PVP、PKP術(shù)后非手術(shù)椎體再發(fā)骨折的相關(guān)因素分析
發(fā)布時間：2018-08-07 11:53
【摘要】：目的：本文探討經(jīng)皮椎體成形術(shù)(percutaneous vertibroplasty,PVP)和經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)術(shù)后非手術(shù)椎體再發(fā)骨折的發(fā)生率及相關(guān)的危險(xiǎn)因素。旨在對其相關(guān)因素進(jìn)一步剖析,并比較鄰近節(jié)段與非鄰近節(jié)段椎體再骨折的異同,為臨床提供參考,同時研究補(bǔ)腎活血中藥對于預(yù)防新發(fā)椎體骨折的作用,指導(dǎo)臨床用藥。方法：本研究回顧采納了2009年1月～2013年12月廣州中醫(yī)藥大學(xué)第二附屬醫(yī)院(廣東省中醫(yī)院)收治的發(fā)生于胸腰段椎體的壓縮性骨折并行單節(jié)段PVP/PKP治療的患者的基本信息、病例、手術(shù)及影像學(xué)等資料。根據(jù)術(shù)后是否再發(fā)非手術(shù)節(jié)段的椎體骨折,分為骨折組及非骨折組；再根據(jù)再發(fā)骨折的椎體節(jié)段分為相鄰椎體組及遠(yuǎn)隔椎體組。通過對所有患者年齡、性別、骨水泥注入量、椎體局部后凸糾正角度、手術(shù)方式(PVP/PKP)、手術(shù)椎體節(jié)段、有否骨水泥外滲、圍手術(shù)期有否行抗骨質(zhì)疏松治療、有否予補(bǔ)腎活血中藥等的統(tǒng)計(jì)和計(jì)算,計(jì)數(shù)資料采用χ2檢驗(yàn),計(jì)量資料采用獨(dú)立樣本t檢驗(yàn),并將有統(tǒng)計(jì)學(xué)意義(P0.05)的指標(biāo)納入多因素Logistic回歸分析,得出術(shù)后非手術(shù)椎體再發(fā)骨折的相關(guān)危險(xiǎn)因素。數(shù)據(jù)用SPSS 19.0統(tǒng)計(jì)軟件處理分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義,PO.01為差異有明顯統(tǒng)計(jì)學(xué)意義。結(jié)果：本研究共納入行PVP/PKP術(shù)的患者452例,隨訪時間12-62個月。平均29.82±11.94個月,其中女性359例,男性93例,年齡49-93歲,平均74.98±8.42歲,其中71～80歲所占比例最高(45%)。行PVP術(shù)211例,行PKP術(shù)241例。發(fā)生骨水泥外滲116例,占25.7%。骨水泥注入量1.2-7.2ml,平均3.56±0.95ml。術(shù)前原椎體局部后凸Cobb's角-31.70°-48.73°,平均11.08°±11.73°,術(shù)后傷椎局部后凸Cobb's角-30.86°～40.53°,平均6.11°±11.31°。傷椎局部后凸Cobb's角糾正角度-3.08。-14.85°,平均4.97°±2.35°。圍手術(shù)期予行抗骨質(zhì)疏松治療的397例,占87.8%,予補(bǔ)腎活血中藥口服的333例,占73.7%。術(shù)后發(fā)生非手術(shù)椎體再發(fā)骨折共64例,包括男性12例,女性52例,發(fā)病率14.2%,再發(fā)骨折時間1-53個月,平均14.56±11.46個月。未發(fā)生骨折的共388例患者。骨折組與非骨折組在性別、年齡、隨訪時間、術(shù)前傷椎局部后凸角、手術(shù)方式(PVP/PKP)、手術(shù)椎體節(jié)段、骨水泥注入量等方面比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。骨折組在骨水泥外滲發(fā)生率方面明顯高于非骨折組(P0.01),而非骨折組在圍手術(shù)期,抗骨質(zhì)疏松藥物及補(bǔ)腎活血中藥的使用率方面明顯高于骨折組。二組在術(shù)后傷椎局部后凸Cobb's角糾正角度方面差異存在統(tǒng)計(jì)學(xué)意義(P0.05),骨折組大于非骨折組。多因素分析結(jié)果顯示發(fā)生骨水泥外滲、術(shù)后未予抗骨質(zhì)疏松治療及補(bǔ)腎活血中藥口服、傷椎局部后凸Cobb's角糾正過度是術(shù)后再發(fā)椎體骨折的危險(xiǎn)因素。骨折組中,相鄰椎體組與遠(yuǎn)隔椎體組在發(fā)生率、性別、年齡、再發(fā)骨折時間、術(shù)前傷椎局部后凸角、手術(shù)方式(PVP/PKP)、骨水泥注入量、骨水泥外滲、抗骨質(zhì)疏松藥物及補(bǔ)腎活血中藥的使用率等方面比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。相鄰椎體組在局部后凸Cobb's角糾正角度方面大于遠(yuǎn)隔椎體組,二者存在統(tǒng)計(jì)學(xué)差異(P0.05)。兩種手術(shù)方式相比,行PKP術(shù)的患者傷椎局部后凸Cobb's角糾正較行PVP術(shù)的患者明顯,而在骨水泥外滲的發(fā)生及再發(fā)骨折時間方面,兩種手術(shù)方式差異無統(tǒng)計(jì)學(xué)差異。結(jié)論：造成PVP、PKP術(shù)后非手術(shù)椎體再發(fā)骨折的危險(xiǎn)因素有很多,本研究結(jié)果顯示,發(fā)生骨水泥外滲、傷椎局部后凸Cobb's角糾正過度、圍手術(shù)期無行抗骨質(zhì)疏松治療等均明顯提高其發(fā)生率。另外術(shù)后圍手術(shù)期予補(bǔ)腎活血中藥可降低術(shù)后非手術(shù)椎體的再發(fā)骨折率。為了更好地預(yù)防非手術(shù)椎體再發(fā)骨折。醫(yī)生應(yīng)掌握其相關(guān)的危險(xiǎn)因素,術(shù)中避免骨水泥外滲的發(fā)生,對于傷椎局部后凸角的糾正不必過于強(qiáng)調(diào),圍手術(shù)期注意抗骨質(zhì)疏松藥物的治療。此外,應(yīng)重視中醫(yī)藥在其中的運(yùn)用,可予補(bǔ)腎活血中藥預(yù)防再發(fā)椎體骨折,中西醫(yī)結(jié)合治療,以提高醫(yī)療質(zhì)量。
[Abstract]:Objective: To investigate the incidence and risk factors of non operative vertebral fractures after percutaneous vertebroplasty (percutaneous vertibroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP), to further analyze the related factors and to compare the re fractures between adjacent segments and non adjacent segments. The effect of tonifying kidney and activating blood Chinese medicine on prevention of new vertebral fracture and guiding clinical use. Methods: This study reviewed and adopted the compression fracture parallel to the thoracolumbar vertebral body from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Traditional Chinese Medical Hospital) from January 2009 to December 2013. Basic information, case, surgery, and imaging data for patients with segmental PVP/PKP treatment. The vertebral fractures were divided into fracture groups and non fracture groups according to the postoperative vertebral fractures of non operative segments, and the vertebral segments of the recurrent