两种椎体成形术治疗骨质疏松性椎体压缩性骨折疗效比较

目的比较经皮椎体后凸成形术(PKP)和经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)的疗效。方法将68例OVCF患者随机分成PVP组和PKP组,各34例。比较两组伤椎Cobb角、楔形指数以及疼痛VAS评分、ODI。结果患者均获得随访,时间13～28个月。VAS评分、ODI两组术后较术前均显著降低(P 0. 05),两组间比较差异无统计学意义(P 0. 05); PVP组伤椎Cobb角、楔形指数术后与术前比较差异无统计学意义(P 0. 05);术后伤椎Cobb角、楔形指数PKP组显著小(高)于PVP组(P 0. 05)。结论 PVP和PKP是OVCF功能恢复和疼痛缓解的有效治疗方法,虽然PKP的影像学结果更好,但与临床疗效并无关系。     

手法复位联合微创手术治疗骨质疏松性椎体压缩骨折疗效的Meta分析

目的:应用Meta分析评价手法复位在联合经皮椎体成形术(percutaneous vertebroplasty,PVP)或经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)中的有效性,为临床治疗提供参考。方法:检索中国学术期刊网、万方数据库、Web of Science 和PubMed,获得1987年1月至2014年4月期间有关手法复位和PVP及PKP治疗骨质疏松性椎体压缩骨折的临床对照研究文献,对入选的文献进行质量评价,选择疼痛(VAS评分)缓解、后凸角(Cobb角)改善、椎体前缘高度恢复等作为Meta分析的评价指标。结果:共纳入文献7篇,包含5篇随机对照研究,2篇非随机对照研究。2篇研究为手法复位联合PVP与单纯PVP治疗OVCF的效果,5篇研究为手法复位联合PKP与单纯PKP治疗OVCF的效果。所有研究均来自中国,共纳入410例研究对象(465个病椎).与单纯PVP比较,手法复位联合PVP能更好地改善Cobb角(WMD=-7.35;95%CI:-12.15,-2.54)和椎体前缘高度(p<0.01),但两组在VAS评分改善方面差异无统计学意义(WMD=-0.01;95%CI:-0.45,0.42);与单纯PKP比较,手法复位联合PKP治疗在VAS评分改善、Cobb角改善、椎体前缘高度恢复方面差异均无统计学意义(p>0.05).结论:与单纯PVP及PKP治疗OVCF相比,手法复位联合PVP能更好地改善Cobb角和椎体前缘高度,而手法复位联合PKP在疼痛缓解、Cobb角改善、椎体前缘高度恢复方面均无明显优势。研究纳入的文献数量较少,有必要进一步开展大样本、高质量的随机对照研究予以证实。     

PKP和PVP治疗骨质疏松性椎体压缩骨折的疗效

目的比较经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的疗效。方法将58例骨质疏松性椎体压缩骨折患者按照治疗方法分为PVP组和PKP组,各29例。比较两组手术时间、骨水泥注入量、骨水泥渗漏率、Cobb角和疼痛VAS评分。结果两组患者均获得随访,时间5～18个月。手术时间PVP组少于PKP组,骨水泥注入量及Cobb角恢复程度PKP组多(高)于PVP组,差异均有统计学意义(P 0. 05)。两组患者术后疼痛均较术前明显改善(P 0. 05),两组间比较差异无统计学意义(P0. 05)。骨水泥渗漏率PKP组低于PVP组,但差异无统计学意义(P 0. 05)。结论 PVP和PKP治疗骨质疏松性椎体压缩骨折均能迅速稳定椎体骨折,缓解疼痛。PVP较PKP手术时间短、骨水泥用量少,而PKP恢复椎体Cobb角更具有优势。     

