体位复位联合经皮球囊扩张椎体成形术治疗骨质疏松性椎体压缩骨折

目的评价体位复位联合经皮球囊扩张椎体成形术(PKP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法对50例骨质疏松性椎体压缩骨折患者行体位复位联合PKP治疗。手术前后分别测量椎体前缘、中线、后缘高度及Cobb角;比较手术前后疼痛VAS评分情况。结果患者均获得随访,时间12个月。术后患者VAS评分、Cobb角均较术前明显改善(P0.05)。术后椎体前缘、中线、后缘高度均明显高于术前,差异均有统计学意义(P0.05),术后12个月椎体高度较术后无明显变化(P0.05)。结论体位复位联合PKP治疗骨质疏松性压缩骨折疗效显著,操作简单,安全可靠。     

单侧与双侧经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效

目的比较单侧与双侧椎弓根入路经皮椎体后凸成形术(PKP)治疗老年新鲜骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法回顾性分析2014年1月至2017年6月接受PKP治疗的134例胸腰椎单椎体OVCF患者的临床资料,按手术入路将患者分为单侧组(经单侧椎弓根入路)和双侧组(经双侧椎弓根入路)。观察患者术后椎体高度恢复率、后凸角改善情况、疼痛改善情况,以及术中骨水泥注入量和骨水泥渗漏情况等。结果单侧组61例,平均年龄(74.7±9.6)岁,双侧组73例,平均年龄(75.1±8.6)岁。两组患者术后伤椎椎体前缘和中间高度的丢失率以及后凸角均较术前减小(P0.05)。Ⅰ°骨折患者,术后伤椎的椎体前缘和中间高度恢复率、后凸角恢复率两组比较无差异(P0.05),单侧组术后骨水泥侧漏少于双侧组(P0.05)。Ⅱ°/Ⅲ°骨折患者,术后伤椎的椎体前缘和中间高度恢复率、后凸角恢复率双侧组均优于单侧组(P0.05),两组骨水泥侧漏情况无差异(P0.05)。与术前相比,两组患者术后3d和末次随访时的VAS均明显降低(P0.05),但两组间术后3d及末次随访的VAS比较无差异(P0.05)。结论单椎体OVCF骨折患者,如果为Ⅰ°骨折或一侧椎弓根破坏严重、进针困难时宜选择单侧入路PKP手术,Ⅱ°或Ⅲ°骨折时宜选择灌注高黏度骨水泥的双侧入路PKP手术。     

单侧分步穿刺骨质疏松性椎体压缩骨折的疗效分析

目的探讨经单侧分步椎弓根经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗椎体骨质疏松性压缩骨折的临床疗效。方法自2009年11月至2016年9月,共收治符合单节段椎体骨质疏松压缩骨折患者144例,其中84例行经皮单侧椎弓根入路PKP治疗,60例经皮单侧椎弓根分步PKP治疗,比较两组患者骨水泥填充量及术后VAS评分结果。结果所有患者手术操作过程顺利,无肺栓塞、神经损伤等严重并发症。单侧穿刺组椎体骨水泥注入量为(4.60±1.10)mL,单侧分步穿刺组椎体骨水泥注入量为(3.40±1.20)mL,两组骨水泥注入量比较差异有统计学意义(P0.05)。单侧穿刺组骨水泥渗漏率与分步穿刺组骨水泥渗漏率比较差异有统计学意义(P0.05)。术后24h、1年,两组VAS评分较术前明显改善(P0.05),但两组间比较差异无统计学意义(P0.05)。结论经单侧椎弓根分步穿刺PKP术治疗骨质疏松性压缩骨折弥散更加均匀,可减少骨水泥注入量及骨水泥渗漏,可取得和传统经皮单侧椎弓根入路椎体成形术的同样的临床效果。     

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

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的疗效。方法将69例骨质疏松性椎体压缩骨折患者随机分为PVP组(34例)和PKP组(35例),记录手术时间、放射暴露次数、治疗费用、骨水泥渗漏情况,比较患者术前和术后疼痛VAS评分、ODI、后凸Cobb角、椎体高度。结果患者均获得随访,时间12~18个月。PKP组手术时间、放射暴露次数、治疗费用均多于PVP组(P0.05,P0.01)。术后PVP和PKP组的VAS评分、ODI均较术前明显改善(P0.05,P0.01);术后Cobb角、椎体高度PKP组优于PVP组(P0.05)。PKP组的骨水泥渗漏率低于PVP组(P0.001)。结论PVP及PKP均为治疗骨质疏松性椎体压缩骨折的有效方法。PKP恢复椎体高度及矫正后凸畸形效果较好,骨水泥渗漏风险小。     

