertebral body, the height of the middle vertebral body and the ODI score were compared. Results all of the 27 patients were treated with special low back pain, which was characterized by severe pain in standing and almost disappeared in supine, and had fissure sign on X-ray film or CT before operation. Edge-sclerosis MRI showed that T 2 weighted images showed high signal intensity or low signal intensity on T 1 weighted images, and fat suppression images showed high signal intensity on T 1 weighted images and fat suppression images on T 1 weighted images. All patients successfully completed the operation using the key techniques of kyphoplasty. Cement leakage occurred in only 2 of the 28 vertebrae postoperatively. The average follow-up of 27 patients was 16.11 卤5.19 months (3 to 23 months). At the last follow-up, the cement filling in the vertebral body was good, no loosening or prolapse. The anterior edge of the vertebrae in this group, The median height of the vertebral body recovered from 53.01 卤21.10 卤57.61 卤18.59 before operation to 77.70 卤12.92 卤75.61 卤13.68 after operation (P0.05), and at the last follow-up was 75.25 卤12.1774.00 卤14.97, respectively. There was no significant difference between the last time and postoperative (P0.05). The scores of Cobb angle VAS and ODI decreased from 17.75 卤14.38 卤8.48 卤0.644.61 卤5.39 to 9.86 卤12.16 卤2.33 卤0.62n 32.48 卤6.04, respectively (P0.05). At the last follow-up, the above indexes were not statistically significant compared with postoperative. Conclusion the thoracolumbar segment of OVF bone is nonunion, the pain is disappeared in supine, the pain is aggravated in standing or sitting position, the sign of vertebral body fissure, vacuum and pseudarthrosis can be seen on imaging. The key techniques of kyphoplasty in the treatment of bone nonunion of osteoporotic vertebral fracture are significant and can effectively reduce the occurrence of bone cement leakage.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前1条
1 杨惠林,顾晓晖,陈亮,陆俭,毛海青,孟斌,牛国旗,赵刘军,唐天驷;后凸成形术治疗骨质疏松性脊柱骨折的选择性与个体化[J];中国医学科学院学报;2005年02期
，本文编号：2251787
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