本文選題：骨質(zhì)疏松性壓縮骨折 + 經(jīng)皮穿刺椎體成形術(shù)　； 參考：《山東中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的:通過分析比較老年骨質(zhì)疏松性脊椎壓縮性骨折(osteoporosis vertebral compression fracture,OVCF)行經(jīng)皮穿刺椎體成形術(shù)(Percutaneous Vertebroplasty,PVP)治療后有或無發(fā)生再次骨折患者的相關(guān)資料,來探討術(shù)后再骨折的發(fā)生機(jī)制及危險(xiǎn)因素,以期降低其發(fā)生率,提高椎體成形術(shù)的進(jìn)一步發(fā)展,從而提高臨床療效。方法:選取2013年04到2014年07月山東中醫(yī)藥大學(xué)脊柱骨科同一治療組收治的骨質(zhì)疏松性脊椎壓縮骨折患者,共81例,其中男性16例,女性65例,年齡50~94歲,平均(73.56±8.73)歲,傷椎總數(shù)129個(gè),其中胸椎58個(gè),腰椎71個(gè)。采用回顧性研究的分析方法,根據(jù)臨床資料及隨訪結(jié)果按術(shù)后是否發(fā)生再次骨折分為A組(非再骨折組)和B組(再骨折組),記錄患者年齡、性別、原發(fā)骨折數(shù)目、骨折椎體部位、骨密度等一般資料,記錄手術(shù)中骨水泥注入量、是否發(fā)生椎間隙滲漏、椎體高度恢復(fù)率、后凸角恢復(fù)角度、不同時(shí)間段VAS(視覺模擬評(píng)分)等手術(shù)相關(guān)因素,對(duì)以上因素進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:所有患者均成功完成手術(shù),沒有出現(xiàn)脊髓損傷及肺栓塞等嚴(yán)重并發(fā)癥。有18例22個(gè)椎體出現(xiàn)非手術(shù)椎體再骨折,比率約為22%,間隔時(shí)間為1~24個(gè)月,平均(8.33±1.25)個(gè)月。骨水泥椎間滲透12例,為0.09%,滲漏后無臨床癥狀發(fā)生。年齡、性別、骨折部位、椎體高度恢復(fù)率、后凸角恢復(fù)角度等因素在A組和B組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)前及術(shù)后1周VAS評(píng)分在A組、B組組內(nèi)比較有統(tǒng)計(jì)學(xué)意義(P0.05),終末隨訪VAS評(píng)分在兩組間對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05),原發(fā)椎體數(shù)目、骨水泥注入量在A組和B組間有統(tǒng)計(jì)學(xué)意義(P0.05);骨密度在A組和B組間有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論:骨質(zhì)疏松性壓縮骨折患者行PVP治療能取得良好的臨床效果,再骨折好發(fā)于術(shù)后8個(gè)月內(nèi),低骨密度、原發(fā)椎體數(shù)目、骨水泥注入量是誘發(fā)再骨折的危險(xiǎn)因素。
[Abstract]:Objective: to analyze and compare the data of patients with or without secondary fracture after percutaneous vertebroplasty and percutaneous vertebroplasty for osteoporotic vertebral compression fracture (OVCF) in elderly patients with osteoporotic vertebral compression fracture. To explore the mechanism and risk factors of postoperative refracture, in order to reduce its incidence, improve the further development of vertebroplasty, so as to improve the clinical efficacy. Methods: 81 patients with osteoporotic vertebral compression fractures were selected from the same treatment group in Department of Spine Orthopedics, Shandong University of traditional Chinese Medicine from 04 to July 2014, including 16 males and 65 females, aged 50 to 94 years, with an average age of 73.56 鹵8.73 years. The total number of injured vertebrae was 129, including 58 thoracic vertebrae and 71 lumbar vertebrae. According to the clinical data and follow-up results, the patients were divided into two groups: group A (non-refracture group) and group B (refracture group). The patients' age, sex and number of primary fractures were recorded. The fracture vertebral body position, bone mineral density and other general data, recorded the amount of bone cement injection, whether the leakage of intervertebral space occurred, the recovery rate of vertebral body height, the angle of kyphosis recovery, the VAS (visual analogue score) in different time period, and so on. The above factors were analyzed statistically. Results: all patients successfully completed the operation without severe complications such as spinal cord injury and pulmonary embolism. Non-operative vertebral refracture occurred in 22 vertebrae of 18 cases, the ratio was about 22. The interval was from 124 months to 24 months, with an average of 8.33 鹵1.25 months. There were 12 cases of bone cement intervertebral osmosis (0.09%). Age, sex, fracture site, vertebral height recovery rate, The recovery angle of kyphosis angle had no significant difference between group A and group B (P 0.05), and the VAS score was significantly higher in group A than that in group B 1 week after operation (P 0.05). The final follow-up VAS score was statistically significant between the two groups. P0.05, number of primary vertebrae, There was significant difference in bone cement injection between group A and group B (P 0.05) and bone mineral density (BMD) in group A and group B (P 0.01). Conclusion: PVP can obtain good clinical effect in patients with osteoporotic compression fracture. The risk factors of refracture are low BMD, number of primary vertebral body and cement injection.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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