fractures were divided into adjacent vertebra group and distant vertebra group. The age, sex, and cement injection of all patients were measured. The correction angle of vertebral local kyphosis, operation mode (PVP/PKP), vertebral segment, bone cement extravasation, anti osteoporosis treatment during the perioperative period, statistics and calculation of tonifying kidney and activating blood, using chi 2 test, measuring data using independent sample t test, and incorporating statistical significance (P0.05) index into Multiple factor Logistic regression analysis, the related risk factors of non operative vertebral fracture after operation were obtained. The data were analyzed with SPSS 19 statistical software, and the difference of P0.05 was statistically significant. The difference of PO.01 was statistically significant. Results: 452 cases of PVP/PKP were enrolled in this study, and the follow-up time was 12-62 months. The average was 29.8. 2 + 11.94 months, of which 359 Cases of women, 93 males, 49-93 years old, average 74.98 + 8.42 years, among which the proportion of 71~80 years was the highest (45%). 211 cases of PVP were performed, 241 cases were performed by PKP. Cement extravasation occurred in 116 cases, accounting for 25.7%. bone cement injection amount 1.2-7.2ml, average 3.56 + 0.95ml. preoperative vertebral local kyphosis Cobb's angle -31.70 degree -48.73 degrees, averaging 11 .08 degree + 11.73 degrees, the local kyphosis Cobb's angle of the injured vertebra was -30.86 degree to 40.53 degree, mean 6.11 degree 11.31 degree. The local kyphosis Cobb's angle of the injured vertebra was corrected to -3.08.-14.85 degrees, averaging 4.97 + 2.35 degrees. 397 cases of anti osteoporosis treatment were performed in perioperative period, accounting for 87.8%. There were 64 cases of fracture, including 12 men, 52 women, 14.2%, 1-53 months of fracture, an average of 14.56 + 11.46 months. There were 388 patients without fracture. The fracture group and non fracture group were in sex, age, follow-up time, local posterior convex angle, PVP/PKP, vertebral segment, bone cement injection, and so on. There was no statistical difference between the two groups (P0.05). The incidence of bone cement extravasation in fracture group was significantly higher than that in non fracture group (P0.01), but in the non fracture group, the use of anti osteoporosis drugs and tonifying kidney and activating blood Chinese medicine was significantly higher than that in the fracture group. The difference between the two groups in the correction angle of the local kyphosis Cobb's angle after the operation was different. In statistical significance (P0.05), the fracture group was larger than the non fracture group. The results of multiple factors analysis showed that the bone cement exoskosoosis occurred, the treatment of osteoporosis and the oral administration of tonifying kidney and activating blood were not taken after the operation. The local kyphosis Cobb's angle correction was the risk factor for the fracture of the vertebral body after the operation. There was no significant difference in the rate of birth, sex, age, recurrent fracture time, local posterior convex angle of the vertebral body, operation mode (PVP/PKP), bone cement injection, bone cement extravasation, the use of anti osteoporosis drugs and traditional Chinese medicine for invigorating kidney and activating blood (P0.05). The correction angle of the adjacent vertebra group in the local kyphosis Cobb's angle was greater than that of the distant vertebra. There was a statistical difference between the two groups (P0.05). Compared with the two surgical methods, the local kyphosis Cobb's angle correction of the injured vertebrae in the patients with PKP was more