经皮椎弓根钉内固定术与经皮椎体后凸成形术治疗单节段中老年胸腰椎骨折的疗效比较

目的 评价经皮椎弓根钉内固定术与经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗单节段中老年胸腰椎骨折的临床疗效.方法 回顾性分析2016年12月～2018年8月期间本科室行手术治疗的80例不伴有神经功能障碍的原发性胸腰椎压缩骨折患者临床资料,根据手术方式的不同分为:PKP组(40例),经皮椎弓根钉内固定组(40例,其中术中采用万向螺钉20例,采用固定螺钉20例).记录并比较所有患者术前、术后3d以及术后12个月随访的腰痛VAS评分、Oswestry功能障碍指数(Oswestrydisabilityindex,ODI)、伤椎高度恢复率以及Cobb角恢复值.结果 PKP组在术后3d的VAS评分优于经皮椎弓根钉内固定组(P<0.01);在ODI指数方面,两组差异无统计学意义(P>0.05);在伤椎高度恢复率及Cobb角恢复值方面,经皮椎弓根钉内固定组在术后3d及术后12个月均优于PKP组(P<0.01),其中固定螺钉较万向螺钉在骨折复位上优势更为明显(P<0.01).结论 经皮椎弓根钉内固定术较PKP手术能更有效地恢复椎体高度和强度,矫正脊柱后凸畸形,重建脊柱稳定性,其中固定螺钉优于万向螺钉.     

3种方法治疗腰椎骨质疏松性椎体压缩骨折的疗效比较分析

目的比较经皮椎弓根钉内固定、经皮椎体后凸成形术(PKP)及非手术治疗腰椎骨质疏松性椎体压缩骨折的疗效。方法回顾性比较分析自2008-06—2013-06诊治的90例老年腰椎骨质疏松性椎体压缩骨折。采用经皮椎弓根钉内固定治疗30例(内固定组),采用PKP治疗30例(PKP组),采用非手术治疗30例(非手术组)。比较3组治疗后1、3、6、12、18个月时的VAS评分和ODI指数。结果 3组均获得随访18~26个月,平均21.6个月。3组治疗后VAS评分和ODI指数较术前明显改善,差异有统计学意义(P0.05)。PKP组治疗后VAS评分改善程度明显优于内固定组和非手术组。内固定组和PKP组治疗后1、3、6、12、18个月ODI指数均明显低于非手术组,且PKP组低于内固定组,差异有统计学意义(P0.05)。结论相对于经皮椎弓根钉内固定术而言,PKP损伤更小,短期治疗效果更明显。     

高黏度骨水泥经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松压缩骨折的临床疗效观察

[目的]探讨高黏度骨水泥经皮椎体成形术与经皮椎体后凸成形术两种疗法治疗老年骨质疏松性椎体压缩骨折的疗效。[方法]将63例老年骨质疏松性单一椎体压缩骨折患者随机分为两组,分别采用PKP和高黏度骨水泥经皮椎体成形术治疗,记录两组患者术前术后VAS评分、椎体高度以及两种手术方式的骨水泥注入量、手术出血量、手术时间和骨水泥渗漏发生率,对所得结果进行统计学分析。[结果](1)两组患者手术前后VAS评分改善值、平均骨水泥注入量、骨水泥渗漏发生率比较差异没有统计学意义(P0.05);(2)高黏度骨水泥经皮椎体成形术组的手术出血量、手术时间少于PKP组且有统计学意义(P0.05);(3)PKP组术后椎体高度恢复优于高黏度骨水泥经皮椎体成形术组且有统计学意义(P0.05);(4)术后影像学资料比较,PKP组患者骨水泥分布集中,密度较高;高黏度骨水泥组患者骨水泥呈弥散状分布,密度相对较低。[结论]高黏度骨水泥经皮椎体成形术与PKP治疗老年性椎体压缩骨折均能有效缓解疼痛且效果相当,两者渗漏率无明显差别;PKP在椎体高度恢复方面具有优势,而高黏度骨水泥经皮椎体成形术的手术时间较短,出血量较少。     

