發(fā)布時間：2018-06-04 15:27

  本文選題：椎體壓縮骨折 + 骨質(zhì)疏松癥　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景脊椎壓縮骨折(VC)因其連帶的社會經(jīng)濟負(fù)擔(dān)正受到越來越廣泛的關(guān)注。VC被認(rèn)為是骨質(zhì)疏松的標(biāo)志之一,能夠?qū)е乱幌盗兄苯蛹伴g接的健康問題,同時對社會衛(wèi)生系統(tǒng)也帶來了不小的負(fù)擔(dān)。隨著全球老齡化的不斷增長,骨質(zhì)疏松性VC及相關(guān)并發(fā)癥的發(fā)生率將不斷增加。VC的主要癥狀為腰部局部疼痛,約84%的VC患者存在上述表現(xiàn)。日�；顒邮芟�,自理能力降低,抑郁,行動不便及平衡性降低共同導(dǎo)致了這部分病人存在較高的整體疾病發(fā)病率和死亡率。治療此類骨折仍存在挑戰(zhàn),雖然目前存在多種手段,但均存在一定限制。近年來由于微創(chuàng)技術(shù)的不斷成熟,經(jīng)皮椎體成形及后凸成形術(shù)漸漸取代了傳統(tǒng)手術(shù)方法,成為治療VC的標(biāo)準(zhǔn)術(shù)式。骨水泥的增強作用緩解了藥物治療無效的椎體骨折,緩解了疼痛并改善了功能。椎體成形術(shù)藉由向椎體內(nèi)注入骨水泥實現(xiàn)緩解疼痛癥狀的同時預(yù)防椎體進(jìn)一步塌陷的目的。后凸成形術(shù)則在注入骨水泥前使用球囊將擬注射區(qū)域進(jìn)行擴張,有利于恢復(fù)椎體高度,并能夠預(yù)防低壓注射相關(guān)的骨水泥滲出。本研究擬比較在局麻和全麻操作下進(jìn)行的癥狀性骨質(zhì)疏松椎體骨折患者椎體成形術(shù)及后凸成形術(shù)兩種手術(shù)方式的效果及預(yù)后,相關(guān)評價指標(biāo)包括疼痛緩解程度、后凸矯正率及椎體前緣高度的重建效果。方法回顧性分析在大連醫(yī)科大學(xué)附屬第二醫(yī)院脊柱外科行椎體重建手術(shù)的47例(11例男性,36例女性)患者資料。其中13例行椎體成形術(shù)、34例行后凸成形術(shù)。34例在局麻下進(jìn)行,13例行全麻。共計治療63節(jié)椎體,涉及節(jié)段含T8-L5水平;椎體成形治療17節(jié)椎體,后凸成形治療46節(jié)椎體。全部操作在C臂輔助下完成。術(shù)前術(shù)后的側(cè)位平片用于測量椎體高度和和局部后凸角度。使用SPSS 22.0進(jìn)行數(shù)據(jù)分析。結(jié)果47例患者(平均年齡74.57±8.38歲)分成兩組:椎體成形組(13例,平均年齡75.38±5.36歲)及后凸成形組(34歲,平均年齡74.26±9.33歲),組間年齡無統(tǒng)計學(xué)差異(t=0.046,p=0.687)。11例男性患者平均年齡78.91±6.95歲,36例女性患者平均年齡73.25±8.41歲,男女年齡差存在統(tǒng)計學(xué)差異(t=2.025,p=0.049)。34例患者在局麻下手術(shù)(平均年齡75.71±9.02歲),其余13例全麻下進(jìn)行手術(shù)(平均年齡71.62±5.67歲),組間無統(tǒng)計學(xué)差異(t=1.518,p=0.136)。椎體成形組含1例男性,其余12例為女性。后凸成形組含10例男性和24例女性,男女構(gòu)成在兩組間無統(tǒng)計學(xué)差異(χ2=2.475,p=0.116)。47例患者存在1到4節(jié)椎體骨折,17例行椎體成形,46例行后凸成形。骨折涉及節(jié)段包括T8-L5。平均椎體前緣高度(AVH)在后凸成形組為(21.65±3.66 mm),相比椎體成形組(21.35±4.12 mm)更高但無統(tǒng)計學(xué)差異(t=-0.278,p=0.782)。術(shù)后后凸成形組AVH為(23.39±3.54 mm),與椎體成型組(22.53±3.92 mm)相比更高,但同樣沒有統(tǒng)計學(xué)差異(t=-0.833,p=0.408)。兩組治療前后比較,可見術(shù)后AVH均均較術(shù)前明顯增加(椎體成形組:術(shù)前21.35±4.12,術(shù)后22.53±3.92 mm,t=-3.305,p=0.004;術(shù)前21.65±3.66 mm,術(shù)后23.39±3.54 mm,t=-9.676,p=0.000)。椎體成形組術(shù)后AVH高度增加6.09±7.61%,與后凸成形術(shù)組的高度增加幅度(8.53±6.42%)相比,增幅較小,但組間無統(tǒng)計學(xué)差異(t=-1.269,p=0.209)。全麻患者AVH增加幅度較大(全麻:9.08±6.00%,局麻:7.22±7.16%),但兩組間無統(tǒng)計學(xué)差異(t=-1.037,p=0.304)。具體到組內(nèi),椎體成形組中局麻患者的AVH恢復(fù)程度更高(局麻6.41±7.37%,全麻3.75±12.37%),但無統(tǒng)計學(xué)差異(t=0.452,p=0.658)。后凸成形組中全麻患者的AVH恢復(fù)程度更高(全麻9.61±5.34%,局麻7.69±7.14%),但無統(tǒng)計學(xué)差異(t=-1.006,p=0.320)。在局麻患者中行椎體成形術(shù)者的AVH恢復(fù)程度稍低(椎體成形:6.41±7.37%,后凸成形:7.69±7.14%),但不存在統(tǒng)計學(xué)差異(7.69±7.14%)。全麻患者中同樣存在類似現(xiàn)象(椎體成形:3.75±12.37%,后凸成形:9.61±5.34%),但同樣不存在統(tǒng)計學(xué)差異(t=-1.342,p=0.195)。術(shù)前后凸角度(LKA)在后凸成形組更大(后凸成形組:21.65±3.66°,椎體成形組:14.65±9.38°),但無統(tǒng)計學(xué)差異(t=0.056,p=0.956)。術(shù)后LKA在椎體成型組更大(椎體成形組:14.06±9.33°,后凸成形組:13.30±6.87°),但同樣沒有統(tǒng)計學(xué)差異(t=0.350,p=0.728)。行椎體成型治療患者的術(shù)前及術(shù)后LKA無統(tǒng)計學(xué)差異(術(shù)前14.65±9.38°,術(shù)后14.06±9.33°;t=1.571,p=0.136)。行后凸成形治療患者的術(shù)前及術(shù)后LKA存在統(tǒng)計學(xué)差異(術(shù)前:14.52±7.28°,術(shù)后13.30±6.87°;t=4.085,p=0.000)。相較術(shù)前角度,后凸成形組的LKA矯正率{(術(shù)后角度-術(shù)前角度)/術(shù)前角度}更大,但兩治療組間比較無統(tǒng)計學(xué)差異(后凸成形組:-9.12±19.77%,椎體成形組:-4.55±12.43%;t=0.887,p=0.379)。在全部行局麻處置的患者,平均LKA矯正率為-8.90±21.61%,在全麻處置的患者這一數(shù)據(jù)為-5.99±8.48%,二者相比不存在統(tǒng)計學(xué)差異(t=-0.604,p=0.548)。在椎體成形組,依據(jù)麻醉方法細(xì)分:行全麻的患者LKA矯正率為-13.33±4.71%,局麻患者LKA矯正率為-3.38±12.75%,兩種麻醉方式并不影響LKA矯正率(t=1.068,p=0.302)。