obvious than that of the patients with PVP, but there was no difference between the two kinds of surgical methods in the occurrence of bone cement exoskosis and the time of re fracture. Conclusion: cause PVP, the non operative vertebral body redevelopment after PKP operation. There are many risk factors of fracture. The results of this study show that the occurrence of bone cement extravasation, the correction of the local kyphosis Cobb's angle of the injured vertebra excessively, and the absence of anti osteoporosis in the perioperative period all obviously improve the incidence of the fracture. Non operative vertebral fractures. Doctors should master the related risk factors, avoid the occurrence of bone cement extravasation during the operation, do not emphasize the correction of the local posterior convex angle of the injured vertebra, and pay attention to the treatment of anti osteoporosis drugs in the perioperative period. In addition, we should pay attention to the use of traditional Chinese medicine in the operation, and can prevent the redevelopment of vertebra bone with Chinese traditional Chinese medicine for invigorating kidney and blood. Combination of traditional Chinese and Western medicine treatment, in order to improve the quality of medical treatment.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：2169938
[Abstract]:Objective: To investigate the incidence and risk factors of non operative vertebral fractures after percutaneous vertebroplasty (percutaneous vertibroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP), to further analyze the related factors and to compare the re fractures between adjacent segments and non adjacent segments. The effect of tonifying kidney and activating blood Chinese medicine on prevention of new vertebral fracture and guiding clinical use. Methods: This study reviewed and adopted the compression fracture parallel to the thoracolumbar vertebral body from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Traditional Chinese Medical Hospital) from January 2009 to December 2013. Basic information, case, surgery, and imaging data for patients with segmental PVP/PKP treatment. The vertebral fractures were divided into fracture groups and non fracture groups according to the postoperative vertebral fractures of non operative segments, and the vertebral segments of the recurrent fractures were divided into adjacent vertebra group and distant vertebra group. The age, sex, and cement injection of all patients were measured. The correction angle of vertebral local kyphosis, operation mode (PVP/PKP), vertebral segment, bone cement extravasation, anti osteoporosis treatment during the perioperative period, statistics and calculation of tonifying kidney and activating blood, using chi 2 test, measuring data using independent sample t test, and incorporating statistical significance (P0.05) index into Multiple factor Logistic regression analysis, the related risk factors of non operative vertebral fracture after operation were obtained. The data were analyzed with SPSS 19 statistical software, and the difference of P0.05 was statistically significant. The difference of PO.01 was statistically significant. Results: 452 cases of PVP/PKP were enrolled in this study, and the follow-up time was 12-62 months. The average was 29.8. 2 + 11.94 months, of which 359 Cases of women, 93 males, 49-93 years old, average 74.98 + 8.42 years, among which the proportion of 71~80 years was the highest (45%). 211 cases of PVP were performed, 241 cases were performed by PKP. Cement extravasation occurred in 116 cases, accounting for 25.7%. bone cement injection amount 1.2-7.2ml, average 3.56 + 0.95ml. preoperative vertebral local kyphosis Cobb's angle -31.70 degree -48.73 degrees, averaging 11 .08 degree + 11.73 degrees, the local kyphosis Cobb's angle of the injured vertebra was -30.86 degree to 40.53 degree, mean 6.11 degree 11.31 degree. The local kyphosis Cobb's angle of the injured vertebra was corrected to -3.08.