不同手术方法治疗骨质疏松性椎体压缩性骨折

目的:了解骨质疏松性椎体压缩性骨折(OVCF)早期进行经皮椎体成形术(PVP),或经皮椎体后凸成形术(PKP)围手术期指标和疗效的差异。方法:回顾性分析86例骨质疏松性椎体压缩骨折患者,其中PVP组52例、PKP组34例。比较两组围手术期指标(手术时间、骨水泥注入总量、术后伤椎增加高度、术后VAS评分)和随访指标(椎体前缘高度、后凸Cobb角、椎体压缩率)的统计学差异。结果:PVP组(27.7±6.0)手术时间短于PKP组(37.3±8.1);PVP组(4.6±1.4)骨水泥注入总量小于PKP组(6.0±2.7),PVP组(2.6±1.5)术后伤椎增加高度小于PKP组(9.0±2.0),PVP组(2.4±0.4)术后VAS评分小于PKP组(1.9±0.2),差异均有统计学意义(P0.05)。两组患者术后比较,PVP组(19.85±2.16)椎体前缘高度低于PKP组(24.18±3.07),PVP组(12.43±2.08)后凸Cobb角大于PKP组(8.01±3.45),PVP组(24.89±5.52)椎体压缩率大于PKP组(20.23±3.49)差异均有统计学意义(P0.05)。术前术后比较,两组患者椎体前缘高度均显著增加、后凸Cobb角和椎体压缩率均显著降低(P0.05)。结论:PKP相比PKP能进一步改善OVCF病椎的裂隙修复,尽可能恢复椎体高度,术后疼痛程度轻;但手术时间较长,骨水泥注入量相对较多,且不适用于重度压缩骨折。     

经皮椎体成形术与经皮椎体后凸成形术治疗相邻双椎体急性骨质疏松性椎体压缩骨折的临床对比研究

目的 比较经皮椎体成形术（percutaneous vertebroplasty,PVP）与经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗相邻双椎体急性骨质疏松性椎体压缩骨折（osteoporotic vetebral compression fractures,OVCF）的临床疗效。方法 回顾性分析西安交通大学医学院附属红会医院2015年1月至2017年12月收治的134例相邻双椎体急性OVCF病人的临床资料,根据手术方式分为PKP组（61例）与PVP组（73例）。比较两组术前、术后及末次随访时的疼痛视觉模拟量表评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）、椎体前缘高度、伤椎局部Cobb角、骨水泥渗漏情况及邻近椎体新发骨折情况。结果 两组病人术后及末次随访时的VAS评分和ODI均显著优于术前,差异均有统计学意义（P均＜0.05）,但两组间术前、术后及末次随访时的VAS评分、ODI比较,差异均无统计学意义（P均＞0.05）。术后及末次随访时,PKP组的椎体前缘高度和伤椎局部Cobb角均显著优于PVP组,组间比较,差异均有统计学意义（P均＜0.05）。PKP组和PVP组的骨水泥渗漏率分别为14.75%、32.88%,邻近椎体新发骨折率分别为11.48%、27.40%,两组比较,差异均有统计学意义（P均＜0.05）。结论 与PVP手术治疗比较,PKP手术治疗相邻双椎体急性OVCF可有效恢复椎体高度,降低骨水泥渗漏率及邻近椎体新发骨折的风险,病人预后更好。     

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椎体压缩骨折的疗效比较分析

目的:对比手法复位结合经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗新鲜单节段骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法:回顾性收集我院收治的63例OVCF患者的临床资料,依采用手法复位结合PVP方法分为观察组32例,采用PKP方法分为对照组31例。记录两组手术时间、骨水泥渗漏例数、住院天数、治疗费用,以及术前术后伤椎前缘高度(AVH)、伤椎后凸Cobb角、疼痛视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)评分。结果:63例患者均顺利完成手术。观察组手术时间、治疗费用少于对照组,差异均有统计学意义(P0.05)。两组骨水泥渗漏例数、住院天数比较差异均无统计学意义(P0.05)。两组术后AVH、Cobb角、VAS评分、ODI评分对比术前,差异均有统计学意义(P0.05);但两组间上述指标比较,差异均无统计学意义(P0.05)。结论:手法复位结合PVP与PKP治疗OVCF均可获得满意的临床疗效,但手法复位结合PVP具有手术时间短、治疗费用少的优势。     

