發(fā)布時間：2018-04-05 00:31

  本文選題：PKP　切入點：骨質(zhì)疏松性椎體壓縮骨折　出處：《吉林大學》2017年碩士論文

【摘要】：目的:探討PKP治療老年骨質(zhì)疏松性椎體壓縮骨折骨水泥注射劑量與止痛效果的相關(guān)性。方法:選取2015年10月至2016年9月期間收入我院治療的具有完整影像學資料并符合PKP手術(shù)適應癥的老年骨質(zhì)疏松性椎體壓縮骨折的病人90例(140個椎體)作為研究對象,病人年齡范圍為65歲-81歲,累及椎體范圍為T10-L3。依據(jù)術(shù)中給予的不同骨水泥劑量將所有患者分為A組(小劑量骨水泥1-3ml),20例患者(20個椎體);B組(常規(guī)劑量骨水泥3-6ml),65例患者(115個椎體);C組(大劑量骨水泥6ml),5例患者(5個椎體)。按術(shù)中C臂透視監(jiān)測下觀察記錄的骨水泥注射部位分成三組,A組(注射部位位于椎體的上1/3處),10例患者(10個椎體);B組(位于椎體正中),50例患者(100個椎體);C組(位于椎體骨折線處),30例病人(30個椎體)。根據(jù)術(shù)后胸腰椎正側(cè)位X線片骨水泥的彌散程度分為兩組,A組(骨水泥未過椎體正中線),30例患者(65個椎體);B組(過正中線),60例患者(75個椎體)。7例病人(10個椎體)發(fā)生骨水泥泄漏。記錄并觀察比較各組患者術(shù)前、術(shù)后1天、術(shù)后1月的VAS評分。結(jié)果:90例患者(140個椎體)手術(shù)均取得成功,未出現(xiàn)嚴重并發(fā)癥,7例出現(xiàn)骨水泥泄露,無臨床癥狀,疼痛完全緩解。對于骨水泥注射劑量,A組(小劑量骨水泥1-3ml)、B組(常規(guī)劑量骨水泥3-6ml)、C組(大劑量骨水泥6ml)三組在分別在術(shù)后1天、術(shù)后1月比較VAS評分無統(tǒng)計學差異(P0.05);各組術(shù)后1天、術(shù)后1月與術(shù)前比較VAS評分均有明顯下降(P0.05)。對于骨水泥注射部位,A組(注射部位位于椎體上1/3處)、B組(注射部位位于椎體正中)、C組(注射部位位于椎體骨折線處)三組在術(shù)后1天、術(shù)后1月分別比較VAS評分無統(tǒng)計學差異(P0.05)。對于骨水泥彌散程度,A組(骨水泥彌散程度未過椎體中間線)、B組(骨水泥彌散程度過椎體中間線)三組在術(shù)后1天、術(shù)后1月比較VAS評分無統(tǒng)計學差異(P0.05)。結(jié)論:PKP能有效緩解老年骨質(zhì)疏松性椎體壓縮骨折引發(fā)的疼痛,近期止痛效果顯著,但注射不同劑量的骨水泥對于患者的止痛效果無明顯差異。PKP術(shù)中注射骨水泥的部位、骨水泥彌散程度對于術(shù)后止痛效果無明顯影響。
[Abstract]:Objective: to investigate the correlation between the injection dose of bone cement and analgesic effect in the treatment of senile osteoporotic vertebral compression fracture with PKP.Methods: from October 2015 to September 2016, 90 patients (140 vertebrae) with complete imaging data and PKP surgical indications were selected.The age range of the patients was 65 to 81 years old and the range of vertebral involvement was T10-L 3.All the patients were divided into two groups according to different dosage of bone cement during operation: group A (20 patients with low dose bone cement 1-3ml) (group B: 20 patients with bone cement) (group B: 65 patients with normal dose of bone cement 3-6ml) (group C: 115 patients (group C: 5 patients with large dose of bone cement 6ml).According to intraoperative C-arm fluoroscopic monitoring, bone cement injection sites recorded in group A were divided into three groups: group A (the injection site was located at the upper 1 / 3 of the vertebral body) in 10 patients (group B) (50 patients were located in the midbody of the vertebral body) (group C, 100 vertebrae).Thirty patients (30 vertebrae) were treated with vertebral fracture line.According to the degree of diffusion of bone cement in thoracolumbar lateral X-ray films after operation, two groups were divided into two groups: group A (30 patients with bone cement not above the midline of vertebral body) (group B: 65 vertebrae) (60 patients with midline suture (75 vertebrae), 7 patients (10 vertebrae))A bone cement leak occurred.VAS scores were recorded and compared before operation, 1 day after operation and 1 month after operation.Results 90 cases (140 vertebrae) were successfully operated without serious complications, 7 cases with bone cement leakage, no clinical symptoms and complete relief of pain.There was no significant difference in VAS score between group A (low dose bone cement 1-3 ml) and group B (normal dose of bone cement 3-6 ml) and group C (large dose of bone cement 6 ml) at 1 day after operation and 1 month after operation (P 0.05), and there was no significant difference between the three groups on the first day after operation, and at 1 day after operation, there was no significant difference in VAS score between the three groups (P < 0.05).The VAS scores decreased significantly after 1 month compared with those before operation (P 0.05).For the bone cement injection site, group A (the injection site was at 1 / 3 of the vertebral body) and group B (the injection site was located in the middle of the vertebral body) group C (the injection site was located at the fracture line of the vertebral body), the three groups were treated 1 day after operation.There was no significant difference in VAS score at 1 month after operation (P 0.05).There was no significant difference in VAS score between group A and group A (the degree of bone cement dispersion was not above the midline of vertebrae) in group B (the degree of bone cement diffusion was over the midline of vertebral body) on the first day after operation (P 0.05).ConclusionWow-PKP can effectively relieve pain caused by osteoporotic vertebral compression fracture in the elderly, and the short-term analgesic effect is remarkable, but there is no significant difference in analgesic effect with different doses of bone cement injection.The extent of bone cement dispersion had no significant effect on postoperative pain relief.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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