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  本文選題：副突定位　切入點：單針穿刺　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討副突定位單針穿刺行椎體成形術(shù)在治療老年骨質(zhì)疏松性腰椎體壓縮性骨折（OVCF）的可行性、臨床療效及診斷與治療要點。 方法：通過使用單針穿刺副突定位椎體成形術(shù)治療老年骨質(zhì)疏松性腰椎壓縮性骨折68例患者，其中76個傷椎，并進行回顧性分析，觀察患者術(shù)前、術(shù)后即刻、術(shù)后1周，術(shù)后3個月、6個月時的VAS評分、改良Macnab評分，進行統(tǒng)計學(xué)比較及分析。 結(jié)果：所有患者均順利完成手術(shù)，術(shù)后較術(shù)前癥狀改善明顯，，疼痛緩解，恢復(fù)正常生活，單個椎體手術(shù)時間為25-40min，平均35min；注射骨水泥量為3.0-6.0ml，平均4.6ml，術(shù)后患者疼痛明顯減輕或消失，恢復(fù)正常生活。患者術(shù)后即刻VAS評分為3.1±0.7，術(shù)后1周為1.8±0.7，術(shù)后3個月為1.5±0.6，術(shù)后6個月為1.6±0.6，所有OVCF患者術(shù)前術(shù)后對比具有統(tǒng)計學(xué)意義（P＜0.05)，術(shù)后1周與術(shù)后3個月、6個月的結(jié)果對比沒有顯著的統(tǒng)計學(xué)差異（P＞0.05)。術(shù)后改良Macnab評定優(yōu)良率在術(shù)后即刻、術(shù)后1周、術(shù)后3個月及術(shù)后6個月達到97%。所有病例沒有穿刺失敗、感染、肺栓塞發(fā)生，在68例患者中有3例病例出現(xiàn)骨水泥滲漏，但沒有臨床癥狀，未發(fā)生骨水泥椎管內(nèi)滲漏，沒有臨床癥狀。 結(jié)論：單針穿刺副突定位椎體成形術(shù)治療老年骨質(zhì)疏松性腰椎壓縮性骨折，通過將穿刺點繼續(xù)向外側(cè)移位，使穿刺終點更容易接近或越過中線，能夠在單針穿刺下獲得更好的骨水泥彌散，減少手術(shù)風(fēng)險、手術(shù)時間及治療費用，并獲得良好療效，值得臨床推廣應(yīng)用。
[Abstract]:Objective: to investigate the feasibility, clinical effect, diagnosis and treatment of osseous lumbar vertebral compression fracture (OVCFC) in elderly patients with paracentesis and single needle vertebroplasty. Methods: Sixty-eight elderly patients with osteoporotic lumbar vertebrae compression fracture were treated with single needle puncture and accessory process positioning vertebroplasty, 76 of which were injured vertebrae. The patients were observed before, immediately after operation and 1 week after operation. The VAS score and modified Macnab score at 3 and 6 months after operation were compared and analyzed statistically. Results: all the patients completed the operation successfully, the postoperative symptoms were improved obviously, the pain was relieved, and the normal life was restored. The operation time of single vertebral body was 25-40 min (mean 35 min), the amount of bone cement injected was 3.0-6.0 ml (mean 4.6 ml), the pain of the patients was relieved or disappeared after operation. The scores of VAS were 3.1 鹵0.7, 1.8 鹵0.7, 1.5 鹵0.6 and 1.6 鹵0.6 at the first week, 3 months and 6 months after operation respectively. There was significant difference between all OVCF patients before and after operation (P < 0.05), 1 week after operation and 3 months and 6 months after operation. There was no significant difference in the results between the two groups (P > 0.05). The excellent and good rate of modified Macnab was evaluated immediately after operation. At 1 week, 3 months and 6 months after operation, 97 cases were involved. No puncture failure, infection, pulmonary embolism occurred in all cases. Bone cement leakage was found in 3 out of 68 patients, but no clinical symptoms were found. There was no osseous leakage in the spinal canal and no clinical symptoms. Conclusion: the treatment of senile osteoporotic lumbar vertebrae compression fracture with single needle puncture accessory process positioning vertebroplasty can make the puncture point more easily approaching or crossing the midline by moving the puncture point to the lateral side. It can obtain better bone cement dispersion under single needle puncture, reduce the operation risk, operation time and treatment cost, and obtain good curative effect. It is worth popularizing and applying in clinic.
【學(xué)位授予單位】：吉林大學(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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