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经皮穿刺椎体后凸成形术在症状性椎体血管瘤中的应用
引用本文:杨益民,张智,李萌,任志伟,王金堂.经皮穿刺椎体后凸成形术在症状性椎体血管瘤中的应用[J].中国微创外科杂志,2013(10):906-909.
作者姓名:杨益民  张智  李萌  任志伟  王金堂
作者单位:西安交通大学医学院第一附属医院骨科,西安710061
摘    要:目的评估经皮穿刺椎体后凸成形术(percutaneous kyphoplasty,PKP)在症状性椎体血管瘤中的安全性及临床疗效。方法2007~2011年,应用PKP治疗28例30椎症状性椎体血管瘤,记录手术时间,术中出血量,术后并发症情况,术前及术后24h、3d、7d、90d用视觉模拟评分(visual analogues cales,VAS)评估患者疼痛情况,用Oswestry功能障碍指数(Oswestry disability index,ODI)量表评估生活质量。结果均顺利完成手术,手术时间42~65min,(58.0±8.5)min;出血量5~30ml,(16.0±10.4)ml。术后第2天下地活动,无脊髓及神经根损伤表现,局部无血肿发生,穿刺口一期愈合。VAS评分术前,术后24h、3d、7d、90d分别为6.39±1.10,4.43±0.84,1.75±1.08,0.50±0.79,0.25±0.59;ODI指数分别为(72.36±6.62)%,(78.57±4.65)%,(55.71±7.50)%,(23.50±6.41)%,(6.07±4.06)%。各时点间VAS评分有显著性差异(F=245.80,P=0.000),术后VAS评分较术前明显下降,并呈递减趋势,两两比较除术后7d与术后90d无显著性差异(P=0.872)外,其余各时点间均有显著性差异(P=0.000);ODI指数各时点间有显著性差异(F=770.16,P=0.000),术后24h较术前增高(P=0.002),考虑系卧床活动受限造成,以后逐渐下降(P=0.000)。结论PKP作为治疗症状性椎体血管瘤的方法,具有微创、安全、疗效可靠等优点。

关 键 词:椎体  血管瘤  椎体后凸成形术

Application of Percutaneous Kyphoplasty in the Treatment of Symptomatic Vertebral Hemangioma
Institution:Yang Yimin, Zhang Zhi, Li Meng , et al. Department of Orthopedics, The First Affiliated Hospital of Xi ' an Jiaotong University Medical College, Xi ' an 710061, China
Abstract:Objective To evaluate the clinical efficacy and safety of percutaneous kyphoplasty (PKP) in the treatment of symptomatic vertebral hemangioma. Methods From 2007 to 2011, 28 patients with 30 vertebraes suffering from symptomatic vertebral hemangioma were treated with percutaneous kyphoplasty. Operative time, blood loss, postoperative complications were recorded. VAS was used to assess pain of patients and Oswestry disability index (ODI) was used to respectively assess patients' life quality preoperatively and 24 h, 3 d, 7 d and 90 d postoperatively. Results All surgeries were performed successfully. Operative time was 42 -65 min, with an average of (58.0 ±8.5) min and blood loss was 5 -30 ml, with an average of (16.0 ± 10.4) ml. All patients were able to walk on the second postoperative day. No spinal cord injury, nerve injury or hematoma occurred, and all punctures were primary healing. The score of VAS was 6.39 ± 1.10, 4.43 ± 0.84, 1.75 ± 1.08, 0.50 ± 0.79, 0.25 ± 0.59 and ODI was (72.36±6.62)%, (78.57±4.65)%, (55.71 ±7.50)%, (23.50±6.41)%, (6.07 ±4.06)% preoperatively and 24 h, 3 d, 7 d and 90 d postoperatively respectively. Postoperative score of VAS was significantly lower than preoperative score ( F = 245.80, P = 0. 000). There were significant differences between the preoperative and postoperative scores of VAS (P = 0. 000) except the score between the 7^th day and 90^th day after the operation (P = 0. 872). The significant difference could be observed among the preoperative and postoperative scores of ODI for each observed time point ( F = 770. 16, P = 0. 000). The score of ODI 24 hours after the surgery was significantly higher than preoperative score (P = 0. 002) , which was probably due to patients' confinement to bed after the surgery. However, the score of ODI was getting increasingly lower thereafter ( P = 0. 000). Conclusion PKP is a minimally invasive, safe and effective treatment for symptomatic vertebral hemangioma.
Keywords:Vertebrae  Hemangioma  Kyphoplasty
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