【摘要】：目的探討經(jīng)皮椎體成形術(shù)(percutaneous vertebroplasty, PVP)及經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty, PKP)治療胸腰椎壓縮性骨折后,手術(shù)對鄰近椎間盤退變(intervertebral disc degeneration, IDD)的影響。方法回顧性分析我院采用PVP或PKP治療胸腰段骨質(zhì)疏松性壓縮性骨折患者49例,其中男性17例,女性32例,年齡59～91歲,手術(shù)椎體65個(gè),節(jié)段T8-L5。術(shù)后隨訪14～38個(gè)月。①以手術(shù)椎體相鄰椎間盤為手術(shù)組,以自身非手術(shù)椎體鄰近椎間盤為對照組。②手術(shù)組的椎間盤中以骨水泥對稱分布于椎體中線兩側(cè)為對稱組,非對稱分布于椎體中線兩側(cè)為側(cè)偏組。③以骨水泥接觸軟骨終板中央1/2面積區(qū)域?yàn)橹醒虢M,以骨水泥未接觸中央?yún)^(qū)域?yàn)橹車M。以MRI T2WI正中矢狀位圖像為基礎(chǔ)對椎間盤進(jìn)行Pfirrmann分級。所有數(shù)據(jù)進(jìn)行歸納、匯總,應(yīng)用SAS 8.0統(tǒng)計(jì)軟件分析,對自身配對等級資料進(jìn)行Wilcoxon符號(hào)秩和檢驗(yàn),對計(jì)數(shù)資料進(jìn)行Wilcoxon秩和檢驗(yàn)。結(jié)果納入研究的椎間盤共230個(gè)。①手術(shù)組124個(gè),對照組106個(gè)。手術(shù)組與對照組Pfirrmann等級增加有顯著性差異(P0.0001),前者高于后者。②對稱組56個(gè)與側(cè)偏組68個(gè)。對稱組與側(cè)偏組椎間盤Pfirrmann等級增加無顯著性差異(P=0.926)。③中央組75個(gè)與周圍組35個(gè)。中央組與周圍組椎間盤Pfirrmann等級增加有顯著性差異(P=0.025),前者高于后者。結(jié)論P(yáng)VP或PKP術(shù)可加速鄰近椎間盤的退變,其影響程度與手術(shù)椎體中骨水泥是否對稱分布無關(guān),與骨水泥是否接觸軟骨終板中央?yún)^(qū)域有關(guān)。
[Abstract]:Objective to investigate the effect of percutaneous vertebroplasty (percutaneous vertebroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP) on degenerative (intervertebral disc degeneration, IDD) in patients with thoracolumbar vertebral compression fracture. Methods 49 cases of thoracolumbar osteoporotic compression fracture treated with PVP or PKP were retrospectively analyzed, including 17 males and 32 females, aged 5991 years, 65 vertebrae and T8-L5. The patients were followed up for 14 ~ 38 months. 1 the adjacent intervertebral disc of the surgical vertebral body was taken as the operation group, and the intervertebral disc adjacent to the non-operative vertebral body was taken as the control group. 2. The intervertebral discs in the surgical group were symmetrically distributed on both sides of the midline of the vertebral body by bone cement symmetry. Asymmetrically distributed on both sides of the midline of vertebral body was the lateral deviation group .3 the central area of bone cement contact cartilage endplate was 1 / 2 area as the central group, and the bone cement non-contact central area was the surrounding group. On the basis of MRI T2WI median sagittal image, Pfirrmann classification of intervertebral disc was carried out. All the data are summed up and analyzed by SAS 8.0 statistical software. The self-matched rank data are tested by Wilcoxon sign rank sum test, and the count data are tested by Wilcoxon rank sum test. Results there were 124 intervertebral discs in 230 .1 operative groups and 106 in control group. There was significant difference in Pfirrmann grade between the operation group and the control group (P0.0001), the former was higher than that of the latter group (56 cases) and the lateral deviation group (68 cases). There was no significant difference in Pfirrmann grade between symmetrical group and lateral deviation group (P0. 926). 3 75 in central group and 35 in peripheral group. There was a significant difference in Pfirrmann grade between central group and peripheral group (P0. 025), the former was higher than the latter. Conclusion PVP or PKP can accelerate the degeneration of adjacent intervertebral disc, and its influence is not related to the symmetrical distribution of bone cement in the vertebral body, but to the central region of the cartilage endplate.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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