PKP、编织囊袋扩张椎体成形术在治疗胸腰椎骨质疏松性压缩骨折的疗效对比
发布时间：2018-12-15 15:55
【摘要】：目的:观察并分析应用经皮穿刺椎体后凸成形术(PKP)和编织囊袋扩张椎体成形术在治疗骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法:2015年2月—2016年2月在我院接受治疗的120例OVCF患者作为研究对象,随机分为PKP组(n=60)和编织囊袋组(n=60)进行手术治疗,观察比较两组患者手术时间,术前术后的疼痛情况、Cobb角,术后椎体后凸矫正率、骨水泥分布、骨水泥渗漏情况。根据统计数字评价与对比分析经皮穿刺椎体后凸成形术(PKP)和编织囊袋扩张椎体成形术在治疗胸腰椎骨质疏松性压缩骨折的临床疗效。结果:1.所有患者术后疼痛视觉评分(VAS)、Cobb角、较术前均有改善,差异有统计学意义(P0.05),组术后VAS评分比较,差异无统计学意义(P0.05),术后椎体后凸矫正囊袋率组优于Pk P组,差异有统计学意义(P0.05);2.两组的骨水泥弥散类型及其对治疗效果的影响:1两组骨水泥弥散类型构成不同,有统计学意义(P0.05);2各种弥散方式的术前术后的VAS评分比较有显著差异(P0.05),三种弥散方式对于患者疼痛缓解均起到良好的效果;三种弥散方式缓解患者疼痛程度的比较无显著差异(P0.05)3三种弥散方式的术前与术后椎体高度压缩率对比,均有显著性差异(P0.05);团块型和混合型高度恢复效果均要大于弥散型(P0.05),而团块型和混合型对于椎体的高度恢复效果相当(P0.05)。3.编织囊袋组骨水泥渗透发生率为7.1%,明显低于PKP组(18.0%),差异有统计学意义(P0.05)。PKP组和编织囊袋组的平均手术时间分别是28.9±1.7min、30.2±1.2min,两组间比较有统计学意义(P0.05)。结论:1、通过对比两种手术方式,扩张型编织囊袋椎体成形术在治疗椎体骨质疏松性压缩骨折方面具有明显优势,在解决疼痛、手术时间、骨水泥注入量方面,两者无差异,在恢复椎体高度、矫正后凸畸形和骨水泥渗漏方面优于PKP。2、不同骨水泥分布方式对治疗效果的影响:PKP组病例骨水泥弥散多呈弥散型和混合型,囊袋组多成混合型和团块型,三种弥散方式的缓解患者疼痛程度基本相同,混合型和团块型的弥散方式在恢复椎体高度较弥散型有一定优势,但在骨水泥及椎体稳定方面,弥散型、混合型、弥散型依次减弱。
[Abstract]:Objective: to observe and analyze the clinical effect of percutaneous kyphoplasty (PKP) and braided bag dilatation vertebroplasty in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods: one hundred and twenty patients with OVCF received treatment in our hospital from February 2015 to February 2016 were randomly divided into two groups: PKP group (n = 60) and braided bag group (n = 60). The operative time was observed and compared between the two groups. Preoperative and postoperative pain, Cobb angle, postoperative kyphosis correction rate, bone cement distribution, bone cement leakage. To evaluate and compare the clinical effect of percutaneous kyphoplasty (PKP) and braided pouch dilatation vertebroplasty in the treatment of osteoporotic compression fracture of thoracolumbar vertebrae. Results: 1. The (VAS), Cobb angle of postoperative pain visual score in all patients was improved compared with that before operation, and the difference was statistically significant (P0.05). The difference of VAS score after operation in all patients was not statistically significant (P0.05). The rate of posterior vertebral kyphosis correction was better in group P than that in group P (P0.05). 2. Two groups of bone cement dispersion type and its effect on the treatment: 1 the two groups of bone cement dispersion type composition is different, there is statistical significance (P0.05); (2) there was significant difference in VAS scores between different diffusion modes before and after operation (P0.05), and the three diffusion modes had a good effect on pain relief. There was no significant difference in the degree of pain relief between the three diffusion modes (P0.05). There was significant difference in the compression ratio of the three diffusion modes before and after operation (P0.05). The height recovery effect of mass type and mixed type was higher than that of diffuse type (P0.05), while the effect of mass type and mixed type on height recovery of vertebral body was similar (P0.05). The incidence of bone cement penetration in the braided bag group was 7.1, significantly lower than that in the PKP group (18.0%). The difference was statistically significant (P0.05). The average operation time of the). PKP group and the braided bag group was 28.9 卤1.7 min and 30.2 卤1.2 min, respectively. There was statistical significance between the two groups (P0.05). Conclusion: 1. By comparing the two operative methods, dilated braided bag vertebroplasty has obvious advantages in the treatment of osteoporotic compression fracture of vertebral body, but there is no difference between them in pain solving, operation time and cement injection. In recovery of vertebral height, correction of kyphosis and leakage of bone cement, the effect of different distribution patterns of bone cement on the treatment effect was better than that of PKP.2,. In PKP group, the dispersion of bone cement was more diffuse and mixed. The degree of pain relief in the three diffusion modes was basically the same. The diffusion mode of mixed and mass type had some advantages in restoring vertebral body height, but in bone cement and vertebral body stability. The dispersion type, the mixed type and the diffuse type are weakened in turn.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
