个性化骨水泥注入PVP治疗骨质疏松性胸腰椎压缩骨折及骨折后椎体缺血坏死

发布时间：2019-04-10 09:56

【摘要】：目的:探讨PVP治疗骨质疏松性胸腰椎压缩骨折及椎体缺血坏死的骨水泥注入及临床疗效。方法:回顾性研究2010年01月-2016年03月在大连大学附属中山医院行经皮椎体成形术(percutaneous vertebroplasty,PVP)的患者65例,其中单纯性骨质疏松性胸腰椎压缩骨折(osteoporotic vertebral compression fractures,OVCF)组50例,胸腰椎压缩骨折不愈合或延迟愈合的缺血坏死(avascular necrosis of bone,AVN)组15例。65例患者均按照常规的PVP手术进行治疗,并记录术中骨水泥的注入量。术后均配合抗骨质疏松治疗并腰围保护。观察术后3天、1个月、3个月、6个月、12个月的疼痛(visual analogue scale,VAS评分)较术前的改善情况、并发症的发生情况、影像学变化及对术后1年的生活质量(SF-36表)与术前对比评估。对相关数据进行t检验统计学分析(SPSS19软件)。结果:65例患者疼痛全部有效缓解,均无椎管内及血管内渗漏,均未出现肺栓塞等并发症。骨质疏松性胸腰椎骨折组骨水泥注入量为(5.0±1.5)ml,缺血性骨坏死组骨水泥注入量为(7.0±1.5)ml。术后影像学检查显示骨水泥位置良好。统计学分析OVCF组及AVN组行PVP术后的疼痛评分及生活质量评分均较术前有明显改善。2组术后均未出现临近椎体骨折。结论:PVP是治疗骨质疏松性胸腰椎压缩骨折(OVCF)及骨折后椎体缺血坏死(AVN)的有效方法;AVN组需要注入骨水泥量比OVCF组多;骨水泥的注入需达到既能填充骨质缺损区,又能充分覆盖骨折线的个性化的原则。
[Abstract]:Objective: to investigate the effect of bone cement injection in the treatment of osteoporotic thoracolumbar compression fracture and vertebral ischemic necrosis with PVP. Methods: from January 2010 to March 2016, 65 patients underwent percutaneous vertebroplasty (percutaneous vertebroplasty,PVP) in Zhongshan Hospital, Dalian University, including 50 patients with simple osteoporotic thoracolumbar compression fracture (osteoporotic vertebral compression fractures,OVCF). Fifteen patients were treated with nonunion or delayed union of thoracolumbar compression fracture with ischemic necrosis (avascular necrosis of bone,AVN). 65 patients were treated by conventional PVP operation and the amount of bone cement injected during the operation was recorded. All patients were treated with anti-osteoporosis and waist circumference protection. The (visual analogue scale,VAS scores of pain at 3 days, 1 month, 3 months, 6 months and 12 months after operation were observed as compared with those before operation, and the occurrence of complications was observed. Imaging changes and quality of life (SF-36) at 1 year after operation were compared with those before operation. The related data were analyzed by t-test (SPSS19 software). Results: all the 65 patients had effective pain relief, no intraspinal and intravascular leakage, no pulmonary embolism and other complications. Bone cement injection was (5.0 卤1.5) ml, in osteoporotic thoracolumbar fracture group, (7.0 卤1.5) ml. in ischemic osteonecrosis group. Postoperative imaging examination showed a good location of bone cement. The pain score and quality of life score after PVP in OVCF group and AVN group were significantly improved compared with those before operation, and there were no adjacent vertebral body fractures in both groups. Conclusion: PVP is an effective method for the treatment of osteoporotic thoracolumbar compression fracture (OVCF) and (AVN) of vertebral body ischemia and necrosis after fracture, the amount of bone cement needed to be injected in AVN group is more than that in OVCF group. Bone cement injection should not only fill the bone defect area, but also fully cover the fracture line.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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