在后凸成形組同樣依據(jù)麻醉方法細(xì)分:行全麻的患者LKA矯正率為-5.26±8.49%,局麻患者LKA矯正率為-12.08±25.05%,兩種麻醉方式并不影響LKA矯正率(t=-1.165,p=0.250)。在全部行局麻患者中,后凸成行者的LKA矯正率較大(后凸成行者:-12.08±25.05%,椎體成形者:-3.38±12.75%),兩種術(shù)式間不存在統(tǒng)計學(xué)差異。在全部行全麻患者中,后凸成行者的LKA矯正率較小(后凸成行者:-5.26±8.49%,椎體成形者:-13.33±4.71%),兩種術(shù)式間不存在統(tǒng)計學(xué)差異。結(jié)論我們的研究顯示椎體加強手術(shù)——包括椎體成形和后凸成形術(shù)都能緩解椎體骨折患者的腰痛癥狀并提升椎體前緣高度,但二者間上述指標(biāo)不存在優(yōu)劣之分。雖然后凸成形術(shù)在減小LKA方面的表觀作用更佳,但數(shù)據(jù)分析提示其與椎體成形術(shù)的效果沒有統(tǒng)計學(xué)差異。另外,兩種治療方式在采用局麻或全麻時并不存在療效差異。
[Abstract]:Background spinal compression fracture (VC) is becoming more and more widely concerned with its social and economic burden. It is considered to be one of the signs of osteoporosis. It can lead to a series of direct and indirect health problems, and it also brings a little burden to the social health system. With the growing global aging, the osteoporotic VC The incidence of the associated complications will increase the main symptoms of.VC for local pain in the lumbar region, and about 84% of the VC patients have the above performance. Limited daily activities, lower self-care ability, depression, mobility and reduction of balance result in higher overall morbidity and mortality in this part of the patients. Treatment of such fractures still remains. In recent years, although there are many kinds of means, there are some restrictions. In recent years, due to the continuous maturation of minimally invasive techniques, percutaneous vertebroplasty and kyphoplasty have gradually replaced the traditional surgical method and become the standard operation for the treatment of VC. The enhancement of bone cement relieves the fracture of the vertebral body, relieves the pain and changes the pain. Good function. Vertebroplasty is aimed at alleviating pain symptoms by injecting bone cement into the vertebral body to prevent further collapse of the vertebral body. Kyphoplasty is used to expand the area of the injected area before injection of bone cement. It is beneficial to restore the height of the vertebral body and to prevent the infiltration of bone cement related to low pressure injection. The results and prognosis of two surgical methods of vertebroplasty and kyphoplasty in patients with symptomatic osteoporotic vertebral fractures under local anesthesia and general anesthesia are compared. The related evaluation indexes include the degree of pain relief, the correction rate of kyphosis and the reconstruction effect of the height of the anterior edge of the vertebral body. Methods a retrospective analysis was attached to the Dalian Medical University. The data of 47 cases (11 men and 36 women) were performed in spinal surgery in second hospital, of which 13 cases were vertebroplasty, 34 cases were performed under local anesthesia and 13 cases were performed under local anesthesia, 13 were treated with 47 vertebral bodies, involving the segment containing T8-L5 level, vertebral body formation for 17 vertebrae, and kyphoplasty for 46 vertebrae. All operations were performed with C arm assistance. The preoperative and postoperative lateral plate was used to measure the vertebral height and the local kyphosis angle. Data analysis was performed