【摘要】：目的：探討單側橫突入路椎體成形術(percutaneous vertebroplasty, PVP)聯(lián)合體位復位治療嚴重腰椎骨質疏松性壓縮骨折(osteoporotic vertebral compression fracture, OVCF)的臨床療效。方法：回顧性分析2012年3月-2014年7月我科收治的45例嚴重腰椎骨質疏松性壓縮骨折,共45個椎體,均給予單側橫突入路椎體成形術聯(lián)合體位復位治療,其中男11例,女34例；年齡60-93歲,平均74.38歲。比較患者術前、術后3天及末次隨訪時疼痛視覺模擬評分(visual analogue scale,VAS), Oswestry功能障礙指數(shù)(Oswestry disability index, ODI),傷椎Cobb角及椎體前緣、中份高度,評價其臨床療效。結果：順利完成所有患病椎體的手術,手術時間29.84±7.73分鐘,骨水泥量5.1±0.97 ml,骨水泥滲漏發(fā)生率15.6%(共7例),無相關臨床癥狀及體征,39例患者獲得滿意隨訪,失訪6例,失訪率13.3%,隨訪時間6-30個月,平均18.2個月,術后3天VAS評分為2.28±0.89分,ODI指數(shù)為33.95±4.44%,Cobb角為8.13±1.69°,傷椎前緣及中份高度分別為24.82±2.52mm、22.77±2.06mm;末次隨訪時VAS評分為1.73±0.76分,ODI指數(shù)為21.33±4.83%,Cobb角為8.44±1.650,傷椎前緣及中份高度分別為23.92±2.34mm、22.07±2.18mm,術前、術后3天及末次隨訪時VAS評分及ODI指數(shù)兩相比較均有統(tǒng)計學差異(P0.05)；術后傷椎Cobb角、椎體前緣及中份高度較術前恢復明顯(P0.05),末次隨訪時傷椎Cobb角及椎體前緣、中份高度較術后3天無明顯改變(P0.05)。結論：單側橫突入路椎體成形術聯(lián)合體位復位能有效的緩解嚴重腰椎骨質疏松性壓縮骨折引起的疼痛,恢復并維持傷椎的椎體高度,糾正腰椎后凸Cobb角,重建矢狀面平衡,明顯提高生活質量,是一種有效、安全、簡單、經(jīng)濟的手術方式。
[Abstract]:Objective: to investigate the clinical effect of unilateral transverse process vertebroplasty (percutaneous vertebroplasty, PVP) combined with reduction in the treatment of severe osteoporotic compression fracture of lumbar vertebrae (osteoporotic vertebral compression fracture, OVCF). Methods: from March 2012 to July 2014, 45 cases of severe osteoporotic compression fractures of the lumbar vertebrae were analyzed retrospectively. All 45 vertebrae were treated with unilateral transverse-process vertebroplasty combined reduction, including 11 males and 34 females. The average age was 74.38 years. To compare the pain visual analogue score (visual analogue scale,VAS), Oswestry) before operation, 3 days after operation and at the last follow-up, (visual analogue scale,VAS), Oswestry dysfunction index (Oswestry disability index, ODI),) was used to evaluate the clinical efficacy of the patients with Cobb angle of vertebrae and the anterior and middle height of vertebral body. Results: the operation time was 29.84 鹵7.73 minutes, and the cement leakage rate was 15.6% (7 cases) with 5. 1 鹵0. 97 ml, bone cement leakage. 39 patients with no related clinical symptoms and signs were followed up satisfactorily and 6 cases were lost. The rate of missing visit was 13.3.The follow-up time was 6-30 months (mean 18.2 months). On the 3rd day after operation, the VAS score was 2.28 鹵0.89 and the ODI index was 33.95 鹵4.44. The Cobb angle was 8.13 鹵1.69 擄, the anterior and middle height of the injured vertebrae were 24.82 鹵2.52 mm and 22.77 鹵2.06 mm respectively, the VAS score was 1.73 鹵0.76 at the last follow-up, and the ODI index of the Cobb angle was 8.44 鹵1.650, the anterior and middle height of the injured vertebra were 23.92 鹵2.34 mm and 22.07 鹵2.18 mm, respectively. There were significant differences in VAS score and ODI index between 3 days and the last follow-up (P0.05), the Cobb angle, anterior and median height of the injured vertebrae recovered significantly (P0.05), the Cobb angle and the anterior edge of the injured vertebra at the last follow-up were significantly higher than those before the operation (P0.05). There was no significant change in median height 3 days after operation (P0.05). Conclusion: unilateral transverse process approach combined with vertebroplasty can effectively relieve the pain caused by severe osteoporotic compression fracture, restore and maintain the height of the injured vertebra, correct the Cobb angle of lumbar kyphosis, and reconstruct the sagittal balance. It is an effective, safe, simple and economical way to improve the quality of life.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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