本文關(guān)鍵詞： 導(dǎo)航 PKP 胸腰椎骨折 個體化　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討光電導(dǎo)航引導(dǎo)個體化穿刺椎體后凸成形術(shù)(Percutaneous kyphoplasty,PKP)治療胸腰椎骨質(zhì)疏松性骨折(Osteoporosis vertebral compression fracture,OVCF)的安全性和有效性。方法:自貢市第四人民醫(yī)院骨科2012年11月~2014年09月采用PKP治療OVCF63例,共82個椎體。其中男12例,女51例。年齡61~86歲,平均年齡71.2歲。根據(jù)導(dǎo)航方式分為兩組:試驗組為光電導(dǎo)航引導(dǎo)個體化穿刺PKP共32例43個椎體,男6例,女26例,年齡62-85歲,平均年齡71.7歲;對照組為常規(guī)C型臂X線機透視下穿刺PKP共31例39個椎體,男6例,女25例,年齡61-86歲,平均年齡70.8歲。兩組患者性別、年齡、病因、VAS評分、患椎分布等一般資料比較,差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。兩組手術(shù)前后進行VAS評分,術(shù)中記錄單側(cè)穿刺成功數(shù)、X線暴露次數(shù)、穿刺次數(shù)及手術(shù)時間,術(shù)后在X線片和CT上觀察椎弓根穿破、骨水泥滲漏情況,術(shù)后記錄血管、神經(jīng)、腦脊液漏等其他并發(fā)癥,并進行統(tǒng)計學(xué)比較。結(jié)果:術(shù)后試驗組椎弓根穿破0例、骨水泥滲漏1例,對照組椎弓根穿破2例、骨水泥滲漏5例,兩組均無血管、神經(jīng)、腦脊液漏等其他并發(fā)癥發(fā)生。術(shù)后24h后試驗組VAS評分與對照組比較,差異無統(tǒng)計學(xué)意義(P0.05);組內(nèi)與術(shù)前比較,差異有統(tǒng)計學(xué)意義(P0.05)。術(shù)中試驗組X線暴露次數(shù)、穿刺次數(shù)明顯少于對照組(P0.05),而兩組手術(shù)時間比較,差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)中試驗組單側(cè)穿刺成功率明顯高于對照組(P0.05)。術(shù)后試驗組椎弓根穿破、骨水泥滲漏、血管、神經(jīng)及腦脊液漏等并發(fā)癥發(fā)生率明顯低于對照組(P0.05)。結(jié)論:光電導(dǎo)航引導(dǎo)個體化穿刺PKP治療OVCF中,單側(cè)穿刺即可達到傳統(tǒng)方法雙側(cè)穿刺的效果;手術(shù)時間與對照組無明顯差異,并沒有增加術(shù)者的工作量和患者的耐受時間,因此本方法有較好的臨床效果。光電導(dǎo)航引導(dǎo)個體化穿刺術(shù)中,單側(cè)穿刺成功率高、穿刺次數(shù)少,與對照組比較穿刺準確性明顯提高;而術(shù)中X線暴露次數(shù)少,椎弓根穿破率、骨水泥滲漏率低,沒有血管、神經(jīng)、腦脊液漏等其他并發(fā)癥,因此本方法安全性較高。光電導(dǎo)航系統(tǒng)對穿刺外傾角度的把握更精確,可依據(jù)導(dǎo)航屏幕上光標延長線的距離來判斷,減少了C型臂X線機導(dǎo)航常依靠術(shù)者手感、經(jīng)驗以及患者體位變化所帶來的誤差。
[Abstract]:Objective: to investigate the percutaneous kyphoplasty guided by photo-electronic navigation through individualized lumbar kyphoplasty. Vertebral compression fracture in the treatment of osteoporotic fracture of thoracolumbar vertebrae. Methods: from November 2012 to September 2014, patients with OVCF63 were treated with PKP in orthopedic department of 4th people's Hospital of Zigong. There were 82 vertebrae, including 12 males and 51 females, aged 61 to 86 years. The average age was 71.2 years. According to the navigation mode, the experimental group was divided into two groups: the experimental group consisted of 32 patients (6 males and 26 females, aged 62-85 years) with PKP guided by photo-electronic navigation. The average age was 71.7 years; The control group consisted of 31 patients (6 males and 25 females, aged 61-86 years, with an average age of 70.8 years) who were punctured with PKP under conventional C-arm fluoroscopy. Compared with the general data of etiology and vertebral distribution, the difference was not statistically significant (P 0.05). The VAS score was performed before and after operation in both groups, and the number of successful unilateral puncture was recorded during the operation. X-ray exposure, puncture times and operation time, X-ray film and CT observation of pedicle perforation, bone cement leakage, postoperative records of blood vessels, nerves, cerebrospinal fluid leakage and other complications. Results: there were 0 cases of pedicle perforation, 1 case of bone cement leakage, 2 cases of pedicle perforation and 5 cases of bone cement leakage in the control group. There were no blood vessels and nerves in both groups. Other complications such as cerebrospinal fluid leakage occurred. 24 hours after operation, there was no significant difference in VAS score between the experimental group and the control group (P 0.05). The number of X-ray exposure and puncture times in the experimental group was significantly lower than that in the control group (P 0.05), and the operative time was compared between the two groups. The success rate of unilateral puncture in the test group was significantly higher than that in the control group (P 0.05). The pedicle perforation, bone cement leakage and blood vessel in the experimental group were significantly higher than those in the control group. The incidence of neurologic and cerebrospinal fluid leakage was significantly lower than that of the control group (P 0.05). Conclusion: photoelectric navigation guided individualized puncture PKP in the treatment of OVCF. Unilateral puncture can achieve the effect of bilateral puncture. There was no significant difference between the operation time and the control group, and did not increase the workload of the operator and patient tolerance time, so this method has a better clinical effect. The success rate of unilateral puncture was high and the frequency of puncture was less. Compared with the control group, the accuracy of puncture was improved obviously. But the number of X-ray exposure during the operation, pedicle puncture rate, bone cement leakage rate is low, there are no blood vessels, nerves, cerebrospinal fluid leakage and other complications. Therefore, the security of this method is high. The photoelectric navigation system is more accurate to grasp the angle of external inclination, can be judged according to the distance of the cursor extension line on the navigation screen, reducing the C-arm X-ray machine navigation often rely on the hand of the warlock. Errors caused by experience and changes in patient posture.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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本文編號：1466718