本文選題：骨質(zhì)疏松性椎體壓縮性骨折 + 墊枕練功法�。� 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對比研究墊枕練功法配合經(jīng)皮椎體成形術(shù)(PVP)與經(jīng)皮椎體后凸成形術(shù)(PKP)治療骨質(zhì)疏松性椎體壓縮性骨折(OVCF)的中短期療效及并發(fā)癥,為臨床選擇經(jīng)濟(jì)、安全、有效的OVCF的治療方法提供一定的依據(jù)。方法:回顧性分析2014年10月~2016年3月西南醫(yī)科大學(xué)附屬中醫(yī)醫(yī)院骨傷科收治的57例OVCF患者,按治療方法分成A、B兩組,A組26例采用墊枕練功法配合PVP治療,B組31例采用PKP治療。所有患者入院時(shí)、術(shù)前及術(shù)后3天、1月、3月、6月、12月進(jìn)行疼痛視覺模擬評分(Visual Analogue Scale VAS),定期拍攝X片,測算患者入院時(shí)、術(shù)前及術(shù)后3天、1月、3月、6月、12月的傷椎椎體高度丟失率及后凸Cobb角,術(shù)中觀察記錄骨水泥滲漏情況,術(shù)后隨訪患者傷椎鄰近椎體骨折情況,統(tǒng)計(jì)分析兩組的一般資料、術(shù)后的一般情況、組內(nèi)不同治療時(shí)間點(diǎn)以及組間相同治療時(shí)間點(diǎn)各研究指標(biāo)的變化情況。結(jié)果:1.一般資料比較:兩組年齡、性別、病程、傷椎壓縮程度比較無統(tǒng)計(jì)學(xué)差異(P㧐0.05),研究具有可比性。2、術(shù)后一般情況比較:A組骨水泥注入量、手術(shù)時(shí)間、住院費(fèi)用明顯低于B組,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.01);住院時(shí)間A組明顯長于B組,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.01)。3.vas評分比較:兩組入院時(shí)比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05);兩組術(shù)后各時(shí)間點(diǎn)與術(shù)前及入院時(shí)比較vas評分均明顯降低(p㩳0.01);術(shù)后各時(shí)間點(diǎn)組間比較vas評分無統(tǒng)計(jì)學(xué)差異(p㧐0.05)。4.椎體高度丟失率比較:兩組入院時(shí)比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05);a組術(shù)前與入院時(shí)比較椎體高度丟失率明顯改善(p㩳0.01),a組術(shù)前及術(shù)后各時(shí)間點(diǎn)之間比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05);b組入院時(shí)與術(shù)前比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05),術(shù)后各時(shí)間點(diǎn)與術(shù)前比較椎體高度丟失率有明顯改善(p㩳0.01),b組術(shù)后1月、3月、6月、12月與術(shù)后3天比較傷椎高度有一定的再次丟失(p㩳0.01),b組術(shù)后1月、3月、6月、12月之間兩兩比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05)。5.后凸cobb角比較:兩組入院時(shí)比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05);a組術(shù)前與入院時(shí)比較cobb角有明顯改善(p㩳0.01),a組術(shù)前及術(shù)后各時(shí)間點(diǎn)之間比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05);b組入院時(shí)與術(shù)前比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05),術(shù)后各時(shí)間點(diǎn)較術(shù)前cobb角有明顯改善(p㩳0.01),b組術(shù)后1月、3月、6月、12月與術(shù)后3天比較cobb角有一定的繼發(fā)增大(p㩳0.01),b組術(shù)后1月、3月、6月、12月之間兩兩比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05)。6.骨水泥滲漏率比較:a組為12.50%(4/32),b組為17.95%(7/39),兩組比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05)。7.術(shù)后鄰椎骨折發(fā)生率比較:a組為11.54%(3/26),b組為16.13%(5/31),兩組比較無統(tǒng)計(jì)學(xué)差異(p㧐0.05)。結(jié)論:墊枕練功法配合pvp與pkp治療ovcf均能有效地緩解疼痛、恢復(fù)傷椎高度、矯正后凸畸形,墊枕練功法配合pvp較pkp的優(yōu)勢在于治療費(fèi)用低、手術(shù)時(shí)間短、術(shù)后椎體高度及后凸cobb角無明顯繼發(fā)性改變,墊枕練功法配合PVP是治療OVCF的一種經(jīng)濟(jì)、安全、有效的治療方法。
[Abstract]:Objective: to compare the short and medium term effects and complications of pillow exercise combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture.Effective treatment of OVCF provides some basis.Methods: from October 2014 to March 2016, 57 patients with OVCF in the Department of Orthopedics and Trauma, affiliated traditional Chinese Medicine Hospital of Southwest Medical University, were analyzed retrospectively. According to the treatment method, the patients in group A were divided into two groups: group A (n = 26) treated with pillow exercises combined with PVP, group B (n = 31) were treated with PKP.Visual Analogue Scale vas (VAS) were assessed before admission, 3 days, 1 month, 3 months, 6 months and 12 months after admission.Three days, one month, three months, six months and twelve months after operation, the rate of loss of vertebral body height and the Cobb angle of kyphosis were observed and recorded during operation. The patients were followed up after operation. The general data of the two groups were statistically analyzed.The changes of the indexes of different treatment time points and the same treatment time points after operation.The result is 1: 1.Comparison of general data: there was no significant difference in age, sex, course of disease, degree of compression of injured vertebrae between two groups (P < 0.05). The study was comparable .2.The general situation after operation was significantly lower than that of group B in terms of the amount of bone cement injected, the time of operation, and the cost of hospitalization.The difference was statistically significant (P < 0.01), the length of hospitalization in group A was longer than that in group B.The difference was statistically significant (P < 0.01). 3. Vas scores: there was no significant difference between the two groups on admission, the vas scores at each time point after operation were significantly lower than those before operation and on admission, and there was no significant difference in vas scores between the two groups at different time points after operation.Comparison of vertebral height loss rate: there was no statistical difference between the two groups on admission. There was no significant difference in the loss rate of vertebral height between the two groups before and after admission. There was no significant difference between the two groups at the time points before and after operation.There was no significant difference between before and after operation. The loss rate of vertebral height at each time point after operation was significantly improved compared with that before operation. In group B, there was a certain loss of vertebral height in 1 month, 3 months, 6 months, 12 months and 3 days after operation.There was no statistical difference between January, March, June and December.Comparison of kyphosis cobb angle: there was no statistical difference between the two groups on admission. There was no significant difference in cobb angle between the two groups before and after admission. There was no statistical difference between the two groups at the time points before and after operation.Compared with the preoperative cobb angle, there was no significant difference in the postoperative cobb angle between the two groups (P 0.05, P 0.05, P 0.05, P 0.05), and there was no significant difference between the two groups (p 0.05U. 6) in comparison with the preoperative cobb angle in 1 month, 3 months, 6 months, 12 months and 3 days after operation.The ratio of bone cement leakage was 12.50% in group A and 17.95% in group B (17.95%). There was no statistical difference between the two groups.The incidence of postoperative vertebral fracture was 11.54% in group A and 16.13% in group B (16.13%). There was no significant difference between the two groups in the incidence of vertebral fracture. There was no statistical difference between the two groups.Conclusion: pillow exercises combined with pvp and pkp can effectively relieve pain, recover the height of injured vertebrae and correct kyphosis deformity. The advantage of pillow exercise combined with pvp is that the treatment cost is lower and the operation time is short.There were no obvious secondary changes in vertebral height and kyphosis cobb angle after operation. Pillow exercise combined with PVP was an economical, safe and effective treatment for OVCF.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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