经皮椎体后凸成形术与经皮椎体成形术治疗骨质疏松椎体压缩骨折的疗效比较

[目的]探讨经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗骨质疏松椎体压缩骨折(OVCF)的效果。[方法]选取2014年12月~2015年12月在本院诊治的86例骨质疏松性椎体压缩性骨折患者的临床资料,采用随机数字表法分为经皮椎体成形术组(PVP),和经皮椎体后凸成形术组(PKP)各43例。观察两组围手术期资料、伤椎Cobb角、手术前后VAS评分、术后伤椎恢复情况及并发症情况。[结果]PKP组手术时间、骨水泥注入量、术后伤椎高度增加都明显高于PVP组(P<0.05);治疗后两组椎体压缩率、伤椎Cobb角显著降低,且PKP组术后椎体压缩率、伤椎Cobb角显著低于PVP组(P<0.05)。术后两组患者VAS评分显著降低,但两组间比较无明显差异(P>0.05)。[结论]经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松椎体压缩骨折效果满意,经皮椎体后凸成形术在改善患者椎体高度、伤椎畸形优势明显。     

经皮椎体后凸成形术对老年骨质疏松椎体压缩骨折的临床疗效探究

目的探讨经皮椎体后凸成形术对老年骨质疏松椎体压缩骨折的临床疗效。方法选取2014年5月至2016年5月在本院治疗的64例老年骨质疏松椎体压缩骨折患者进行研究,按照简单随机法,将患者分为对照组(采用经皮椎体成形术)、观察组(采用经皮椎体后凸成形术)。比较两组患者VAS评分及Oswestry评分变化、治疗效果、影响学指标变化及术后并发症发生情况。结果两组患者手术后VAS评分及Oswestry评分明显低于手术前(P0.05);观察组患者VAS评分及Oswestry评分明显低于对照组(P0.05)。对照组患者手术治疗有效率为87.50%,观察组手术治疗有效率为91.62%,观察组手术治疗有效率高于对照组,但比较无统计学意义(P0.05)。两组患者术后椎体后凸角明显低于术前,椎体前缘高度、中线高度、后缘高度明显高于术前,比较具有统计学意义(P0.05);观察组患者术后后凸角明显低于对照组,而椎体前缘高度、中线高度、后缘高度明显高于对照组,比较具有统计学差异(P0.05)。对两组患者术后随访30天,对照组并发症发生率为40.63%,观察组并发症发生率为21.88%,观察组并发症发生风险明显低于对照组(P0.05)。结论经皮椎体后凸成形术治疗老年骨质疏松椎体压缩骨折效果较好,术后患者症状明显得到改善,且并发症发生风险低,值得广泛应用于临床。     

经皮椎体成形术和经皮椎体后凸成形术治疗不同压缩程度骨质疏松性椎体骨折疗效的比较

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性骨折(OVCF)的疗效及不同压缩程度下对脊柱楔形角和后凸角的纠正,为不同压缩程度下最佳术式的选择提供依据. 方法 选取2004年4月至2010年1月治疗的123例OVCF患者,分别采用PVP治疗(60例)和PKP治疗(63例),两组患者基线学数据比较差异均无统计学意义(P＞0.05),具有可比性.根据Genant等的方法,将所有患者压缩椎体分为轻度(A级)、中度(B级)和重度(C级)压缩,评价术前、术后视觉模拟评分(VAS)、楔形角、后凸角的改善情况及两种术式的效果.比较不同压缩等级下两种术式间VAS评分、楔形角、后凸角的改善.结果 所有患者术后VAS评分均明显改善,楔形角、后凸角均矫正,差异均有统计学意义(P＜0.05);两种术式对VAS评分改善比较差异无统计学意义(P＞0.05);PKP对楔形角和后凸角的矫正效果优于PVP,差异均有统计学差异(P＜0.05).不同压缩程度下的患者两种术式间的VAS评分改善比较差异均无统计学意义(P＞0.05);A、B级患者两种术式楔形角和后凸角的矫正比较差异均无统计学意义(P＞0.05);但C级患者中PKP组楔形角和后凸角的矫正均优于PVP组,差异有统计学意义(P＜0.05). 结论 PKP和PVP都能明显缓解OVCFs患者的疼痛,纠正楔形角和后凸角,恢复脊柱全长的生理曲度.但PKP能更好地纠正楔形角和后凸角,尤其是在重度压缩骨折情况下.     

