本文選題：經(jīng)皮椎體成形術　切入點：經(jīng)皮椎體后凸成形術　出處：《重慶醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:比較經(jīng)皮椎體成形術(Percutaneous Vertebroplasty,PVP)和經(jīng)皮椎體后凸成形術(Percutaneous Kyphoplasty,PKP)治療脊柱轉(zhuǎn)移瘤,分析其治療效果。方法:2011年5月至2016年5月,對39例(77椎)脊柱轉(zhuǎn)移瘤導致的病理性骨折行微創(chuàng)手術,其中包括PVP 14例(33椎),PKP25例(44椎);測量術前和術后即刻、術后1周、3月、6月、12月的疼痛視覺模擬評分法(Visual Analogue Score,VAS)和Oswestry功能障礙指數(shù)(Oswestry disability index,ODI);比較分析兩組的術后住院時間、骨水泥使用量、手術出血量、病變椎體高度、Cobb角、骨水泥彌散、骨水泥滲漏、經(jīng)濟效用比值、生存時間。結果:全部患者均順利完成手術,38例患者均在術后第一天疼痛得到緩解,1例術后出現(xiàn)疼痛加重;疼痛由術前(7.70±1.11)下降到術后(4.02±2.22),1周(3.50±1.92),3月(3.60±1.00),6個月(3.96±1.02),12月(4.34±1.25);ODI也顯著下降,術前(74.42±8.97)%下降到術后(40.57±21.63)%,1周(37.50±10.45)%,3月(37.27±10.45)%,6月(38.60±8.42)%,12月(37.42±6.68)%。比較兩組術后至出院時間、骨水泥注射量、術中出血量、椎體高度恢復均無顯著性差別;PVP骨水泥滲漏率為42.42%(14/33椎),PKP為(27.27%,12/44椎),無一例出現(xiàn)骨水泥滲漏引起癥狀,通過經(jīng)濟效用比值發(fā)現(xiàn),PVP比PKP性價比更高(P=0.02);且行兩種手術的患者術后生存時間無明顯差異(P=0.38)。結論:PVP和PKP治療脊柱轉(zhuǎn)移瘤均能很好的緩解病椎部位疼痛,提高腫瘤患者生活的質(zhì)量。相比PVP而言,PKP更昂貴,兩者均能部分恢復椎體中部和后緣高度,但不能改善后凸畸形。兩者手術方式對患者生存壽命無差別。
[Abstract]:Objective: to compare the effect of percutaneous Vertebroplasty (PVP) and percutaneous kyphosis (PKP) in the treatment of spinal metastases. A minimally invasive operation was performed on 39 patients with spinal metastases resulting from spinal metastases, including 14 patients with PVP and 33 patients with PKP. Visual Analogue Scorevas (VAS) and Oswestry dysfunction index (Oswestry disability index) were evaluated 1 week after operation, March, June, December. The postoperative hospitalization time, bone cement usage, operative bleeding volume, the height of the lesion vertebral body and the dispersion of bone cement were compared between the two groups. Results: all the 38 patients with successful operation were relieved of pain on the first day after operation and 1 patient had severe pain after operation. The pain decreased from 7.70 鹵1.11 before operation to 3.50 鹵1.92 in 1 week after operation, 3.60 鹵1.00 in March, 3.96 鹵1.02 in 6 months, and 4.34 鹵1.25m on December. It also decreased from 74.42 鹵8.97% preoperatively to 40.57 鹵21.6363 鹵37.50 鹵10.45 in 1 week, 37.27 鹵10.45 in March, 38.60 鹵8.422 in March, 37.42 鹵6.6820 in #date8#, and 37.42 鹵6.680.The time between discharge and discharge was 37.42 鹵6.680.The blood loss was 37.50 鹵10.45, 37.27 鹵10.45, 38.60 鹵8.422, 37.42 鹵6.68 respectively. There was no significant difference in the recovery of vertebral body height. The leakage rate of PVP bone cement was 42.42% and the PKP of 14 / 33 was 27.272712 / 44 vertebrae. None of the cases had symptoms caused by cement leakage. According to the ratio of economic utility, it was found that the cost / performance ratio of PKP was higher than that of PKP, and there was no significant difference in postoperative survival time between the two types of patients. Conclusion the treatment of spinal metastases with PKP and PKP can relieve the pain of spinal metastases. It is more expensive than PVP to improve the quality of life of tumor patients. Both of them can partially recover the height of the middle and posterior edge of vertebral body, but can not improve kyphosis. There is no difference in the survival life between the two surgical methods.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R738

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