单侧经皮椎体后凸成形术联合针刀治疗单节段骨质疏松性胸腰椎压缩性骨折的临床观察

周文静; 李华杰; 孙欢; 闵有宝; 刘磊; 周平辉

doi:10.16766/j.cnki.issn.1674-4152.0033233

单侧经皮椎体后凸成形术联合针刀治疗单节段骨质疏松性胸腰椎压缩性骨折的临床观察

doi: 10.16766/j.cnki.issn.1674-4152.0033233

1.
安徽中医药大学附属滁州市中西医结合医院骨伤二科，安徽滁州 239000
2.
蚌埠医学院第一附属医院骨科，安徽蚌埠 233004

基金项目:

国家自然科学基金项目 31700854

详细信息

通讯作者:
周文静，E-mail：66417686@qq.com

中图分类号: R683.2 R687.42
计量
- 文章访问数: 200
- HTML全文浏览量: 103
- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-18
- 网络出版日期: 2024-01-13

Efficacy of percutaneous unilateral balloon kyphoplasty combined with small-needle knife in the treatment of postoperative pain from single-level osteoporotic thoracolumbar vertebral compression fractures

1.
Department 2 of Orthopedics, Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine, Anhui University of Traditional Chinese Medicine, Chuzhou, Anhui 239000, China

摘要

摘要: 目的探讨单节段骨质疏松性胸腰椎压缩性骨折采用单侧经皮穿刺球囊扩张椎体后凸成形术联合小针刀治疗的临床疗效。方法选择滁州市中西医结合医院2017年7月—2019年3月骨伤二科收治的符合纳入与排除标准的单节段骨质疏松性胸腰椎压缩性骨折患者共46例，统计患者年龄、性别、病变椎体节段等一般资料，统计术前、术后24 h、针刀治疗后、术后6个月VAS评分，术前、术后、术后6个月Cobb角以及6个月内神经症状及再发压缩骨折情况。结果 46例患者术后疼痛较术前均明显改善，手术前后VAS评分、Cobb角比较差异有统计学意义[(2.63±0.74)分vs. (7.30±0.66)分、(8.78±0.16)° vs. (15.52±0.27)°，均P＜0.05]。其中1例患者发生骨水泥渗漏，无心肺系统及下肢血栓并发症发生，无死亡患者。结论单侧经皮穿刺球囊扩张椎体后凸成形术联合小针刀治疗单节段骨质疏松性压缩性骨折能够快速缓解患者疼痛，可有效提高老年患者的生活质量，安全性较好。
- 骨质疏松性椎体压缩性骨折 /
- 椎体后凸成形 /
- 小针刀
Abstract: Objective To evaluate the clinical efficacy of percutaneous unilateral balloon kyphoplasty combined with small-needle knife treatment in the management of postoperative pain in patients with single-level osteoporotic thoracolumbar compression fractures. Methods A total of 46 patients with single-level osteoporotic thoracolumbar compression fractures who were admitted to the second orthopaedic department of our hospital, Chuzhou Integrated Chinese and Western Medicine Hospital, from July 2017 to March 2019, and met the inclusion and exclusion criteria were selected for this study. General information such as age, sex, and vertebral segment was recorded. The VAS scores were recorded pre-operatively, 24 hours pre-operatively, after needle-knife treatment and at 6 months post-operatively. The Cobb angle before and after surgery and the occurrence of neurological symptoms and recurrent compression fractures within 6 months, were also recorded. Results Post-operative pain was significantly improved compared to pre-operative pain in all 46 patients. The differences in VAS scores and Cobb angles before and after surgery were statistically significant [(2.63±0.74) points vs. (7.30±0.66) points, (8.78±0.16) ° vs. (15.52±0.27) °, all P<0.05]. One case of bone cement overflow occurred and there were no complications such as cardiopulmonary system or lower extremity thrombosis or deaths. Conclusion Percutaneous unilateral balloon kyphoplasty combined with small-needle knife treatment is effective in reducing pain and improving the quality of life in elderly patients with single-level osteoporotic compression fractures. It is considered a safe procedure.
- Osteoporotic thoracolumbar compression fracture /
- Percutaneous kyphoplasty /
- Small needle knife

HTML全文

图 1 L₁椎体骨折患者PKP手术前后MRI

注：A为术前MRI示L₁椎体骨折; B、C为术后复查腰椎正侧位片示L₁椎体骨水泥填充; D为术后半年随访MRI示L₁椎体高度无明显丢失。

Figure 1. MRI before and after PKP surgery in patients with L₁ vertebral fracture