[Abstract]:Objective: to observe and analyze the clinical effect of percutaneous kyphoplasty (PKP) and braided bag dilatation vertebroplasty in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods: one hundred and twenty patients with OVCF received treatment in our hospital from February 2015 to February 2016 were randomly divided into two groups: PKP group (n = 60) and braided bag group (n = 60). The operative time was observed and compared between the two groups. Preoperative and postoperative pain, Cobb angle, postoperative kyphosis correction rate, bone cement distribution, bone cement leakage. To evaluate and compare the clinical effect of percutaneous kyphoplasty (PKP) and braided pouch dilatation vertebroplasty in the treatment of osteoporotic compression fracture of thoracolumbar vertebrae. Results: 1. The (VAS), Cobb angle of postoperative pain visual score in all patients was improved compared with that before operation, and the difference was statistically significant (P0.05). The difference of VAS score after operation in all patients was not statistically significant (P0.05). The rate of posterior vertebral kyphosis correction was better in group P than that in group P (P0.05). 2. Two groups of bone cement dispersion type and its effect on the treatment: 1 the two groups of bone cement dispersion type composition is different, there is statistical significance (P0.05); (2) there was significant difference in VAS scores between different diffusion modes before and after operation (P0.05), and the three diffusion modes had a good effect on pain relief. There was no significant difference in the degree of pain relief between the three diffusion modes (P0.05). There was significant difference in the compression ratio of the three diffusion modes before and after operation (P0.05). The height recovery effect of mass type and mixed type was higher than that of diffuse type (P0.05), while the effect of mass type and mixed type on height recovery of vertebral body was similar (P0.05). The incidence of bone cement penetration in the braided bag group was 7.1, significantly lower than that in the PKP group (18.0%). The difference was statistically significant (P0.05). The average operation time of the). PKP group and the braided bag group was 28.9 卤1.7 min and 30.2 卤1.2 min, respectively. There was statistical significance between the two groups (P0.05). Conclusion: 1. By comparing the two operative methods, dilated braided bag vertebroplasty has obvious advantages in the treatment of osteoporotic compression fracture of vertebral body, but there is no difference between them in pain solving, operation time and cement injection. In recovery of vertebral height, correction of kyphosis and leakage of bone cement, the effect of different distribution patterns of bone cement on the treatment effect was better than that of PKP.2,. In PKP group, the dispersion of bone cement was more diffuse and mixed. The degree of pain relief in the three diffusion modes was basically the same. The diffusion mode of mixed and mass type had some advantages in restoring vertebral body height, but in bone cement and vertebral body stability. The dispersion type, the mixed type and the diffuse type are weakened in turn.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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