發(fā)布時(shí)間：2018-07-10 13:55

  本文選題：納米骨 + 經(jīng)皮��； 參考：《川北醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的:研究納米骨植入結(jié)合經(jīng)皮微創(chuàng)固定治療胸腰椎骨質(zhì)疏松性骨折的臨床療效,并與經(jīng)皮椎體成型術(shù)治療胸腰椎骨質(zhì)疏松性骨折進(jìn)行對(duì)比研究。方法:選取2012年3月至2014年6月48例胸腰椎骨質(zhì)疏松性骨折,隨機(jī)分為A、B組,其中A組為實(shí)驗(yàn)組,共20例,B組為對(duì)照組,共28例,A組的治療方案為經(jīng)傷椎椎弓根椎體內(nèi)納米骨植入同時(shí)經(jīng)傷椎上下椎體微創(chuàng)椎弓根固定,B組的治療方案為經(jīng)傷椎椎弓根椎體內(nèi)骨水泥注入,通過(guò)收集患者術(shù)前、術(shù)后、術(shù)后隨訪(隨訪時(shí)間為術(shù)后3月、6月、12月)臨床資料,包括傷椎前緣高度、Cobb角變化、復(fù)查MRI術(shù)前術(shù)后對(duì)比了解相鄰階段椎間盤退變情況、病人疼痛改變。統(tǒng)計(jì)時(shí)采SPSS13.0統(tǒng)計(jì)軟件建立數(shù)據(jù)庫(kù),分析時(shí)采用方法為傷椎高度改變、Cobb角變化、疼痛程度采用配對(duì)或非配對(duì)的t檢驗(yàn)、方差分析(P0.05差異有統(tǒng)計(jì)學(xué)意義)。臨床臨床效果評(píng)價(jià)用Kruska1 Wallis檢驗(yàn)。結(jié)果:1、實(shí)驗(yàn)組所有病例術(shù)后與術(shù)前椎體前緣高度相比有明顯改變,與術(shù)前椎體前緣高度統(tǒng)計(jì)數(shù)據(jù)有明顯差異(P0.05)。2、實(shí)驗(yàn)組所有病例術(shù)后與術(shù)前Cobb角相比較有獲得明顯改善,與術(shù)前Cobb角統(tǒng)計(jì)數(shù)據(jù)有明顯差異(P0.05)。3、術(shù)后12月復(fù)查MRI,實(shí)驗(yàn)組和對(duì)照組在相鄰節(jié)段椎間盤退變方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4、實(shí)驗(yàn)組所有病例術(shù)前VAS評(píng)分與術(shù)后1周、3月、6月、12月VAS評(píng)分獲得明顯改變,其數(shù)據(jù)統(tǒng)計(jì)具有明顯差異(P0.05)。5、實(shí)驗(yàn)組術(shù)后1年隨訪到20例,所有患者均行MRI檢查,8例椎間盤出現(xiàn)退變,其余12例相鄰節(jié)段椎間盤未出現(xiàn)明顯加重的情況。6、對(duì)照組所有病例術(shù)前VAS評(píng)分與術(shù)后1周、3月、6月、12月VAS評(píng)分獲得明顯改善,術(shù)后與術(shù)前統(tǒng)計(jì)數(shù)據(jù)有明顯差異(P0.05)。7、對(duì)照組術(shù)后1年隨訪到28例,所有28例患者均行MRI檢查,與術(shù)前MRI檢查相比較,有12例傷椎相鄰階段椎間盤出現(xiàn)退變明顯加重情況。8、術(shù)后1周、3月、6月、12月復(fù)查影像學(xué)資料顯示兩組間在傷椎前緣高度改變、Cobb角改變方面比較有顯著性差異(P0.05)。9、術(shù)前、術(shù)后1周、術(shù)后3月術(shù)后6月、術(shù)后12月兩組VAS評(píng)分無(wú)顯著差異(P0.05)。結(jié)論:納米骨植入結(jié)合經(jīng)皮微創(chuàng)固定與經(jīng)傷椎椎弓根椎體內(nèi)骨水泥置入相比較,同樣具有創(chuàng)傷小、恢復(fù)快等優(yōu)點(diǎn),而且其在恢復(fù)椎體高度、改善Cobb角、防止椎體高度及Cobb角丟失方面具有明顯的優(yōu)勢(shì),是一種有效治療胸腰椎骨質(zhì)疏松性骨折方式。能否減緩鄰近節(jié)段椎間盤退變需要大宗的病例以及中長(zhǎng)期的隨訪。
[Abstract]:Objective: to study the clinical effect of nano-bone implantation combined with percutaneous minimally invasive fixation in the treatment of thoracolumbar osteoporotic fractures and compare it with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic fractures. Methods: from March 2012 to June 2014, 48 patients with osteoporotic fractures of thoracolumbar vertebrae were randomly divided into two groups: group A (experimental group) and group B (20 cases) as control group. A total of 28 patients in group A were treated by transpedicular bone implantation and minimally invasive pedicle fixation through the upper and lower vertebrae of the injured vertebrae. The patients were injected with bone cement in the pedicle of the injured vertebrae. The patients were collected before and after operation. All the patients were followed up for 3 months, 6 months and 12 months, including the changes of the anterior edge of the injured vertebrae and Cobb angle. SPSS 13.0 statistical software was used to establish the database. The method of analysis was used to change the Cobb angle of injured vertebra height, and the degree of pain was tested by paired or unpaired t-test. The variance analysis was significant (P0.05). The clinical efficacy was evaluated by Kruska1 Wallis test. Results all cases in the experimental group had significant changes after operation compared with the anterior height of the vertebral body before operation, and there was a significant difference between the statistical data of the height of the anterior edge of the vertebral body before operation (P0.05). All the cases in the experimental group were significantly improved compared with the preoperative Cobb angle after operation. There was significant difference between preoperative Cobb angle statistical data and preoperative Cobb angle statistical data (P0.05). 3 months after operation, there was no significant difference in adjacent segment disc degeneration between experimental group and control group (P0.05). The VAS score of all cases in experimental group was significantly higher than that in 1 week, 3 months and 6 months after operation. In December, VAS score was significantly changed, There was significant difference between the two groups (P0.05). The patients in the experimental group were followed up to 20 cases one year after operation. All the patients were examined by MRI in 8 cases with degeneration of intervertebral disc. In the control group, the VAS scores before operation and 1 week, 3 months, 6 months and 12 months after operation were significantly improved. There was a significant difference between postoperative and preoperative statistical data (P0.05). The control group was followed up to 28 cases one year after operation. All the 28 cases were examined by MRI, which was compared with that of preoperative MRI. There were 12 cases with severe degeneration of intervertebral disc in adjacent stage of injured vertebra. The imaging data of 1 week, 3 months, 6 months and 12 months after operation showed that there was a significant difference between the two groups in the change of anterior edge height of injured vertebrae and Cobb angle (P0.05). Before operation, 1 week after operation, there was a significant difference between the two groups in the change of anterior edge height and Cobb angle (P0.05). There was no significant difference in VAS score between the two groups 3 months after operation and 12 months after operation (P0.05). Conclusion: Nano-bone implantation combined with percutaneous minimally invasive fixation has the advantages of less trauma and faster recovery compared with bone cement implantation in the pedicle of injured vertebrae, and it can improve Cobb angle and restore the height of vertebral body. Prevention of vertebral height and Cobb angle loss has obvious advantages and is an effective treatment of thoracolumbar osteoporotic fracture. Mitigation of adjacent disc degeneration requires large numbers of cases and long-term follow-up.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊立民;老年骨質(zhì)疏松脊柱骨折的治療應(yīng)取積極態(tài)度[J];中國(guó)骨與關(guān)節(jié)損傷雜志;2005年07期

