中国医药科学
中國醫藥科學
중국의약과학
CHINA MEDICINE AND PHARMACY
2013年
11期
9-11,59
,共4页
原向伟%陈忠羡%范全%梁胜根%赵振东%秦英%谢清华%付朝华%雷洪俊%薛忠林
原嚮偉%陳忠羨%範全%樑勝根%趙振東%秦英%謝清華%付朝華%雷洪俊%薛忠林
원향위%진충이%범전%량성근%조진동%진영%사청화%부조화%뢰홍준%설충림
经皮椎体成形术%经皮后凸成形术%骨质疏松性胸腰椎压缩骨折%并发症
經皮椎體成形術%經皮後凸成形術%骨質疏鬆性胸腰椎壓縮骨摺%併髮癥
경피추체성형술%경피후철성형술%골질소송성흉요추압축골절%병발증
Percutaneous vertebroplasty%Percutaneous kyphosis%Osteoporotic thoracolumbar vertebral compression fracture%Complication
目的探讨PVP和PKP治疗骨质疏松性胸腰椎压缩骨折的并发症及防治。方法对2009年1月～2011年12月本院确诊骨质疏松性胸腰椎新鲜压缩骨折患者182例共267椎进行PVP（102例）和PKP（80例）治疗，随访12～42个月，比较治疗前后视觉模拟评分（VAS）、Barthel指数等疗效指标，观察并处理手术并发症。结果 PVP组和PKP组术后胸腰背痛均获良好缓解，术后3天、术后1年VAS评分及Barthel指数较术前均明显改善，差异具有统计学意义（P＜0.05）。182例发生并发症80例，发生率43.96%。其中PVP组和PKP组发生穿刺并发症各1、2例；骨水泥渗漏各40例（53椎）、13例（15椎），发生率各为36.05%和18.75%，差异具有统计学意义（P＜0.05），未发生因骨水泥渗漏导致截瘫、肺栓塞等严重并发症；截至术后1年随访发生临近椎体骨折21例（11.54%），其中PVP组和PKP组各10例（9.80%）、11例（13.75%），差异无统计学意义（P＞0.05）。术中发生一过性呼吸困难、呛咳3例，予加强吸氧、安抚患者后好转。结论PVP和PKP均可明显改善患者症状和生活质量，但并发症发生率较高，在骨水泥渗漏率上PKP相对于PVP具有优越性，在相邻椎体骨折发生率二者无明显差别，完善术前检查评估、良好的手术操作以及规范的抗骨松治疗有助于预防和减少并发症的发生。
目的探討PVP和PKP治療骨質疏鬆性胸腰椎壓縮骨摺的併髮癥及防治。方法對2009年1月～2011年12月本院確診骨質疏鬆性胸腰椎新鮮壓縮骨摺患者182例共267椎進行PVP（102例）和PKP（80例）治療，隨訪12～42箇月，比較治療前後視覺模擬評分（VAS）、Barthel指數等療效指標，觀察併處理手術併髮癥。結果 PVP組和PKP組術後胸腰揹痛均穫良好緩解，術後3天、術後1年VAS評分及Barthel指數較術前均明顯改善，差異具有統計學意義（P＜0.05）。182例髮生併髮癥80例，髮生率43.96%。其中PVP組和PKP組髮生穿刺併髮癥各1、2例；骨水泥滲漏各40例（53椎）、13例（15椎），髮生率各為36.05%和18.75%，差異具有統計學意義（P＜0.05），未髮生因骨水泥滲漏導緻截癱、肺栓塞等嚴重併髮癥；截至術後1年隨訪髮生臨近椎體骨摺21例（11.54%），其中PVP組和PKP組各10例（9.80%）、11例（13.75%），差異無統計學意義（P＞0.05）。術中髮生一過性呼吸睏難、嗆咳3例，予加彊吸氧、安撫患者後好轉。結論PVP和PKP均可明顯改善患者癥狀和生活質量，但併髮癥髮生率較高，在骨水泥滲漏率上PKP相對于PVP具有優越性，在相鄰椎體骨摺髮生率二者無明顯差彆，完善術前檢查評估、良好的手術操作以及規範的抗骨鬆治療有助于預防和減少併髮癥的髮生。
목적탐토PVP화PKP치료골질소송성흉요추압축골절적병발증급방치。방법대2009년1월～2011년12월본원학진골질소송성흉요추신선압축골절환자182례공267추진행PVP（102례）화PKP（80례）치료，수방12～42개월，비교치료전후시각모의평분（VAS）、Barthel지수등료효지표，관찰병처리수술병발증。결과 PVP조화PKP조술후흉요배통균획량호완해，술후3천、술후1년VAS평분급Barthel지수교술전균명현개선，차이구유통계학의의（P＜0.05）。182례발생병발증80례，발생솔43.96%。기중PVP조화PKP조발생천자병발증각1、2례；골수니삼루각40례（53추）、13례（15추），발생솔각위36.05%화18.75%，차이구유통계학의의（P＜0.05），미발생인골수니삼루도치절탄、폐전새등엄중병발증；절지술후1년수방발생림근추체골절21례（11.54%），기중PVP조화PKP조각10례（9.80%）、11례（13.75%），차이무통계학의의（P＞0.05）。술중발생일과성호흡곤난、창해3례，여가강흡양、안무환자후호전。결론PVP화PKP균가명현개선환자증상화생활질량，단병발증발생솔교고，재골수니삼루솔상PKP상대우PVP구유우월성，재상린추체골절발생솔이자무명현차별，완선술전검사평고、량호적수술조작이급규범적항골송치료유조우예방화감소병발증적발생。
Objective To investigate the complications of PVP and PKP in the treatment of osteoporotic thoracolumbar vertebral compression fracture and its prevention. Methods 182 patients (267 vertebrae) diagnosed with fresh osteoporotic thoracolumbar vertebral compression fracture in our hospital from January 2009 to December 2011 received PVP (102 patients) and PKP (80 patients) treatment.After 12 ~ 42 months of follow-up,surgical complications such as visual analogue scale (VAS) and Barthel Index before and after treatment were compared and the surgical complications were observed and dealt with. Results The postoperative chest, waist and back pain of both the PVP group and PKP group relieved well. The VAS score and Barthel index 3 days and 1 year after surgery improved significantly,with statistically significant differences(P<0.05) Of the 182 patients,80 patients had complications, with the incidence of 43.96%. In the PVP group and the PKP group, 1 patient and 2 patients had puncture complications respectively, 40 patients (53 vertebrae) and 13 patients (15 vertebrae) had bone cement leakage respectively, accounting for 36.05% and 18.75%, with statistically significant differences (P < 0.05),none had bone cement leakage induced paraplegia, pulmonary embolism and other severe complications. By the end of 1-year follow-up after surgery,21 patients (11.54%) had adjacent vertebral facture, consisting of 10 patients (9.80%) and 11 patients (13.75%) in the PVP group and the PKP group respectively, with no statistically significant differences (P > 0.05). Three patients had intraoperative transient dyspnea and bucking, which improved after enhancing oxygen uptake and consolation. Conclusion Both PVP and PKP can significantly improve the patients’symptoms and quality of life, but they were accompanied with high incidence of complications. PKP is better than PVP in the incidence of bone cement leakage,but is not significantly different from PVP in the incidence of adjacent vertebral fracture. Improvement of preoperative examination and evaluation, good surgical operation and standardized anti-osteoporosis treatment help to prevent and reduce the occurrence of complications.
