本文關(guān)鍵詞： 經(jīng)皮穿刺椎體成形術(shù) 經(jīng)椎弓根植骨 胸腰椎骨折　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討經(jīng)皮穿刺椎體內(nèi)植骨成形術(shù)治療無神經(jīng)損傷的胸腰椎壓縮骨折的臨床療效。方法:本研究通過收集2014年12月至2016年2月因胸腰椎壓縮骨折在我院骨科住院并行經(jīng)皮穿刺椎體內(nèi)植骨成形術(shù)治療的患者共36例,其中男性21例,女性15例,平均年齡43.5±9.3(19-64)歲。神經(jīng)功能按Frankel分級均為E級。骨折節(jié)段:T12合并L11例,T116例,T1210例,L112例,L26例,L31例。骨折類型:均為單純壓縮骨折。術(shù)前計算好植骨需要量,術(shù)中記錄手術(shù)時間、出血量及植骨量,分別于術(shù)前、術(shù)后3 d、術(shù)后3個月、術(shù)后6個月、術(shù)后1年對患者進(jìn)行隨訪,獲得疼痛程度、X線片和CT或MRI資料。得到本組患者各隨訪時間點的VAS評分值、傷椎椎體前緣高度百分比(AVH%)及后凸畸形角度(Cobb'角)數(shù)據(jù),并做統(tǒng)計學(xué)對比分析,評估臨床效果。結(jié)果:本組患者均獲得良好隨訪,平均隨訪時間14個月(12-20個月),手術(shù)時間平均為55min,術(shù)中平均出血量12ml,平均植骨量8.7±1.2 g(8-10g)。疼痛程度改善情況:VAS評分術(shù)后3天從術(shù)前7.3±0.9下降至2.8±0.6,3月時為2.0±0.5,6月時為1.4±0.5,1年時為1.1±0.5。傷椎前緣高度和后凸畸形角度(Cobb'角)方面,傷椎椎體前緣高度百分比(AVH%)術(shù)后3天從術(shù)前62.8%±3.4%恢復(fù)至90.4%±3.0%,3個月時為88.1%±2.9%,6個月時為87.3%±2.9%,1年時為87.0%±2.9%。后凸畸形角度(Cobb'角)術(shù)后3天從18.6±2.5°下降至3.5±0.6°,3個月時為4.8±0.9°,6個月時為5.1±0.9°,1年時為5.4±0.9°。所有患者均獲得良好的骨性愈合,未出現(xiàn)神經(jīng)功能受損,無頑固性腰背痛殘留,無進(jìn)行性后凸畸形加重等并發(fā)癥發(fā)生。結(jié)論:對于無神經(jīng)損傷胸腰椎壓縮骨折的患者,經(jīng)皮穿刺椎體內(nèi)植骨成形術(shù)可有效恢復(fù)傷椎的結(jié)構(gòu)完整性和穩(wěn)定性,早期能有效緩解傷椎疼痛,減輕患者臥床及康復(fù)鍛煉時的痛苦,椎體內(nèi)充分的打壓植骨在恢復(fù)并維持椎體高度的同時避免了“蛋殼樣”椎體的發(fā)生,進(jìn)而減少了進(jìn)行性后凸畸形加重、頑固性腰背痛等并發(fā)癥的發(fā)生。經(jīng)皮穿刺椎體內(nèi)植骨成形術(shù)具有創(chuàng)傷小、安全性高、并發(fā)癥少等優(yōu)點,是一種安全、有效的微創(chuàng)手術(shù)治療方法。
[Abstract]:Objective: to investigate the clinical effect of percutaneous vertebroplasty in the treatment of thoracolumbar compression fractures without nerve injury. Methods: from December 2014 to February 2016, this study was carried out in orthopedic department of our hospital by collecting thoracolumbar compression fractures from December 2014 to February 2016. A total of 36 patients were hospitalized and treated with percutaneous vertebroplasty. Among them, 21 cases were male, 15 cases were female, mean age was 43.5 鹵9.3 鹵19-64 years old. The neurological function was grade E according to Frankel grade. The time of operation, the amount of blood loss and the amount of bone graft were recorded during the operation. The patients were followed up before, 3 days, 3 months, 6 months and 1 year after operation, respectively. X-ray films and CT or MRI data of pain degree were obtained. The data of VAS score, anterior height percentage of injured vertebrae and angle of kyphosis deformity were obtained, and the data were compared and analyzed statistically. Results: all the patients were followed up well. The mean follow-up time was 14 months to 20 months, the average operative time was 55 minutes, the average amount of blood loss during operation was 12 ml, the average bone graft volume was 8.7 鹵1.2 g / L and the mean bone graft volume was 8. 8 鹵0. 6 g / L. The improvement of pain degree decreased from 7. 3 鹵0. 9 before operation to 2. 8 鹵0. 6 at 3 days after operation, 2. 0 鹵0. 5 on March, 1.4 鹵0. 5 on June, and 1 year after operation. 1. 1 鹵0. 5. Anterior height of injured vertebrae and angle of kyphosis. The percentage of anterior height of injured vertebrae recovered from 62.8% 鹵3.4% to 90.4% 鹵3.0, 88.1% 鹵2.9 at 3 months, 87.3% 鹵2.9 at 6 months, 87.0% 鹵2.9 at 1 year). The angle of kyphosis decreased from 18.6 鹵2.5 擄to 3.5 鹵0.6 擄, 4.8 鹵0.9 擄at 3 months, 5.1 鹵0.9 擄at 6 months, and 5.1 鹵0.9 擄at 1 year. 5.4 鹵0.9 擄. Good bone healing was achieved in all patients. There were no complications such as no neurological impairment, no residual intractable low back pain, no exacerbation of progressive kyphosis, etc. Conclusion: for patients with compression fracture of thoracolumbar vertebrae without nerve injury, Percutaneous transluminal osteoplasty can effectively restore the structural integrity and stability of the injured vertebrae, relieve the pain of the injured vertebrae in the early stage, and relieve the pain of the patients during bed rest and rehabilitation exercise. Adequate compression of the vertebrae and bone graft can restore and maintain the height of the vertebrae while avoiding the occurrence of "eggshell like" vertebrae, thereby reducing the exacerbation of progressive kyphosis. Percutaneous vertebroplasty has the advantages of small trauma, high safety and less complications, so it is a safe and effective minimally invasive surgical treatment.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 徐華梓;田乃鋒;;關(guān)于胸腰椎損傷分類及嚴(yán)重程度評分系統(tǒng)的若干反思[J];中華創(chuàng)傷雜志;2016年05期