-14.85 degrees, averaging 4.97 + 2.35 degrees. 397 cases of anti osteoporosis treatment were performed in perioperative period, accounting for 87.8%. There were 64 cases of fracture, including 12 men, 52 women, 14.2%, 1-53 months of fracture, an average of 14.56 + 11.46 months. There were 388 patients without fracture. The fracture group and non fracture group were in sex, age, follow-up time, local posterior convex angle, PVP/PKP, vertebral segment, bone cement injection, and so on. There was no statistical difference between the two groups (P0.05). The incidence of bone cement extravasation in fracture group was significantly higher than that in non fracture group (P0.01), but in the non fracture group, the use of anti osteoporosis drugs and tonifying kidney and activating blood Chinese medicine was significantly higher than that in the fracture group. The difference between the two groups in the correction angle of the local kyphosis Cobb's angle after the operation was different. In statistical significance (P0.05), the fracture group was larger than the non fracture group. The results of multiple factors analysis showed that the bone cement exoskosoosis occurred, the treatment of osteoporosis and the oral administration of tonifying kidney and activating blood were not taken after the operation. The local kyphosis Cobb's angle correction was the risk factor for the fracture of the vertebral body after the operation. There was no significant difference in the rate of birth, sex, age, recurrent fracture time, local posterior convex angle of the vertebral body, operation mode (PVP/PKP), bone cement injection, bone cement extravasation, the use of anti osteoporosis drugs and traditional Chinese medicine for invigorating kidney and activating blood (P0.05). The correction angle of the adjacent vertebra group in the local kyphosis Cobb's angle was greater than that of the distant vertebra. There was a statistical difference between the two groups (P0.05). Compared with the two surgical methods, the local kyphosis Cobb's angle correction of the injured vertebrae in the patients with PKP was more obvious than that of the patients with PVP, but there was no difference between the two kinds of surgical methods in the occurrence of bone cement exoskosis and the time of re fracture. Conclusion: cause PVP, the non operative vertebral body redevelopment after PKP operation. There are many risk factors of fracture. The results of this study show that the occurrence of bone cement extravasation, the correction of the local kyphosis Cobb's angle of the injured vertebra excessively, and the absence of anti osteoporosis in the perioperative period all obviously improve the incidence of the fracture. Non operative vertebral fractures. Doctors should master the related risk factors, avoid the occurrence of bone cement extravasation during the operation, do not emphasize the correction of the local posterior convex angle of the injured vertebra, and pay attention to the treatment of anti osteoporosis drugs in the perioperative period. In addition, we should pay attention to the use of traditional Chinese medicine in the operation, and can prevent the redevelopment of vertebra bone with Chinese traditional Chinese medicine for invigorating kidney and blood. Combination of traditional Chinese and Western medicine treatment, in order to improve the quality of medical treatment.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
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