本文選題：骨質(zhì)疏松性椎體骨折　切入點(diǎn)：遠(yuǎn)程遙控骨水泥推注系統(tǒng)　出處：《中國(guó)修復(fù)重建外科雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的通過與術(shù)中間斷手推注骨水泥進(jìn)行比較,評(píng)估遠(yuǎn)程遙控骨水泥推注系統(tǒng)(remote controlled injection manipulator system,RCIM)輔助經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)治療后壁破裂型骨質(zhì)疏松性椎體骨折的效果。方法回顧分析2010年9月—2016年1月收治并符合選擇標(biāo)準(zhǔn)的48例行PKP治療的單節(jié)段后壁破裂型骨質(zhì)疏松性胸腰椎骨折老年患者臨床資料,根據(jù)術(shù)中骨水泥推注方式分為2組:對(duì)照組22例采用手推桿間斷推注骨水泥,試驗(yàn)組26例采用RCIM輔助推注骨水泥。兩組患者性別、年齡、病程、致傷原因、累及椎體、骨密度T值、疼痛持續(xù)時(shí)間及術(shù)前疼痛視覺模擬評(píng)分(VAS)、傷椎前緣相對(duì)高度、傷椎后凸Cobb角等一般資料比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。記錄兩組術(shù)中骨水泥灌注期時(shí)間、醫(yī)患雙方接受輻射劑量、骨水泥注入量;采用VAS評(píng)分、傷椎后凸Cobb角、傷椎前緣相對(duì)高度、骨水泥彌散面積比值、骨水泥滲漏率評(píng)價(jià)療效。結(jié)果兩組患者均獲隨訪,隨訪時(shí)間6個(gè)月。術(shù)后均無骨水泥毒性反應(yīng),無脊髓、神經(jīng)損傷,無感染、血管栓塞等并發(fā)癥發(fā)生。兩組骨水泥注入量及術(shù)者接受輻射劑量比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),但試驗(yàn)組骨水泥灌注期時(shí)間、骨水泥彌散面積比值及患者接受輻射劑量顯著少于對(duì)照組(P0.05)。對(duì)照組和試驗(yàn)組分別有6例(27.27%)和2例(7.69%)出現(xiàn)骨水泥滲漏,比較差異有統(tǒng)計(jì)學(xué)意義(χ~2=4.850,P=0.029);兩組均無經(jīng)后壁向椎管內(nèi)滲漏。兩組術(shù)后3 d及6個(gè)月VAS評(píng)分、傷椎前緣相對(duì)高度和傷椎后凸Cobb角均較術(shù)前顯著改善(P0.05);兩組間以上指標(biāo)比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 RCIM輔助PKP治療后壁破裂型骨質(zhì)疏松性椎體骨折可獲得滿意臨床效果,縮短了灌注期時(shí)間,可有效減少患者接受輻射劑量,降低骨水泥滲漏發(fā)生率。
[Abstract]:Objective to compare bone cement with intermittent manual injection during operation. To evaluate the effect of remote controlled injection manipulator system (RCIM-assisted percutaneous kyphoplastysia PKK) in the treatment of posterior wall ruptured osteoporotic vertebral fracture. Methods from September 2010 to January 2016, we retrospectively analyzed the effect of percutaneous kyphoplast kyphoplasty in the treatment of osteoporotic vertebral fracture of posterior wall rupture. Clinical data of 48 elderly patients with single segmental posterior wall ruptured osteoporotic thoracolumbar fracture treated with PKP were selected. According to the intraoperative method of bone cement injection, the patients in the control group were divided into two groups: the control group (22 cases) received intermittent injection of bone cement by hand push rod, and the experimental group (26 cases) were treated with RCIM assisted injection of bone cement, the sex, age, course of disease, cause of injury, and vertebral body involvement in the two groups. T value of bone mineral density, duration of pain, visual analogue score of pain before operation, relative height of anterior edge of injured vertebrae, Cobb angle of kyphosis were compared. The difference was not statistically significant (P 0.05), which was comparable. The time of bone cement perfusion in the two groups was recorded, the dose of radiation and the amount of bone cement injected were recorded, the VAS score was used to evaluate the Cobb angle of kyphosis and the relative height of the anterior edge of the injured vertebrae. Results the patients in both groups were followed up for 6 months. There was no toxic reaction of bone cement, no spinal cord, no nerve injury, no infection, no spinal cord injury and no infection. Complications such as vascular embolism occurred. There was no significant difference between the two groups in bone cement injection and radiation dose, but the time of bone cement perfusion in the experimental group was not significantly different from that in the control group. Bone cement diffusion area ratio and radiation dose in patients were significantly lower than those in control group (P 0.05). Bone cement leakage was found in 6 cases in the control group and in 2 cases in the test group (P = 27.27) and 2 cases in the control group (n = 2). The difference was statistically significant (蠂 ~ (2 +) 4.850). There was no posterior wall leakage in the two groups. The VAS score was 3 days and 6 months after operation in the two groups. The relative height of the anterior edge of the injured vertebrae and the Cobb angle of the injured vertebral kyphosis were significantly improved compared with those before operation, and there was no significant difference in the above indexes between the two groups. Conclusion RCIM assisted with PKP can obtain satisfactory clinical results in the treatment of posterior wall ruptured osteoporotic vertebral fracture. The time of perfusion can be shortened, the radiation dose can be reduced effectively, and the incidence of cement leakage can be reduced.
【作者單位】： 來賓市人民醫(yī)院脊柱外科;
【分類號(hào)】：R580;R687.3
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本文編號(hào)：1609216