[1]李洪珂,郝申申,董胜利,等.手法复位联合经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床研究[J].中医正骨,2020,32(08):6-11.
　LI Hongke,HAO Shenshen,DONG Shengli,et al.A clinical study of manipulative reduction combined with percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(08):6-11.
点击复制

手法复位联合经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年08期
页码:
6-11
栏目:
临床研究
出版日期:
2020-08-20

文章信息/Info

Title:
A clinical study of manipulative reduction combined with percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures
作者:
李洪珂; 郝申申; 董胜利; 刘帅; 陈红磊; 张志芳; 王鹏程; 杨贤玉; 郭阿雷
(平煤神马医疗集团总医院,河南 平顶山 467000)
Author(s):
LI Hongke; HAO Shenshen; DONG Shengli; LIU Shuai; CHEN Honglei; ZHANG Zhifang; WANG Pengcheng; YANG Xianyu; GUO Alei
General Hospital of Pingmei Shenma Medical Group,Pingdingshan 467000,Henan,China
关键词:
脊柱骨折;  胸椎;  腰椎;  骨折; 压缩性;  骨质疏松性骨折;  正骨手法;  椎体成形术;  椎体后凸成形术;  临床试验
Keywords:
spinal fractures;  thoracic vertebrae;  lumbar vertebrae;  fractures; compression;  osteoporotic fractures;  bone setting manipulation;  vertebroplasty;  kyphoplasty;  clinical trial
摘要:
目的:探讨手法复位联合经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效和安全性。方法:回顾性分析80例OVCF患者的病例资料,根据采用的治疗方法分为3组,采用手法复位联合PVP治疗28例、采用手法复位联合经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗25例、采用单纯PKP治疗27例。比较3组患者的手术时间、术中透视次数、骨水泥分布情况、骨水泥渗漏情况、腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评分。结果:3组患者手术时间、术中透视次数、骨水泥分布情况比较,组间差异均有统计学意义(F=4.424,P=0.015; F=5.584,P=0.004; Z=13.759,P=0.001)。手法复位联合PVP组手术时间短于手法复位联合PKP组和单纯PKP组(P=0.008; P=0.019); 手法复位联合PKP组和单纯PKP组手术时间的差异无统计学意义(P=0.724)。手法复位联合PVP组术中透视次数少于手法复位联合PKP组和单纯PKP组(P=0.001; P=0.019); 手法复位联合PKP组和单纯PKP组术中透视次数的差异无统计学意义(P=0.348)。手法复位联合PKP组的骨水泥分布情况最优,手法复位联合PVP组次之,单纯PKP组最差(R^-1=33.94; R^-2=34.39; R^-3=52.92)。3组患者治疗前、治疗后1周的腰背部疼痛VAS评分比较,组间差异无统计学意义(F=0.186,P=0.830; F=0.988,P=0.376); 3组患者治疗后1周的腰背部疼痛VAS评分均显著低于治疗前[(7.5±1.3)分,(2.0±0.5)分,t=20.894,P=0.000;(7.7±1.5)分,(2.0±0.7)分,t=16.613,P=0.000;(7.7±1.4)分,(2.2±0.6)分,t=18.762,P=0.000]。3组患者治疗前、治疗后1周的ODI评分比较,组间差异无统计学意义(F=0.375,P=0.688; F=0.728,P=0.485)。3组患者治疗后1周的ODI评分均显著低于治疗前[(40.2±7.5)分,(20.4±7.4)分,t=9.944,P=0.000;(41.5±7.3)分,(20.1±7.0)分,t=10.579,P=0.000;(41.8±7.0)分,(22.3±7.2)分,t=10.090,P=0.000]。手法复位联合PVP组2例骨水泥渗漏,手法复位联合PKP组1例骨水泥渗漏,单纯PKP组2例骨水泥渗漏,均在暂停注入后停止渗漏,调整注入位点后完成骨水泥注入; 3组患者骨水泥渗漏率比较,组间差异无统计学意义(χ2=0.316,P=0.854)。术中无刺破椎体、神经血管损伤、医源性骨折。结论:手法复位联合PVP治疗OVCF与手法复位联合PKP、单纯PKP治疗的短期临床疗效与安全性相当,但手法复位联合PVP治疗OVCF的手术时间短、术中透视次数少,且骨水泥分布好。
Abstract:
To explore the clinical curative effects and safety of manipulative reduction combined with percutaneous vertebroplasty(PVP)for treatment of osteoporotic vertebral compression fractures(OVCF).Methods:The medical records of 80 OVCF patients were analyzed retrospectively.The patients were divided into three groups according to the therapies they received.Twenty-eight patients were treated with manipulative reduction combined with PVP(group A),25 patients were treated with manipulative reduction combined with percutaneous kyphoplasty(PKP)(group B),while the others were treated with monotherapy of PKP(group C).The operative time,intraoperative X-ray exposure,bone cement distribution,bone cement leakage,low back pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)scores were compared between the 3 groups.Results:There was statistical difference in operative time,intraoperative

