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[1]于東方,王祥善,張華,等.經(jīng)皮椎體成形術(shù)后手術(shù)椎體再骨折的病因、治療及預(yù)防[J].中醫(yī)正骨,2018,30(10):69-73.
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經(jīng)皮椎體成形術(shù)后手術(shù)椎體再骨折的病因、治療及預(yù)防()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年10期
頁(yè)碼:
69-73
欄目:
臨床報(bào)道
出版日期:
2018-10-20

文章信息/Info

作者:
于東方王祥善張華曹順海
(河南省鄭州市骨科醫(yī)院,河南 鄭州 450052)
關(guān)鍵詞:
骨質(zhì)疏松性骨折 脊柱骨折 椎體成形術(shù) 手術(shù)后并發(fā)癥 再骨折
摘要:
目的:探討經(jīng)皮椎體成形術(shù)(percutaneous vertebroplasty,PVP)后手術(shù)椎體再骨折的病因、治療方法及預(yù)防措施。方法:2013年8月至2016年8月收治15例PVP術(shù)后手術(shù)椎體再骨折患者。第1次手術(shù)病因均為骨質(zhì)疏松加輕微外力損傷致椎體壓縮骨折,均采用單側(cè)穿刺PVP治療。初次手術(shù)至此次入院時(shí)間為1周至1年,中位數(shù)4個(gè)月。15例均表現(xiàn)為腰背及腰骶部緩解的疼痛再次發(fā)作,休息難以緩解,其中1例癥狀僅表現(xiàn)在第1次手術(shù)對(duì)側(cè),1例伴有會(huì)陰區(qū)麻木及下肢神經(jīng)受壓癥狀。與第1次手術(shù)最后一次復(fù)查時(shí)相比,X線檢查顯示9例未見原手術(shù)椎體高度明顯丟失、6例原手術(shù)椎體高度輕度丟失,MRI檢查T1WI、T2WI均顯示原手術(shù)椎體內(nèi)異常信號(hào)不同程度加重。此次入院后采用視覺模擬量表(visual analogue scale,VAS)評(píng)定疼痛程度,3例VAS評(píng)分<3分者行非手術(shù)治療,12例VAS評(píng)分≥3分者行手術(shù)治療,其中11例經(jīng)第1次手術(shù)對(duì)側(cè)穿刺行PVP手術(shù),1例伴有會(huì)陰區(qū)麻木及下肢神經(jīng)受壓癥狀者,行后路切開復(fù)位骨水泥清除植骨釘棒內(nèi)固定治療。結(jié)果:3例采用非手術(shù)治療者,經(jīng)1~2周住院治療后疼痛明顯緩解(VAS評(píng)分1分),生活完全自理。11例再次行PVP手術(shù)治療者,住院3~5 d,每個(gè)椎體注入骨水泥2~3.5 mL,其中3例骨水泥經(jīng)椎間隙少量滲漏,未出現(xiàn)神經(jīng)損傷癥狀; 術(shù)后6例疼痛完全緩解(VAS評(píng)分0分),3例疼痛部分緩解(VAS評(píng)分2分),2例需口服非甾體類抗炎藥(VAS評(píng)分2分),生活均可自理。行后路切開復(fù)位骨水泥清除植骨釘棒內(nèi)固定術(shù)治療的患者,術(shù)后會(huì)陰區(qū)麻木及下肢神經(jīng)受壓癥狀均明顯改善,配合口服非甾體類抗炎藥,患者對(duì)治療效果滿意。結(jié)論:PVP術(shù)后手術(shù)椎體再骨折是多個(gè)相關(guān)危險(xiǎn)因素綜合作用的結(jié)果,應(yīng)從多個(gè)方面著手進(jìn)行預(yù)防,治療時(shí)應(yīng)仔細(xì)評(píng)估患者的具體情況,采用非手術(shù)、再次PVP手術(shù)或開放手術(shù)治療。

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通訊作者:王祥善 E-mail:[email protected]
更新日期/Last Update: 2019-02-25