using SPSS 22. Results 47 patients (average age 74.57 + 8.38 years old) were divided into two groups: Vertebroplasty group (13 cases, average age 75.38 + 5.36 years) and kyphosis group (34 years old, average age 74.26 + 9.3 3 years old), there was no statistical difference between groups (t=0.046, p=0.687), the average age of male patients with.11 was 78.91 + 6.95 years old, and the average age of 36 female patients was 73.25 + 8.41 years old. The difference of age between men and women was statistically different (t=2.025, p=0.049).34 patients operated under local anesthesia (average age 75.71 + 9.02 years old), and the other 13 cases were operated under general anesthesia (average age). There was no statistical difference between 71.62 + 5.67 years (t=1.518, p=0.136). There were 1 males and 12 women in the vertebroplasty group. There were 10 males and 24 females in the kyphoplasty group. There was no statistical difference between the two groups (x 2=2.475, p=0.116). There were 1 to 4 vertebral fractures, 17 vertebroplasty, 46 kyphoplasty. The segmental segment included the T8-L5. average vertebral anterior edge height (AVH) in the kyphoplasty group (21.65 + 3.66 mm), higher than the vertebroplasty group (21.35 + 4.12 mm), but there was no statistical difference (t=-0.278, p=0.782). The postoperatively kyphoplasty group AVH was (23.39 + 3.54 mm), and was higher than the vertebral body forming group (22.53 + 3.92 mm), but there was no statistical difference. T=-0.833, p=0.408). The comparison of the two groups before and after treatment showed that all the postoperative AVH were significantly increased (vertebroplasty group: preoperative 21.35 + 4.12, 22.53 + 3.92 mm postoperatively, t=-3.305, p=0.004; 21.65 + 3.66 mm before operation, 23.39 + 3.54 mm, t=-9.676, p=0.000). The height of AVH in the group of vertebral bodies was increased by 6.09 + 7.61%, and the height of the protruding group was increased. Compared with the amplitude (8.53 + 6.42%), the increase was small, but there was no statistical difference between the groups (t=-1.269, p=0.209). The increase of AVH in the patients with general anesthesia was larger (9.08 + 6% and 7.22 + 7.16%), but there was no statistical difference between the two groups (t=-1.037, p=0.304). The degree of AVH recovery was higher in the group in the group. (local anesthesia 6.41 + 7.37%,) The general anesthesia was 3.75 + 12.37%), but there was no statistical difference (t=0.452, p=0.658). The degree of AVH recovery in the patients with general anesthesia in the kyphosis group was higher (9.61 + 5.34% and 7.69 + 7.14%), but there was no statistical difference (t=-1.006, p=0.320). The degree of AVH recovery was slightly lower in the patients who underwent vertebroplasty in the local anesthesia patients (6.41 + 7.37%, and kyphoplasty: 7.69 +. 