2 周其璋;劉永恒;梁必如;;經(jīng)椎弓根植骨內(nèi)固定治療胸腰椎骨折的臨床分析[J];中國(guó)骨與關(guān)節(jié)損傷雜志;2006年04期

3 葉春萬(wàn);朱敏;甘業(yè)春;樊道斌;王欣;;計(jì)算骨喪失量經(jīng)椎弓根打壓植骨治療胸腰椎壓縮性骨折的生物力學(xué)研究與臨床應(yīng)用[J];中國(guó)骨與關(guān)節(jié)損傷雜志;2011年05期

4 劉明;潘薇;陳德才;;甲狀旁腺激素治療骨質(zhì)疏松癥的研究進(jìn)展[J];中華骨質(zhì)疏松和骨礦鹽疾病雜志;2012年02期

5 賈軍;馮世慶;張超;吳英華;;骨質(zhì)疏松及其預(yù)防[J];國(guó)際骨科學(xué)雜志;2012年05期

6 曾凡偉;王曉林;王進(jìn);何秦;徐利軍;王枰稀;;經(jīng)皮穿刺椎體成形術(shù)治療老年性骨質(zhì)疏松性椎體壓縮骨折的臨床應(yīng)用[J];華西醫(yī)學(xué);2010年06期

7 胡軍;張華;牟青;;骨質(zhì)疏松癥的流行病學(xué)趨勢(shì)與防治進(jìn)展[J];臨床薈萃;2011年08期

8 馮明錄;路磊;鮑德國(guó);何勇;李江;董濤;;老年骨質(zhì)疏松性脊柱骨折的保守治療[J];全科醫(yī)學(xué)臨床與教育;2007年02期

9 黃永輝;沈鐵城;徐曉峰;左華;韓志強(qiáng);田進(jìn);;納米羥基磷灰石/膠原骨修復(fù)骨缺損的效果評(píng)估[J];中國(guó)臨床康復(fù);2006年37期

10 韓昕;詹志偉;張紅紅;裴育;胡亞卓;王熙然;韓志濤;;北京部分漢族男性維生素D受體基因Fok Ⅰ多態(tài)性與骨密度的關(guān)系[J];中國(guó)組織工程研究與臨床康復(fù);2009年24期

相關(guān)碩士學(xué)位論文 前3條

1 盧斌;PVP治療老人骨質(zhì)疏松性椎體骨折較PKP更有優(yōu)勢(shì)[D];浙江大學(xué);2010年

2 鄭澤龍;腰椎融合內(nèi)固定組和非內(nèi)固定組術(shù)后相鄰上一節(jié)段退變的回顧性研究[D];吉林大學(xué);2011年

3 劉則征;腰椎半堅(jiān)強(qiáng)與堅(jiān)強(qiáng)內(nèi)固定術(shù)后鄰近節(jié)段退變的對(duì)比研究[D];南方醫(yī)科大學(xué);2010年

，

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