Ultrasound-guided percutaneous ureterostomy

The authors present a new technique for percutaneous insertion of a drain into the upper urinary tract, using the direct lumbar transureteric approach under ultrasonographic control. This ultrasound-guided percutaneous ureterostomy was performed in two patients to drain the upper urinary tract and to evaluate the adjacent renal parenchyma. In both cases, ureterostomy was preferred to nephrostomy because of the difficulties of performing the latter operation and because of the considerable dilatation of the ureter.     

Retrograde percutaneous nephrostomy

Retrograde percutaneous nephrostomy puncture to aid in stone removal is a safe and acceptable alternative to antegrade techniques. For urologists with expertise in endoscopic instrumentation and technique, it is easy to learn and does not require the presence of a skilled interventional radiologist. The advantages of the technique are that it can be performed in a non-dilated collecting system and can result in more accurate and less traumatic puncture. We have found it difficult to use in the presence of staghorn calculi filling the kidney, and its application is obviously limited if access to the lower urinary tract and ureter cannot be obtained. If the technique is unsuccessful, it does not preclude or complicate immediate antegrade percutaneous or open stone removal.     

Postoperative percutaneous choledochoscopy

Postoperative percutaneous choledochoscopy (PC) is becoming an important aid to surgeons in the diagnosis and treatment of complex biliary tract disease. The authors retrospectively examined the results of 27 PCs performed on 22 patients at the University of Louisville Affiliated Hospitals from 1980 to 1987. Indications for PC included: suspected choledocholithiasis stricture, sclerosing cholangitis, and cholangiocarcinoma. The biliary tree was accessed through a T-tube tract in 18 patients, and through a biliary-enterocutaneous fistula in four patients. The patient population included 11 men and 11 women with a mean age of 62 years. T-tubes varied in size from #16F to #24F. The time allowed for T-tube tract maturation ranged from four weeks to five months. Percutaneous choledochoscopy was performed 16 times in 13 patients for possible choledocholithiasis. Stones were present in 13, and 11 of 13 attempted extractions were successful. Two patients underwent PC for stent placement. Nine procedures were performed on eight patients to obtain biopsies or to evaluate possible strictures. Four studies were normal, two patients had sclerosing cholangitis, one had a stricture of the Sphincter of Oddi, and one patient had benign ductal tissue on biopsy after an iridium implantation for cholangiocarcinoma. Two minor complications occurred in this series. The authors conclude that by using PC the surgeon may safely manage complicated biliary problems and avoid re-operation in selected cases.     

Antegrade percutaneous endopyelotomy

Ureteropelvic junction obstruction (UPJO) is a well-known pathologic condition with several potential associated urologic complications. The treatment for UPJO has evolved dramatically during the past two decades with the advent of minimally invasive treatment options. This has resulted in shorter hospital stays, reduced postoperative pain, and quicker convalescence compared with the gold standard, open pyeloplasty. Antegrade (percutaneous) endopyelotomy is one of the many minimally invasive treatment options for this disorder. In this article, we review the technical aspects, outcomes, and current role of antegrade endopyelotomy in the treatment of UPJO.     

Automated percutaneous discectomy

Automated percutaneous discectomy is a new, safe procedure for treating herniated lumbar discs still contained by the annulus or posterior longitudinal ligament. In 1985, one of the authors reported a percutaneous nucleus aspiration technique using a 2-mm aspiration probe. This small probe produced minimal tissue damage, allowing the procedure to be done on an outpatient. In this series, 518 patients were treated using this technique for an overall success rate of 85%. Compensation patients, elderly patients, and patients with previous surgery were treated successfully using percutaneous discectomy on an outpatient basis. No intraoperative or postoperative complications occurred.     

Outpatient percutaneous nephrostolithotomy

Technical advances and operator experience have resulted in a rapid and marked streamlining of the percutaneous approach to renal calculi. The development of nephrostomy tract balloon dilators, improved grasping instruments and the use of assisted local anesthesia have been integral in reducing the morbidity and cost of the procedure. We report our initial favorable experience in the use of percutaneous stone removal on an outpatient basis. All 5 patients underwent an uncomplicated 1-stage stone removal. Cost for outpatient percutaneous stone removal was substantially less than for surgery or extracorporeal shock wave lithotripsy.