下载: 全尺寸图片幻灯片

图 2 T₁₂椎体骨折患者PKP手术前后MRI

A为术前MRI示T₁₂椎体骨折; B、C为术后复查腰椎正侧位片示T₁₂椎体骨水泥填充; D为术后半年随访MRI示T₁₂椎体高度无明显丢失。

Figure 2. MRI before and after PKP surgery in patients with T12 vertebral fractures

下载: 全尺寸图片幻灯片

参考文献(20)

[1]	HUANG K Y, LEE S C, LIU W L, et al. Long term survival of pathological thoracolumbar fractures treated with vertebroplasty: analysis using a nationwide insurance claim database[J]. J Clin Med, 2019, 9(1): 78. doi: 10.3390/jcm9010078
[2]	冯现锋, 杨建锋, 毛帅辉. 经皮椎体成形术治疗老年骨质疏松性胸腰椎压缩骨折的效果评价[J]. 航空航天医学杂志, 2018, 29(10): 1233-1234. doi: 10.3969/j.issn.2095-1434.2018.10.034 FENG X F, YANG J F, MAO S H. Effect of percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in elderly patients[J]. Chin J Aerospace Med, 2018, 29(10): 1233-1234. doi: 10.3969/j.issn.2095-1434.2018.10.034
[3]	刘德坚. 经皮椎体成形术和保守疗法治疗老年骨质疏松性胸腰椎压缩性骨折的临床效果对比分析[J]. 中外医学研究, 2019, 17(16): 119-121. LIU D J. Comparative analysis of clinical effects of percutaneous vertebroplasty and conservative therapy in the treatment of senile osteoporotic thoracolumbar compression fractures[J]. Chin and Foreign Med Res, 2019, 17(16): 119-120.
[4]	陈昊, 潘文琦, 张有磊, 等. 681例胸腰椎骨质疏松性椎体压缩骨折流行病学和临床特征分析[J]. 中国修复重建外科杂志, 2022, 36(7): 873-880. CHEN H, PAN W Q, ZHANG Y L, et al. Epidemiological and clinical characteristics of 681 cases of thoracolumbar osteoporotic vertebral compression fractures[J]. Chin J Pepar Reconstr Surg, 2022, 36(7): 873-880.
[5]	贾叙锋, 龙苗, 黄光平, 等. 弯角与传统单、双侧椎体成形术治疗老年骨质疏松性椎体压缩骨折[J]. 西部医学, 2022, 34(2): 298-303. JIA X F, LONG M, HUANG G P, et al. Analysis of the effect difference between the traditional single and bilateral vertebroplasty and bending angle in the treatment of osteoporotic vertebral compression fractures[J]. Medical Journal of West China, 2022, 34(2): 298-303.
[6]	王复案, 陈允震. 骨质疏松性椎体压缩性骨折诊疗现状及其对策[J]. 中国骨质疏松杂志, 2019, 25(5): 590-594, 599. doi: 10.3969/j.issn.1006-7108.2019.05.004 WANG F A, CHEN Y Z. The current diagnosis and treatment status and strategies for osteoporotic vertebral compression fracture[J]. Chin J Osteoporosis, 2019, 25(5): 590-594. doi: 10.3969/j.issn.1006-7108.2019.05.004
[7]	刘华, 胡梁深, 范少勇. 补肾壮骨汤联合经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折临床观察[J]. 广州中医药大学学报, 2020, 37(1): 46-49. LIU H, HU L S, FAN S Y. Clinical observation of Bushen Zhuanggu Decoction combined with percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture[J]. J Guangzhou Univ Tradit Chin Med, 2020, 37(1): 46-49.
[8]	刘益锋, 李强, 武文, 等. 骨质疏松性胸腰椎压缩骨折PKP术后慢性腰痛的相关因素分析[J]. 中国医师杂志, 2019, 21(12): 1860-1863. doi: 10.3760/cma.j.issn.1008-1372.2019.12.027 LIU Y F, LI Q, WU W, et al. Analysis of related factors of chronic low back pain after PKP of osteoporotic thoracolumbar compression fracture[J]. Chin J Medical Medicine, 2019, 21(12): 1860-1863. doi: 10.3760/cma.j.issn.1008-1372.2019.12.027
[9]	弓伊宁, 王江, 贺宝荣. 骨质疏松性椎体骨折开放手术治疗的相关问题[J]. 中华创伤杂志, 2022, 38(2): 97-100. GONG Y N, WANG J, HE B R. Related issues in open surgery for osteoporotic vertebral fracture[J]. Chin J Trauma, 2022, 38(2): 97-100.