参考文献/References:

[1] ZUO X H,ZHU X P,BAO H G,et al.Network meta-analysis of percutaneous vertebroplasty,percutaneous kyphoplasty,nerve block,and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures(OVCFs)in short-term and long-term effects[J].Medicine(Baltimore),2018,97(29):e11544.
[2] JOHNELL O,KANIS J A.An estimate of the worldwide prevalence and disability associated with osteoporotic fractures [J].Osteoporos Int,2006,17(12):1726-1733.
[3] 孙永强,李增方,于增军,等.手法复位联合经皮椎体成形术对老年骨质疏松性椎体骨折患者椎体高度及疼痛的影响[J].解放军医学院学报,2018,39(1):39-41.
[4] NG J P,CAWLEY D T,BEECHER S M,et al.The Reverse thomas position for thoracolumbar fracture height restoration:relative contribution of patient positioning in percutaneous balloon kyphoplasty for acute vertebral compressions[J].Int J Spine Surg,2016,10:21.
中医正骨2020年8月第32卷第8期 J Trad Chin Orthop Trauma,2020,Vol.32,No.8(总571)
(总572)中医正骨2020年8月第32卷第8期 J Trad Chin Orthop Trauma,2020,Vol.32,No.8
[5] 牛强卫.手法复位联合经皮椎体成形术和中医骨折三期辨证用药治疗骨质疏松性胸腰椎压缩骨折的临床研究[J].中医正骨,2017,29(4):16-22.
[6] 赵刚,王许可,禚汉杰,等.仿真优化手法复位结合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性胸腰椎骨折的疗效比较[J].中华创伤杂志,2019,35(10):888-895.
[7] 印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.
[8] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:119-121.
[9] CHU W,TSUEI Y C,LIAO P H,et al.Decompressed percutaneous vertebroplasty:a secured bone cement delivery procedure for vertebral augmentation in osteoporotic compression fractures [J].Injury,2013,44(6):813-818.
[10] 刘庆,徐俊杰,李业海,等.经皮椎体成形术与后凸成形术治疗骨质疏松性椎体压缩骨折的疗效比较[J].临床骨科杂志,2017,20(2):150-153.
[11] 陈欣.术前复位结合椎体成形术治疗骨质疏松性椎体严重压缩骨折[J].浙江临床医学,2016,18(8):1487-1489.
[12] 豆贲,袁万福,杨子情,等.手法复位PVP与单纯PVP治疗骨质疏松性胸腰椎压缩骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(7):740-742.
[13] 宋仁谦,郑怀亮,周英杰,等.平乐正骨手法复位结合高黏度骨水泥经皮椎体成形术治疗老年骨质疏松脊柱压缩骨折的疗效分析[J].中国中医急症,2018,27(8):1348-1351.
[14] HONG S J,LEE S,YOON J S,et al.Analysis of intradiscal cement leakage during percutaneous vertebroplasty:multivariate study of risk factors emphasizing preoperative MR findings[J].J Neurorad,2014,41(3):195-201.
[15] 李世梁,连育才,孙海东,等.骨水泥分布系数及骨水泥量与经皮椎体后凸成形术早期疗效相关性分析[J].重庆医学,2019,48(5):870-872.
[16] 刘杰,朱小龙,石晨.手法复位联合经皮椎体后凸成形术治疗胸腰椎压缩性骨折[J].中医正骨,2016,28(5):28-30.
[17] 熊森,毛克亚,韩振川,等.应用弯角椎体成形装置修复胸腰段骨质疏松性椎体压缩骨折[J].中国组织工程研究,2016,20(17):24456-24462.
[18] 贺宝荣,许正伟,郝定均,等.骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系[J].中华骨科杂志,2012,32(8):768-773.
[19] 钟睿,姜威,熊森,等.单侧弯角与直行入路椎体成形治疗骨质疏松性椎体压缩骨折疗效的对照研究[J].中华创伤杂志,2018,34(2):102-108.
[20] 刘贤平,余春燕.经皮椎体成形术联合手法复位治疗胸腰椎骨质疏松性压缩骨折的疗效观察[J].中医外治杂志,2017,26(4):16-17.
[21] 佟训哲,赵小林,臧传义.经皮椎体成形术联合复位对骨质疏松性胸腰椎压缩骨折的治疗效果[J].解放军预防医学杂志,2019,37(4):124-125.
[22] 何保玉,刘宝戈,李学民,等.骨水泥弥散容积率在骨质疏松性椎体压缩骨折PKP术后疗效评价中的应用[J].中国骨与关节杂志,2016,5(1):68-73.
[23] 江晓兵,黄伟权,庞智晖,等.基于Mimics软件计算椎体强化术后椎体内骨水泥体积及骨水泥/椎体体积比的新方法[J].中国脊柱脊髓杂志,2013,23(3):238-243.
[24] 俞武良,陆建猛,韦勇力,等.经皮椎体成形术中椎体内骨水泥分布范围对疗效的影响[J].中国矫形外科杂志,2015,23(20):1836-1840.
[25] 文坤树,蔡勇平,张家金,等.PKP术中骨水泥的灌注量与分布对OVCF早期疗效的影响[J].重庆医学,2016,45(1):62-65.
[26] 仇建军,纪斌,王明飞,等.牵引手法复位椎体成形术治疗骨质疏松性胸腰椎体压缩性骨折[J].国际骨科学杂志,2017,38(6):389-392.
[27] 郭阿雷,郝申申,孟赛克,等.手法复位PVP与单纯PKP手术治疗骨质疏松性胸腰段脊柱压缩骨折的疗效比较[J].中国骨与关节损伤杂志,2020,35(1):44-46.

