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手法整复联合PKP单侧穿刺治疗老年骨质疏松性胸腰椎骨折的疗效观察

Manipulative reduction combined with PKP unilateral puncture in treatment of elderly osteoporotic thoracolumbar spine fractures
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摘要 目的比较手法整复联合PKP单侧穿刺与PKP双侧穿刺治疗老年骨质疏松性胸腰椎骨折的临床疗效。方法回顾性分析自2014-01—2020-12诊治的112例老年骨质疏松性胸腰椎骨折,观察组56例采用手法整复联合PKP单侧穿刺治疗,对照组56例采用PKP双侧穿刺治疗。比较两组术后3 d、术后12个月椎体前缘高度、椎体中部高度、伤椎Cobb角、疼痛VAS评分、ODI指数。比较末次随访时的疗效、术后并发症发生情况、骨水泥弥散程度。结果两组随访时间均不少于12个月。观察组手术时间、中位透视次数、骨水泥注入量均较对照组少,差异有统计学意义(P<0.05)。两组住院时间比较差异无统计学意义(P>0.05)。两组术后12个月椎体前缘高度、椎体中部高度、伤椎Cobb角与术后3 d比较差异无统计学意义(P>0.05),椎体前缘高度、椎体中部高度、伤椎Cobb角均未明显丢失。术前、术后3 d、术后12个月时两组椎体前缘高度、椎体中部高度、伤椎Cobb角组间比较,差异均无统计学意义(P>0.05)。两组术后12个月疼痛VAS评分、ODI指数与术后3 d比较差异有统计学意义(P>0.05),疼痛VAS评分、ODI指数均持续改善。术前、术后3 d、术后12个月时两组疼痛VAS评分、ODI指数组间比较,差异均无统计学意义(P>0.05)。观察组骨水泥渗漏率低于对照组,差异有统计学意义(P<0.05)。末次随访时两组相邻椎体再骨折发生率比较差异无统计学意义(P>0.05)。结论手法整复联合PKP单侧穿刺与PKP双侧穿刺治疗老年骨质疏松胸腰椎骨折疗效相当,但是前者在减少手术时间、辐射暴露以及降低骨水泥渗漏率方面具有优势,尤其适应于基础状态较差不能耐受长时间俯卧位的老年患者。 Objective To compare the clinical efficacy of manual reduction combined with unilateral PKP puncture and bilat⁃eral PKP puncture in the treatment of elderly osteoporotic thoracolumbar spine fractures.Methods A retrospective analysis of 112 elderly patients with osteoporotic thoracolumbar spine fractures from January 2014 to December 2020 was conducted.Fifty-six cases were treated with manual reduction combined with PKP unilateral puncture(observation group)while 56 cases were treated with PKP bilateral puncture(control group).The anterior vertebral height,middle vertebral height,Cobb Angle of in⁃jured vertebrae,VAS score,and ODI index at 3 days and 12 months after operation,and the effective rate,postoperative compli⁃cations,and the degree of bone cement dispersion at the last follow-up were compared between the two groups.Results The follow-up time of the two groups was not less than 12 months.The operation time,median fluoroscopy times,and bone cement injection volume in the observation group were less than those in the control group,and the differences were statistically signifi⁃cant(P<0.05).There was no significant difference in hospital stay between the two groups(P>0.05).There was no significant dif⁃ference in the anterior vertebral height,middle vertebral height,and injured vertebral Cobb Angle between 12 months after oper⁃ation and 3 days after operation(P>0.05),and there was no significant loss of anterior vertebral height,middle vertebral height,and injured vertebral Cobb Angle.There was no significant difference in anterior vertebral height,middle vertebral height,and Cobb Angle of injured vertebrae between 2 groups before operation,at 3 days and 12 months after operation(P>0.05).The pain VAS score and ODI at 12 months after operation were significantly different from those at 3 days after operation(P>0.05),and the pain VAS score and ODI index continued to improve.There was no significant difference in VAS score and ODI index be⁃tween the two groups before operation,at 3 days and 12 month
作者 贺志亮 王德成 李苹 刘超 HE Zhiliang;WANG Decheng;LI Ping;LIU Chao(Department of Spinal Trauma,Beijing Tongzhou District Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100102,China;不详)
出处 《中国骨与关节损伤杂志》 2023年第11期1126-1131,共6页 Chinese Journal of Bone and Joint Injury
基金 北京市中医药科技项目(JJ2014-05)。
关键词 老年骨质疏松胸腰椎骨折 经皮穿刺椎体后凸成形术 手法整复 穿刺方式 Elderly patients with osteoporotic thoracolumbar spine fractures Percutaneous kyphoplasty Manual reduction Method of puncture
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