本文關(guān)鍵詞： 椎體成形術(shù) 壓縮骨折 陳舊性骨折 骨質(zhì)疏松癥　出處：《河北聯(lián)合大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的應(yīng)用經(jīng)皮穿刺椎體成形術(shù)（percutaneous vertebroplasty,PVP）治療陳舊性骨質(zhì)疏松椎體壓縮骨折（osteoporotic vertebral compression fracture,OVCF），通過(guò)對(duì)手術(shù)前后視覺(jué)模擬評(píng)分（VAS評(píng)分）、Oswestry傷殘指數(shù)（Oswestry Disability Index，ODI）、后凸Cobb角及脊柱后凸角的比較評(píng)價(jià)經(jīng)皮穿刺椎體成形術(shù)治療陳舊性骨質(zhì)疏松椎體壓縮骨折的臨床療效。 方法自2010年6月1日至2011年9月1日，在河北聯(lián)合大學(xué)附屬骨科醫(yī)院（河北省唐山市第二醫(yī)院）脊柱外科收集陳舊性骨質(zhì)疏松椎體壓縮骨折患者資料共41例。其中男19例,女22例；年齡60～83歲，平均67.5歲；病程3～12周，平均5.9周。所有患者術(shù)前均有胸腰背部頑固性疼痛病史，日�；顒�(dòng)受限，行X線、CT、MRI檢查后證實(shí)為單節(jié)段陳舊性O(shè)VCF。骨折椎體：T113例，T1210例，L117例，L29例，L32例。通過(guò)術(shù)前及術(shù)后3天、3個(gè)月、12月視覺(jué)模擬評(píng)分（VAS評(píng)分）、Oswestry傷殘指數(shù)（Oswestry Disability Index，ODI）、后凸Cobb角及脊柱后凸角評(píng)價(jià)PVP臨床療效。所有患者均在局部浸潤(rùn)麻醉下接受經(jīng)皮穿刺椎體成形術(shù)治療，手術(shù)過(guò)程順利，術(shù)后嚴(yán)密觀察患者生命體征及雙下肢感覺(jué)、運(yùn)動(dòng)情況，給予靜脈滴注抗生素預(yù)防感染等治療�；颊咝g(shù)后臥床1天，術(shù)后第2天下床活動(dòng)。術(shù)后常規(guī)行X線、CT檢查，定期復(fù)查。統(tǒng)計(jì)和測(cè)量術(shù)后3天、3個(gè)月、12個(gè)月VAS評(píng)分、ODI指數(shù)、后凸Cobb角、脊柱后凸角。 結(jié)果所有患者均得到隨訪。術(shù)后囑患者自行翻身，腰背部疼痛較術(shù)前明顯減輕。椎體成形術(shù)后患者的腰痛癥狀明顯緩解，VAS評(píng)分顯著降低，術(shù)前VAS評(píng)分為（7.6±0.7），術(shù)后3天、3個(gè)月、12個(gè)月VAS評(píng)分分別為（2.3±0.5）、（2.2±0.4）、（2.1±0.3），與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后ODI評(píng)分也顯著降低，術(shù)前ODI評(píng)分為（73.6±7.3）%，術(shù)后3天、3個(gè)月、12個(gè)月ODI評(píng)分分別為（26.5±4.7）%、（25.5±3.9）%、（24.4±3.1）%，與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后后凸Cobb角無(wú)明顯改善，術(shù)前后凸Cobb角為（12.2±1.0）°，術(shù)后3天、3個(gè)月、12個(gè)月后凸Cobb角分別為（12.2±1.0）°、（12.3±1.0）°、（12.3±1.0）°，，與術(shù)前比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后脊柱后凸角無(wú)明顯改善，術(shù)前脊柱后凸角為（10.1±0.4）°，術(shù)后3天、3個(gè)月、12個(gè)月脊柱后凸角分別為（10.1±0.4）°、（10.1±0.4）°、（10.2±0.4）°，與術(shù)前比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。術(shù)后行CT檢查發(fā)現(xiàn)5例骨水泥滲漏事件，但均無(wú)臨床癥狀，其中1例為椎旁血管滲漏，4例為椎體前緣滲漏，滲漏發(fā)生率為12.2%（5/41）。 結(jié)論對(duì)于陳舊性骨質(zhì)疏松椎體壓縮骨折，經(jīng)皮椎體成形術(shù)作為一種微侵入手術(shù)，是一項(xiàng)安全、有效的治療手段，其在緩解疼痛、穩(wěn)定椎體、運(yùn)動(dòng)能力改善方面非常顯著。椎體成形術(shù)與保守治療相比，其優(yōu)勢(shì)在于可大大縮短病人臥床時(shí)間，其不僅手術(shù)創(chuàng)傷小，而且并發(fā)癥相對(duì)較少，在有效避免保守治療帶來(lái)的椎體高度丟失及長(zhǎng)時(shí)間臥床的同時(shí)，還能有效避免殘留腰背痛等問(wèn)題，所以其臨床應(yīng)用價(jià)值較高。因此，對(duì)于有長(zhǎng)期腰背痛，經(jīng)影像學(xué)證實(shí)為陳舊骨折患者來(lái)說(shuō)，若無(wú)手術(shù)禁忌證，應(yīng)盡早接受椎體成形術(shù)。經(jīng)皮椎體成形術(shù)在后凸Cobb角、后凸角恢復(fù)方面不明顯。在本研究中，隨訪期內(nèi)未發(fā)生新發(fā)骨折，由于本研究病例數(shù)較少，隨訪時(shí)間較短，故不能排除PVP后有增加椎體新發(fā)骨折的風(fēng)險(xiǎn)。
[Abstract]:The purpose of the application of percutaneous vertebroplasty (percutaneous, vertebroplasty, PVP) in treatment of osteoporotic vertebral compression fractures (osteoporotic vertebral compression fracture, OVCF), the score of visual simulation before and after operation (VAS score), Oswestry disability index (Oswestry Disability, Index, ODI), kyphosis Cobb angle and spinal kyphosis comparison evaluation of percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fractures.
Methods from June 1, 2010 to September 1, 2011 in the Department of orthopedics, Affiliated Hospital of Hebei United University (Hebei province Tangshan City second hospital) spine surgery to collect old osteoporotic vertebral compression fractures were 41 cases. 19 cases were male, 22 were female; the average age is 60~83 years old, 67.5 years old; the course of 3~12 weeks, average 5.9 weeks. All patients have suffered from back intractable pain history, daily activity limitation, X-ray, CT, MRI examination confirmed after single segment of old OVCF. fracture of vertebral body: T113 cases, T1210 cases, L117 cases, L29 cases, L32 cases. The preoperative and postoperative 3 days, 3 months, December, visual analogue scale (VAS score), Oswestry disability index (Oswestry Disability, Index, ODI), the clinical curative effect of kyphosis Cobb angle and PVP angle of kyphosis evaluation. All patients received the treatment of percutaneous vertebroplasty under local anesthesia, the operation went smoothly, after Yan Close observation of vital signs of patients and lower limbs feeling, movement, given an intravenous infusion of antibiotics to prevent infection treatment. Patients in bed for 1 days, second days after the surgery bed. Postoperative X-ray and CT examination regularly. 3 days after the operation statistics and measurement, 3 months, 12 months VAS score, ODI index, kyphosis Cobb angle, kyphosis angle.
緇撴灉鎵

本文編號(hào)：1470370