相似文献/References:

[1]许兵,叶小雨,王萧枫,等.小管径经皮椎体后凸成形术治疗 骨质疏松性椎体重度压缩骨折[J].中医正骨,2015,27(11):29.
[2]郭小伟,梅伟,潘玉林,等.一期后路病灶清除纳米仿生骨椎体支撑体植骨融合 内固定治疗胸腰椎结核[J].中医正骨,2015,27(07):66.
[3]谢小利,李晓程.经皮椎体后凸成形术治疗骨质疏松性椎体 压缩骨折的围手术期护理[J].中医正骨,2015,27(05):79.
[4]潘雄,刘其顺,应行,等.中药联合4步康复锻炼法对骨质疏松性椎体压缩 骨折患者生存质量的影响[J].中医正骨,2015,27(04):65.
[5]李格,梅伟,刘沛霖,等.骨质疏松性椎体压缩骨折经皮椎体成形术后邻近椎体再骨折的危险因素探讨[J].中医正骨,2016,28(06):18.
　LI Ge,MEI Wei,LIU Peilin,et al.Investigation on risk factors for adjacent vertebral refractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(08):18.
[6]梅 伟.胸腰椎骨折临床诊疗中的热点问题[J].中医正骨,2016,28(07):1.
[7]李英周,叶锋,王晓,等.后路撬拨植骨椎弓根螺钉内固定治疗胸腰椎骨折[J].中医正骨,2016,28(07):46.
[8]王军,陈哲,王硕凡.胸腰椎骨折椎体植骨材料的临床应用进展[J].中医正骨,2016,28(07):64.
[9]张旭桥,王晓晖,黄光明,等.生骨胶囊在经皮椎体强化术治疗老年骨质疏松性胸腰椎骨折中的应用研究[J].中医正骨,2016,28(11):21.
　ZHANG Xuqiao,WANG Xiaohui,HUANG Guangming,et al.Application of Shenggu Jiaonang(生骨胶囊)to the treatment of osteoporotic thoracolumbar vertebral fractures in the aged who received percutaneous vertebral augmentation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(08):21.
[10]张 涛.常规抗骨质疏松疗法联合脉冲射频术和银质针松解术治疗骨质疏松性椎体压缩骨折[J].中医正骨,2017,29(04):74.
[11]邓红军.硫酸钙骨水泥椎体成形联合后路短节段椎弓根螺钉 内固定治疗创伤性胸腰椎骨折[J].中医正骨,2015,27(10):35.
[12]李鹏,徐世涛,谭磊.椎旁肌间隙入路伤椎单侧植骨内固定治疗 单节段胸腰椎骨折[J].中医正骨,2015,27(06):43.
[13]孙德舜,王小鹤,王晓燕,等.气囊托板复位配合骨伤复元汤口服治疗 胸腰椎单纯压缩骨折[J].中医正骨,2015,27(05):65.
[14]武祥仁,胡海涛,茅祖斌.经椎旁肌间隙入路伤椎植骨内固定治疗 无神经损伤的胸腰椎骨折[J].中医正骨,2015,27(03):56.
[15]刘杰,朱小龙,石晨.手法复位联合经皮椎体后凸成形术治疗胸腰椎压缩性骨折[J].中医正骨,2016,28(05):28.
[16]杨振国,王树强,范杰,等.钉棒系统复位内固定联合经椎弓根撬拨植骨术治疗胸腰椎压缩性骨折[J].中医正骨,2016,28(05):31.
[17]陈思凯,邢金明.骨水泥强化椎弓根螺钉内固定治疗老年胸腰椎压缩性骨折[J].中医正骨,2016,28(05):35.
[18]孙彦鹏,史相钦,马虎升,等.小开窗减压短力臂伤椎置钉复位内固定术治疗胸腰椎爆裂性骨折[J].中医正骨,2016,28(11):26.
[19]江涛,徐彪炳,党旗.后路经伤椎椎弓根置钉联合椎板开窗减压关节突间植骨融合治疗胸腰椎爆裂性骨折[J].中医正骨,2017,29(02):72.
[20]陈华,李宇卫,姜宏.非手术疗法治疗单纯性胸腰椎骨折的研究进展[J].中医正骨,2017,29(07):48.

备注/Memo

备注/Memo:
通讯作者:郝申申 E-mail:316902786@qq.com
更新日期/Last Update: 2020-08-20