PVP和PKP治疗老年骨质疏松性椎体爆裂骨折的对比研究

【】 目的 探讨经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体爆裂骨折的临床疗效和安全性。 方法 回顾性分析2008年2月-2014年2月我院收治的63例单节段骨质疏松性椎体爆裂骨折老年患者的临床资料;按照治疗方法分为PVP组(n=37例)和PKP组(n=26例)。对比两组手术时间、骨水泥注入量、住院时间、住院花费及骨水泥渗漏等并发症;对比两组术前、术后及随访结束时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎体高度(前缘、中央)、后凸Cobb角、椎管占位程度及生活质量SF-36评分。 结果 PVP组手术时间、骨水泥注入量和住院花费明显低于PKP组,差异具有统计学意义(P<0.05);两组住院时间比较差异无统计学意义(P>0.05);PVP组和PKP骨水泥渗漏率分别为10.8% vs 3.8%,PKP组低于PVP组,差异具有统计学意义(P<0.05);两组术前的VAS、ODI、椎体高度、后凸Cobb角、椎管占位程度及SF-36评分比较差异无统计学意义(P>0.05);两组术前的VAS、ODI、椎体高度、后凸Cobb角、椎管占位程度及SF-36评分比较差异无统计学意义(P>0.05);两组术后及末次随访时的VAS、ODI、椎体高度、后凸Cobb角、椎管占位程度及SF-36评分均较术前明显改善,PKP在椎体高度、后凸Cobb角、椎管占位程度改善方面明显优于PVP组,差异具有统计学意义(P<0.05)。 结论 采用PVP和PKP治疗椎管占位小于20%且无神经症状的老年骨质疏松性椎体爆裂骨折安全可行,两者各有优势,可根据具体情况选择。     

两种椎体成形术治疗骨质疏松性椎体压缩骨折的疗效比较

目的 比较经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCF)的疗效。方法 将116例OVCF患者根据术式不同分为PVP组(采用PVP治疗，66例)和PKP组(采用PKP治疗，50例)。记录两组手术情况、疼痛VAS评分、局部Cobb角以及骨水泥渗漏情况，比较手术前后伤椎前缘及中部高度压缩率。结果 患者均获得随访，时间10～39个月。手术时间PVP组短于PKP组(P<0.05),骨水泥注入量PKP组多于PVP组(P<0.05)。伤椎前缘及中部高度压缩率、疼痛VAS评分、局部Cobb角：两组术后3 d、末次随访均较术前明显改善(P<0.05),术后3 d、末次随访时两组比较差异均无统计学意义(P>0.05)。PVP组28例(42.4%)骨水泥渗漏，PKP组28例(56.0%)骨水泥渗漏，骨水泥渗漏率两组比较差异无统计学意义(P>0.05)。结论 PVP和PKP治疗OVCF均能获得良好的疗效。与PVP比较，PKP在恢复椎体高度、改善局部Cobb角、减少骨水泥渗漏上无明显优势。     

经皮椎体成形术联合桃红接骨胶囊治疗老年骨质疏松性椎体压缩骨折的疗效分析

目的 探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)联合桃红接骨胶囊治疗老年骨质疏松性椎体压缩骨折(osteoporosis vertebral compression fracture,OVCF)的临床疗效.方法 选取2018年07月～2019年12月本院收治的老年OVCF患者68例,采用随机数字表法分为对照组(34例)和观察组(34例),对照组采用单纯PVP治疗,观察组在PVP治疗的基础上联合桃红接骨胶囊治疗.比较两组术前、术后2个月的相关疗效指标.结果 两组患者术前VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎体高度丢失率、后凸Cobb角、骨密度比较,差异无统计学意义(P>0.05).术后2个月,观察组VAS评分、ODI指数显著低于对照组,差异有统计学意义(P<0.05);两组间椎体高度丢失率、后凸Cobb角比较,差异无统计学意义(P>0.05);观察组骨密度高于对照组,骨折再发生率低于对照组,差异有统计学意义(P<0.05).结论 相较于单纯PVP,PVP联合桃红接骨胶囊治疗老年OVCF患者可进一步缓解疼痛症状,提高腰椎功能、骨密度,降低骨折再发生率.     

