经皮椎体后凸成形术骨水泥渗漏的影响学观察与临床研究

发布时间：2018-10-30 13:19

【摘要】：目的通过分析骨质疏松压缩性骨折和骨质疏松爆裂性骨折行经皮椎体后凸成形术(PKP)的影像学资料,探讨骨水泥渗漏及渗漏位置、途径、骨折类型对临床疗效的影响。方法南昌大学第二附属医院2013年1月-2016年1月采用经皮椎体后凸成形术治疗骨质疏松骨折215例245个椎体。术后根据影像学将患者分为骨质疏松压缩骨折组和骨质疏松破裂骨折组。符合纳入标准的OVBF有35个椎体,OVCF有210个。将骨水泥渗漏分为椎管内、椎间隙,及其他部位渗漏(椎旁、椎旁静脉、针道)。采用VAS评分分析各组患者腰背部疼痛缓解的情况。结果OVBF组与OVCF组骨水泥渗漏比较有统计学意义(P0.05),但两组椎管内骨水泥渗漏的比较无差别(P0.05)。OVBF组椎间隙和椎旁软组织渗漏率要明显高于OVCF组,两组该部位比较有明显差别(P0.05)。其他部位渗漏两组比较无统计学意义(P0.05)。骨水泥可以通过椎基静脉,椎体后壁,椎弓根破裂的内壁3种途径进入椎管内,但椎基静脉可能是骨水泥渗漏至椎管内的主要途径。OVBF组和OVCF组经PKP治疗术后及末次随访VAS评分比较无统计学意义(P0.05)。两组中有骨水泥渗漏患者与无骨水泥渗漏患者术前术后VAS比较均无差别(P0.05)。两组患者中骨水泥渗漏入椎管内术后及末次随访VAS评分比较均无统计学差异(P0.05)。两组患者中骨水泥渗漏到椎间隙内术前和术后VAS评分比较无统计学意义(P0.05),但术前和末次随访VAS评分有统计学差异(P0.05)。结论1.经皮椎体后凸成形术治疗椎体骨质疏松破裂性骨折与骨质疏松压缩骨折椎管内骨水泥渗漏率无差别。骨水泥可能主要通过椎基静脉漏入椎管。2.椎体骨质疏松破裂性骨折更易发生骨水泥渗漏,椎间隙渗漏和椎旁渗漏率明显高于骨质疏松压缩骨折。3.经皮椎体后凸成形术治疗椎体骨质疏松脊柱骨折腰背部疼痛的缓解与是否发生骨水泥渗漏、渗漏部位和骨折类型无关。但椎间隙内骨水泥渗漏可能短时间内影响患者的腰痛。
[Abstract]:Objective to analyze the imaging data of percutaneous kyphoplasty (PKP) for osteoporotic compression fracture and burst osteoporotic fracture, and to explore the effect of osseous cement leakage, location, approach and fracture type on clinical efficacy. Methods from January 2013 to January 2016, 215 patients with osteoporotic fractures were treated with percutaneous kyphoplasty in the second affiliated Hospital of Nanchang University. The patients were divided into osteoporotic compression fracture group and osteoporotic fracture group according to imaging. There were 35 vertebrae in OVBF and 210 in OVCF. Bone cement leakage is divided into spinal canal, intervertebral space, and other sites (paravertebral, paravertebral vein, needle). VAS score was used to analyze the relief of lumbar and back pain in each group. Results there was significant difference in bone cement leakage between OVBF group and OVCF group (P0.05), but there was no difference between the two groups. (P0.05) the leakage rate of intervertebral space and paraspinal soft tissue in). OVBF group was significantly higher than that in OVCF group. There was significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). Bone cement can enter the spinal canal through three ways: the vertebral basal vein, the posterior wall of the vertebral body and the inner wall of the broken pedicle. But vertebrobasilar vein may be the main way of bone cement leakage into the spinal canal. There was no significant difference in VAS score between OVBF group and OVCF group after PKP treatment and the last follow-up (P0.05). There was no difference in VAS between the patients with bone cement leakage and those without bone cement leakage (P0.05). There was no significant difference in VAS score between the two groups after bone cement leakage into the spinal canal and at the last follow-up (P0.05). There was no significant difference in VAS score between the two groups before and after the bone cement leakage into the intervertebral space (P0.05), but there was significant difference between the preoperative and the last follow-up VAS scores (P0.05). Conclusion 1. There was no difference between percutaneous kyphoplasty and osteoporotic compression fracture in the treatment of vertebral canal cement leakage. Bone cement may leak into the spinal canal mainly through the vertebrobasilar vein. 2. Fracture of vertebral body with osteoporosis is more likely to occur cement leakage, the leakage rate of intervertebral space and paravertebral leakage is obviously higher than that of osteoporotic compression fracture. The relief of lumbar and back pain caused by percutaneous kyphoplasty in the treatment of osteoporotic spinal fracture is not related to the occurrence of cement leakage, leakage site and fracture type. However, bone cement leakage in intervertebral space may affect the patient's low back pain in a short time.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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