【摘要】：目的通過分析骨質(zhì)疏松壓縮性骨折和骨質(zhì)疏松爆裂性骨折行經(jīng)皮椎體后凸成形術(shù)(PKP)的影像學(xué)資料,探討骨水泥滲漏及滲漏位置、途徑、骨折類型對臨床療效的影響。方法南昌大學(xué)第二附屬醫(yī)院2013年1月-2016年1月采用經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松骨折215例245個(gè)椎體。術(shù)后根據(jù)影像學(xué)將患者分為骨質(zhì)疏松壓縮骨折組和骨質(zhì)疏松破裂骨折組。符合納入標(biāo)準(zhǔn)的OVBF有35個(gè)椎體,OVCF有210個(gè)。將骨水泥滲漏分為椎管內(nèi)、椎間隙,及其他部位滲漏(椎旁、椎旁靜脈、針道)。采用VAS評分分析各組患者腰背部疼痛緩解的情況。結(jié)果OVBF組與OVCF組骨水泥滲漏比較有統(tǒng)計(jì)學(xué)意義(P0.05),但兩組椎管內(nèi)骨水泥滲漏的比較無差別(P0.05)。OVBF組椎間隙和椎旁軟組織滲漏率要明顯高于OVCF組,兩組該部位比較有明顯差別(P0.05)。其他部位滲漏兩組比較無統(tǒng)計(jì)學(xué)意義(P0.05)。骨水泥可以通過椎基靜脈,椎體后壁,椎弓根破裂的內(nèi)壁3種途徑進(jìn)入椎管內(nèi),但椎基靜脈可能是骨水泥滲漏至椎管內(nèi)的主要途徑。OVBF組和OVCF組經(jīng)PKP治療術(shù)后及末次隨訪VAS評分比較無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組中有骨水泥滲漏患者與無骨水泥滲漏患者術(shù)前術(shù)后VAS比較均無差別(P0.05)。兩組患者中骨水泥滲漏入椎管內(nèi)術(shù)后及末次隨訪VAS評分比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組患者中骨水泥滲漏到椎間隙內(nèi)術(shù)前和術(shù)后VAS評分比較無統(tǒng)計(jì)學(xué)意義(P0.05),但術(shù)前和末次隨訪VAS評分有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.經(jīng)皮椎體后凸成形術(shù)治療椎體骨質(zhì)疏松破裂性骨折與骨質(zhì)疏松壓縮骨折椎管內(nèi)骨水泥滲漏率無差別。骨水泥可能主要通過椎基靜脈漏入椎管。2.椎體骨質(zhì)疏松破裂性骨折更易發(fā)生骨水泥滲漏,椎間隙滲漏和椎旁滲漏率明顯高于骨質(zhì)疏松壓縮骨折。3.經(jīng)皮椎體后凸成形術(shù)治療椎體骨質(zhì)疏松脊柱骨折腰背部疼痛的緩解與是否發(fā)生骨水泥滲漏、滲漏部位和骨折類型無關(guān)。但椎間隙內(nèi)骨水泥滲漏可能短時(shí)間內(nèi)影響患者的腰痛。
[Abstract]:Objective to analyze the imaging data of percutaneous kyphoplasty (PKP) for osteoporotic compression fracture and burst osteoporotic fracture, and to explore the effect of osseous cement leakage, location, approach and fracture type on clinical efficacy. Methods from January 2013 to January 2016, 215 patients with osteoporotic fractures were treated with percutaneous kyphoplasty in the second affiliated Hospital of Nanchang University. The patients were divided into osteoporotic compression fracture group and osteoporotic fracture group according to imaging. There were 35 vertebrae in OVBF and 210 in OVCF. Bone cement leakage is divided into spinal canal, intervertebral space, and other sites (paravertebral, paravertebral vein, needle). VAS score was used to analyze the relief of lumbar and back pain in each group. Results there was significant difference in bone cement leakage between OVBF group and OVCF group (P0.05), but there was no difference between the two groups. (P0.05) the leakage rate of intervertebral space and paraspinal soft tissue in). OVBF group was significantly higher than that in OVCF group. There was significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). Bone cement can enter the spinal canal through three ways: the vertebral basal vein, the posterior wall of the vertebral body and the inner wall of the broken pedicle. But vertebrobasilar vein may be the main way of bone cement leakage into the spinal canal. There was no significant difference in VAS score between OVBF group and OVCF group after PKP treatment and the last follow-up (P0.05). There was no difference in VAS between the patients with bone cement leakage and those without bone cement leakage (P0.05). There was no significant difference in VAS score between the two groups after bone cement leakage into the spinal canal and at the last follow-up (P0.05). There was no significant difference in VAS score between the two groups before and after the bone cement leakage into the intervertebral space (P0.05), but there was significant difference between the preoperative and the last follow-up VAS scores (P0.05). Conclusion 1. There was no difference between percutaneous kyphoplasty and osteoporotic compression fracture in the treatment of vertebral canal cement leakage. Bone cement may leak into the spinal canal mainly through the vertebrobasilar vein. 2. Fracture of vertebral body with osteoporosis is more likely to occur cement leakage, the leakage rate of intervertebral space and paravertebral leakage is obviously higher than that of osteoporotic compression fracture. The relief of lumbar and back pain caused by percutaneous kyphoplasty in the treatment of osteoporotic spinal fracture is not related to the occurrence of cement leakage, leakage site and fracture type. However, bone cement leakage in intervertebral space may affect the patient's low back pain in a short time.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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