[10]	郭勇. 微创手术和传统开放手术治疗骨质疏松性脊柱压缩性骨折的临床效果比较[J]. 智慧健康, 2019, 5(32): 171-172. GUO Y. Clinical comparison of minimally invasive surgery and traditional open surgery for osteoporotic spinal compression fractures[J]. Smart Healthcare, 2019, 5(32): 171-172.
[11]	张海明, 郭建栋, 李敏皋. 单、双侧穿刺经皮椎体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, 2021, 24(6): 769-772. ZHANG H M, GUO J D, LI M G. Comparison effects of unipedicular and bipedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. J Clin Orthop, 2021, 24(6): 769-772.
[12]	陈然, 蒋传海, 顾庆陟, 等. 单、双侧经皮穿刺椎体后凸成形术治疗胸腰段骨质疏松性椎体压缩骨折的疗效比较[J]. 颈腰痛杂志, 2021, 42(2): 215-218. CHEN R, JIANG C H, GU Q Z, et al. Comparison of the effects of unipedicular and bipedicular percutaneous PKP in the treatment of osteoporotic vertebral compression fractures[J]. The Journal of Cervicodynia and Lumbodynia, 2021, 42(2): 215-218.
[13]	李凯明, 李玲慧, 王尚全, 等. 经皮穿刺椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的Meta分析[J]. 海南医学院学报, 2019, 25(15): 1164-1170. LI K M. Meta-analysis of percutaneous kyphoplasty for elderly osteoporotic vertebral compression fractures[J]. J Hainan Med Univ, 2019, 25(15): 1164-1170.
[14]	刘亚南, 杨双, 徐世莲. 小针刀疗法在病理性疼痛中的研究进展[J]. 昆明医科大学学报, 2021, 42(2): 158-161. LIU Y N, YANG S, XU S L. Advances in the research of small needle knife therapy for pathological pain[J]. J Kunming Med Univ, 2021, 42(2): 158-161.
[15]	李卓洲, 李其虎, 卢文. 小针刀联合整脊治疗胸腰椎压缩性骨折术后疼痛[J]. 颈腰痛杂志, 2018, 39(1): 119-120. LI Z Z, LI Q H, LU W. Treatment of postoperative pain of compression fracture of thoracolumbar spine with small acupotomy[J]. The Journal of Cervicodynia and Lumbodynia, 2018, 39 (1): 119-120.
[16]	ZHANG D, CHENG Y, XU G, et al. Evidence for miniscalpel-needle/needle knife in the management of chronic pain related conditions: a protocol for systematic review and meta-analysis[J]. Medicine, 2019, 98(28): e16474. DOI: 10.1097/MD.0000000000016474.
[17]	杨戈, 马中华, 高丙南, 等. 针刀辨因论治腰椎间盘突出症的临床研究[J]. 中国中医骨伤科杂志, 2018, 26(6): 41-43. YANG G, MA Z H, GAO B N, et al. Clinical study of needle knife differentiation of etiology in treatmentof lumbar disc herniation[J]. Chin J Tradit Med Traumatol Orthop, 2018, 26(6): 41-43.
[18]	刘键, 李明东, 陈科, 等. 经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折围手术期并发症分析[J]. 国际老年医学杂志, 2021, 42(3): 148-151, 162. LIU J, LI M D, CHEN K, et al. Analysis of perioperative complications of percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Int J Geriatr, 2021, 42(3): 148-151, 162.
[19]	安忠诚, 陈晨, 董黎强, 等. 经皮椎体后凸成形术后邻近节段再骨折的危险因素分析[J]. 中华全科医学, 2022, 20(4): 591-593, 712. doi: 10.16766/j.cnki.issn.1674-4152.002407 AN Z C, CHEN C, DONG L Q, et al. Risk factors for adjacent segment refracture after percutaneous kyphoplasty[J]. Chin J Gen Pract, 2022, 20(4): 591-593, 712. doi: 10.16766/j.cnki.issn.1674-4152.002407
[20]	陈琳洁, 李志军. 原发性骨质疏松症诊断与治疗[J]. 中华全科医学, 2020, 18(10): 1619-1620. http://www.zhqkyx.net/article/id/5c756c38-3de0-43c5-af82-69be383bf5b2 CHEN L J, LI Z J. Diagnosis and treatment of primary osteoporosis[J]. Chin J Gen Pract, 2020, 18(10): 1619-1620. http://www.zhqkyx.net/article/id/5c756c38-3de0-43c5-af82-69be383bf5b2