111例PVP/PKP术治疗胸腰椎老年骨质疏松性骨折的回顾性分析

目的 回顾性分析前期111例PVP/PKP术治疗胸腰椎老年骨质疏松性骨折患者临床资料,探讨PVP、PKP手术疗效及相关问题.方法 回顾性分析我院2007年～2010年期间运用PVP、PKP治疗111例椎体压缩性骨折患者,术后随访3～24个月,平均13.7±7.09个月,采用VAS疼痛评分、镇痛药使用评分、Oswestry功能障碍指数临床疗效评定,Cobb角测量椎体形态评价术后椎体再压缩及相邻近椎体压缩情况,设计量表观察PVP与PKP、单侧进针与双侧进针、骨水泥量、俯卧与侧卧的治疗效果及渗漏情况.结果 经统计分析发现,PVP与PKP、单侧进针及双侧进针、不同骨水泥用量、俯卧与侧卧治疗椎体压缩性骨折的临床疗效无统计学差异,PVP与PKP对渗漏影响有统计学差异;并发现三例患者术后发生邻近椎体再骨折.结论 无论采取PVP、PKP,单、双侧进针,俯卧与侧卧的手术方式,运用一定量骨水泥,均能有效缓解椎体压缩性骨折的椎体疼痛;另外PKP相比PVP能较为有效防止骨水泥渗漏.     

Tubeless percutaneous nephrolithotomy. A comparative study with standard percutaneous nephrolithotomy

INTRODUCTION: To assess the efficacy, safety and morbidity of tubeless percutaneous nephrolithotomy. MATERIALS AND METHODS: One hundred and fifty-two patients with renal and upper ureteric calculi were included in this study. Sixty-nine patients (71 renal units; group 1) in whom no nephrostomy tube was placed at the conclusion of the procedure was compared with a similar control group of 83 patients (group 2) in whom a nephrostomy tube was placed. Operating time, blood loss, analgesia requirement, puncture site urinary leakage, hospital stay and mean convalescence period were compared in both groups. RESULTS: Both groups were similar with respect to age, sex distribution and stone size. Operating time and blood loss were less in group 1 although they did not reach statistical significance. The mean analgesic requirement, puncture site urinary leakage and hospital stay were significantly less in group 1. CONCLUSION: Tubeless percutaneous nephrolithotomy is a safe and effective procedure in this selected group of patients.     

Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube

BACKGROUND AND PURPOSE: Recent trials using smaller percutaneous catheters as well as "tubeless" percutaneous technique have attempted to reduce postoperative analgesia requirements and the morbidity of a traditional large-bore nephrostomy tube after percutaneous nephrolithotomy (PCNL). We performed a randomized trial comparing tubeless procedures and use of small catheters to elucidate any differences in perioperative parameters, postoperative discomfort, complications, convalescence, and CT scan findings. PATIENTS AND METHODS: Twenty-four consecutive patients underwent randomization into tubeless (using a tailed 6F double-J stent) and small tube (using an 8.2 pigtail nephrostomy tube) (N = 12 each). A CT scan of the abdomen and pelvis without contrast was obtained the morning of the first postoperative day. Morphine equivalents and a visual analog pain score, as well as questionnaires for convalescence at the postoperative check, postoperative day 1, time of tube removal (3-5 days), and 1-week follow-up were recorded. RESULTS: The mean pain scores and morphine requirements for the tubeless and small-tube groups at postoperative day 0, postoperative day 1, time of stent removal, and 10 days were not significantly different. Convalescence significantly favored stented patients. The CT findings were equivalent. Three patients had inadvertent dislodgment of their stents. CONCLUSIONS: Tubeless and small-bore procedures cause similar postoperative discomfort, with indwelling stents appearing to quicken return to normal activities. Tailed stents may not be appropriate for all patients.     