7.14%), but there was no statistical difference (7.69 + 7.14%). There were similar phenomena in general anesthesia (vertebroplasty: 3.75 + 12.37%, and kyphosis: 9.61 + 5.34%), but there was no statistical difference (t=-1.342, p=0.195). The protruding angle (LKA) before and after operation was larger in the kyphoplasty group (kyphosis group: 21.65 + 3.66 degrees, vertebroplasty group: 14.65 + 9.38 degrees. But there was no statistical difference (t=0.056, p=0.956). The postoperative LKA was larger in the vertebroplasty group (14.06 + 9.33 degrees and 13.30 + 6.87 degrees in the kyphoplasty group), but there was no statistical difference (t=0.350, p=0.728). There was no statistical difference between preoperative and postoperative LKA (14.65 + 9.38 degrees before operation, 14.06 + 9.33 degree after operation), t=1.571, P=0.136). There were statistical differences between preoperative and postoperative LKA (preoperative: 14.52 + 7.28 degrees, 13.30 + 6.87 degrees, t=4.085, p=0.000). Compared with the pre operation angle, the LKA correction rate {(after operation angle to preoperative angle) / preoperative angle} was greater, but there was no statistical difference between the two treatment groups (kyphoplasty group: -9.12 19.77%, vertebroplasty: -4.55 + 12.43%; t=0.887, p=0.379). The average correction rate of LKA was -8.90 21.61% in all patients treated with local anesthesia. The data was -5.99 8.48% in the patients treated with general anesthesia, and there was no statistical difference between the two (t=-0.604, p=0.548). In the vertebroplasty group, the anesthesia was subdivided: LKA in general anesthesia patients. The correction rate was -13.33 + 4.71% and the correction rate of LKA in the local anesthesia patients was -3.38 12.75%. The two anesthesia methods did not affect the correction rate of LKA (t=1.068, p=0.302). In the kyphosis group, the same according to the anesthesia method subdivision: the LKA correction rate of the patients undergoing general anesthesia was -5.26 + 8.49%, the LKA correction rate of the local anesthesia patients was -12.08 + 25.05%, and the two anesthesia methods did not affect LKA. The correction rate (t=-1.165, p=0.250). In all patients with local anesthesia, the correction rate of LKA was larger in the kyphosis Walker (kyphosis traveler: -12.08 + 25.05%, vertebroplasty: -3.38 12.75%), and there was no statistical difference between the two types of operation. In all patients with general anesthesia, the correction rate of LKA was smaller (kyphotic Walker: -5.26 + 8.49%, vertebral body formation). Conformers: -13.33 + 4.71%), there is no statistical difference between the two types of operation. Conclusion our study showed that vertebral augment surgery, including vertebroplasty and kyphosis, could relieve the symptoms of lumbago and enhance the height of the vertebral anterior edge of vertebral fractures, but the above indicators did not exist between the two. Although kyphoplasty was reduced by L The apparent effect of KA is better, but data analysis suggests that there is no statistical difference in the effect of vertebroplasty. In addition, there is no difference in efficacy between the two treatments in the use of local anesthesia or general anesthesia.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 袁文;謝寧;;椎體成形術(shù)與后凸成形術(shù)的臨床應(yīng)用及相關(guān)問題[J];中國骨傷;2010年10期

2 傅建淞;莊新明;付長峰;曲志剛;姜亦坤;劉一;;球囊擴張后凸成形術(shù)治療骨質(zhì)疏松性椎體壓縮骨折的療效及安全性評價[J];吉林大學(xué)學(xué)報(醫(yī)學(xué)版);2012年05期

3 葉添文,賈連順;后凸成形術(shù)應(yīng)用于骨質(zhì)疏松性椎體壓縮性骨折的現(xiàn)狀[J];中國脊柱脊髓雜志;2002年04期

4 許明嫻;經(jīng)皮后凸成形術(shù)的手術(shù)配合2例[J];中國實用護(hù)理雜志;2005年02期

5 顧曉暉;楊惠林;張U，

本文編號：1977880