2 董學(xué)亮;倪飛;張政宏;黃海;成羿;;胸腰椎壓縮性骨折保守治療同PKP術(shù)治療的比較[J];中國中醫(yī)骨傷科雜志;2016年02期

3 唐曉明;戴健;朱國太;孫海浪;費昊東;;聚甲基丙烯酸甲酯骨水泥椎體成形治療高齡骨質(zhì)疏松性胸腰椎骨折[J];中國組織工程研究;2015年47期

4 遇呈祥;王忠平;邱渝江;姜光財;舒華;傅杰;;經(jīng)皮椎體成形術(shù)治療骨質(zhì)疏松型胸腰椎壓縮性骨折的臨床評價[J];骨科;2015年04期

5 周英杰;趙鵬飛;鄭懷亮;李立新;趙剛;;兩種骨水泥應(yīng)用于老年胸腰椎骨折椎體成形術(shù)的療效觀察[J];中國矯形外科雜志;2015年04期

6 王勇;;經(jīng)椎弓根椎體內(nèi)植骨在胸腰椎爆裂性骨折中的應(yīng)用[J];實用臨床醫(yī)藥雜志;2015年03期

7 丁富軍;顧國明;龔景海;;PVP和PKP治療中重度椎體壓縮骨折的療效比較[J];中國骨與關(guān)節(jié)損傷雜志;2014年11期

8 聶鋒鋒;張英華;黃壽國;鞠亮;陳波;;經(jīng)皮微創(chuàng)椎弓根螺釘內(nèi)固定與開放手術(shù)治療胸腰椎骨折:Cobb’s角與椎體前緣高度恢復(fù)的比較[J];中國組織工程研究;2014年44期

9 麥合木提江·穆海麥提;祝少博;李景峰;金林;蘇日罕;王希;;兩種方法治療骨質(zhì)疏松致椎體壓縮性骨折:安全與有效性的Meta分析[J];中國組織工程研究;2014年22期

10 劉建泉;于遠(yuǎn)洋;孔祥錄;黃寶良;王傳宇;崔成亮;高畔;;經(jīng)椎弓根椎體內(nèi)植骨治療胸腰椎骨折的影像學(xué)觀察[J];中國骨與關(guān)節(jié)雜志;2014年01期

相關(guān)碩士學(xué)位論文 前1條

1 王驊;經(jīng)椎弓根植骨治療腰椎骨折的生物力學(xué)研究[D];揚州大學(xué);2007年

，

本文編號：1551489