Anaesthetic experience with percutaneous lithotripsy

Percutaneous lithotripsy has evolved over the last several years as a procedure for removing renal calculi via percutaneous puncture of the renal collecting system. This article reviews our initial anaesthetic experience with 48 procedures and identifies both actual and potential complications. The most significant complication identified is instillation of large volumes of irrigation fluid into the retroperitoneal space. Two cases of metabolic acidosis and abdominal distension are presented. One responded to treatment while the other progressed to a fatal disseminated intravascular coagulopathy. Recommendations to prevent this are given.     

Early experience with percutaneous nephrolithotomy

Fifty-four percutaneous nephrolithotomy (PNL) procedures were performed in 41 patients between May 1986 and December 1987. Six patients required more than one procedure and there was one failure which was treated by open ureterolithotomy. Most of the stones were initially found in the pelvicalyceal system, one in the lower third and nine in the middle or upper third of the ureter. There were five significant complications: one "steinstrasse" (accumulation of stone fragments in the distal ureter after the procedure), one massive perirenal haematoma, one intramural perforation by a ureteric catheter and two extravasations of irrigation fluid one of which necessitated intensive care. Most of the renal and upper ureteric stones have now been successfully removed percutaneously with good patient tolerance.     

Early experience with percutaneous lateral discectomy

Seventeen patients were treated by percutaneous lumbar discectomy for a herniated disc and sciatica. The criteria for inclusion in this series included: (1) a protruding disc in the lumbar area causing neural compression; (2) persistent sciatica; (3) failure of conservative treatment; (4) magnetic resonance imaging, computer tomographic, or myelographic confirmation of the protrusion; and (5) chronic low-back pain with definite evidence of a protruding disc at the appropriate level. The only contraindication to the procedure is the presence of an extruded fragment. There were ten male and seven female patients, with an average age of 40 years. The operation was performed under local anesthesia and by the method of Hijikata. Six cases were at L5-S1, nine at L4-L5, four at L3-L4, and one at L2-L3. Fourteen of 16 patients were relieved of their symptoms. One operation was aborted due to the inability to pass the cannula beneath arthritic facet joints. One complication occurred early while using general anesthetic. An L5 nerve root was injured, causing a permanent drop foot. Major possible complications include infection, nerve root injury, and vascular injury. The success rate with an average follow-up period of six and one-half months was 87.5%.     

Serious complications associated with percutaneous nephrolithotomy

Serious complications occurred in 2 patients after percutaneous removal of renal calculi. The first was in a patient, who was referred to our institution, with ureteropelvic atresia following three unsuccessful percutaneous attempts to remove an upper ureteral stone which was removed by ureterolithotomy. The second was in one of our patients in whom serious bleeding developed three days postoperatively that was managed with Foley balloon tamponade followed by selective upper pole renal artery branch embolization.     

Early experience with endoscopic percutaneous gastrostomy

We performed endoscopic percutaneous gastrostomy (EPG) on 22 patients. All procedures were performed using local anesthesia with intravenous diazepam sedation. Formal laparotomy was not required. The mean patient age was 58 years (range, 21 to 83 years). Indications for EPG placement included neurologic disorders in 17 patients, head and neck tumors in four patients, and esophageal disease in one patient. The mean operative time for EPG was 27.5 minutes, with a range of 11 to 60 minutes. Two major complications, a gastrocolic fistula and an intraperitoneal gastric leak, occurred early in the series. The technique has been modified with no similar complications. Pneumoperitoneum after EPG was demonstrated in eight patients without sequelae. Ileus following EPG was not observed in any patient, and enteral feedings were uniformly resumed 48 hours after tube placement. Our early experience with EPG suggests that this technique is a safe, cost-effective, and time-saving alternative to traditional gastrostomy tube placement.