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目的探讨多节同时穿刺和逐节穿刺两种穿刺方案在骨质疏松性胸腰椎体骨折患者方法和疗效。方法选取2014年1月至2016年1月治疗的126例骨质疏松性胸腰椎体骨折患者,根据穿刺方案不同分为两组,对照组60例,采用多节同时穿刺经皮椎体成形术,观察组66例,采用逐节穿刺经皮椎体成形术治疗。记录骨水泥渗漏及伤椎高度恢复率等情况,应用健康调查简表SF-36和视觉模拟疼痛评分(VAS)评估患者的疼痛情况和生活质量情况。结果观察组手术时间(38.4±1.4)min短于对照组(27.5±6.0)min,骨水泥注入量(5.8±1.4)ml少于对照组(4.9±2.5)ml,骨水泥渗漏率低于对照组(18.18%vs 40.00%),术后伤椎高度增加(9.2±2.2)mm高于对照组(2.4±1.8)mm,术后6个月观察组伤椎椎体高度丢失(1.9±0.8)mm大于对照组(0.8±0.5)mm,差异均有统计学意义(P<0.05,P<0.01)。术后2周观察组伤椎前柱高度恢复率(50.32±2.17)%优于对照组(39.45±2.69)%,观察组伤椎中柱高度恢复率(56.36±0.86)%优于对照组(47.81±3.56)%(P均<0.05)。两组患者术后2周及术后6个月的VAS、SF-36评分均优于术前(P<0.05)。VAS评分术后2周及术后6个月两组比较差异均有统计学意义(P均<0.05)。SF-36评分术后2周及术后6个月两组比较差异均无统计学意义(P均>0.05)。结论逐节穿刺经皮椎体成形术在骨水泥渗漏情况与椎体高度恢复情况均优于多节同时穿刺椎体成形术,对于骨质疏松性胸腰椎体骨折患者来说是更好的选择。
Objective To explore the methods and curative effects of two kinds of puncture protocols of multiple simultaneous puncture and punctual puncture in the treatment of osteoporotic thoracolumbar vertebral fractures. Methods 126 cases of osteoporotic thoracolumbar vertebral fractures treated from January 2014 to January 2016 were divided into two groups according to the different puncture protocols. The control group consisted of 60 patients. Multiple simultaneous percutaneous vertebroplasty 66 cases in the observation group were treated with percutaneous vertebroplasty by puncture. Record the leakage of bone cement and the recovery rate of vertebral height. SF-36 and VAS were used to assess the patient’s pain and quality of life. Results The operation time of the observation group was shorter than that of the control group (38.4 ± 1.4) min (27.5 ± 6.0) min. The bone cement injection volume (5.8 ± 1.4) ml was less than that of the control group (4.9 ± 2.5) In the control group (18.18% vs 40.00%), the height of the injured vertebra increased 9.2 ± 2.2 mm compared with 2.4 ± 1.8 mm in the control group. The height of the injured vertebral body in the observation group was 1.9 ± 0.8 ) mm was significantly higher than that of the control group (0.8 ± 0.5) mm, the difference was statistically significant (P <0.05, P <0.01). The height recovery rate of the anterior vertebral column in the observation group at 2 weeks after operation was (50.32 ± 2.17)% better than that in the control group (39.45 ± 2.69)%, and the recovery rate of the height of the column in the vertebral column was 56.36 ± 0.86% 47.81 ± 3.56)% (P <0.05). The VAS and SF-36 scores of both groups were better than those before operation (P <0.05) after 2 weeks and 6 months after operation. VAS score 2 weeks after operation and 6 months after operation were significantly different between the two groups (all P <0.05). There was no significant difference between two groups in SF-36 score 2 weeks and 6 months postoperatively (all P> 0.05). Conclusions Percutaneous vertebroplasty with percutaneous puncture is superior to multi-section simultaneous vertebroplasty in the case of cement leakage and vertebral height recovery, which is better for patients with osteoporotic thoracolumbar vertebral fractures select.