PVP与PKP治疗骨质疏松性胸腰椎压缩骨折的疗效比较

目的比较经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗骨质疏松性胸腰椎压缩骨折的临床疗效。方法回顾性分析自2015-09—2017-08诊治的75例骨质疏松性胸腰椎压缩骨折,39例(63椎)采用PVP手术治疗(PVP组),36例(55椎)PKP手术治疗(PKP组)。比较2组手术时间、术中透视时间、骨水泥注入量、骨水泥渗漏发生率、非手术椎体再骨折发生率,术后疼痛VAS评分、ODI指数、伤椎前缘高度比值与后凸Cobb角。结果 75例均获得至少12个月随访。PKP组手术时间、术中透视时间较PVP组长,骨水泥注入量较PVP组多,骨水泥渗漏发生率较PVP组低,差异有统计学意义(P <0.05)。PVP组与PKP组术后疼痛VAS评分、非手术椎体再骨折发生率比较差异无统计学意义(P>0.05)。PKP组术后1周、3个月ODI指数、伤椎前缘高度比值、后凸Cobb角均优于PVP组,差异有统计学意义(P <0.05)。结论PVP与PKP手术均可以有效缓解骨质疏松性胸腰椎压缩骨折患者的临床症状,但PKP手术对伤椎前缘相对高度恢复、后凸畸形改善的效果更好,进而更能够减轻患者脊柱功能障碍。     

改良单侧PKP治疗骨质疏松性椎体压缩骨折的疗效观察

目的分析改良单侧经皮椎体后凸成形术(Percutanous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析自2017-09—2019-10采用改良单侧PKP治疗的98例骨质疏松性椎体压缩骨折,比较术前与术后1 d疼痛VAS评分、伤椎Cobb角、伤椎中部高度、伤椎前缘高度。结果 98例均顺利完成手术,随访时间3～27个月,平均13.7个月。手术时间19～55 min,平均28.3 min。98例骨水泥均分布满意,7例出现骨水泥渗漏,1例出现邻近椎体骨折。术后1 d疼痛VAS评分、伤椎Cobb角较术前降低,伤椎中部高度、伤椎前缘高度较术前增加,差异有统计学意义(P0.05)。结论改良单侧PKP治疗骨质疏松性椎体压缩骨折手术时间较短,骨水泥渗漏率较低,骨水泥分布情况与临床疗效满意。     

PVP与PKP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(Percutaneous vertebro plasty,PVP)与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的临床疗效。方法回顾性分析自2016-01—2020-11诊治的82例骨质疏松性椎体压缩骨折,41例采用PKP治疗(PKP组),41例采用PVP治疗(PVP组),比较2组手术时间、骨水泥注入量、骨水泥渗漏情况,比较2组术后3个月疼痛VAS评分、ODI指数、伤椎前缘高度、伤椎Cobb角。结果 2组均顺利完成手术并获得至少3个月的随访。PKP组骨水泥注入量较PVP组多,骨水泥渗漏数较PVP组少,手术时间较PVP组长,差异有统计学意义(P0.05)。术后3个月2组疼痛VAS评分、ODI指数比较差异无统计学意义(P0.05);PKP组伤椎前缘高度较PVP组大,伤椎Cobb角较PVP组小,差异有统计学意义(P0.05)。结论骨质疏松性椎体压缩骨折采用PVP与PKP治疗均能显著减轻疼痛并促进术后快速康复,PKP在恢复伤椎高度、矫正椎体后凸畸形的效果优于PVP,且能减少骨水泥渗漏率。     

骨填充网袋灌注骨水泥治疗合并椎体裂隙征骨质疏松性胸腰椎压缩骨折的疗效分析

目的探讨骨填充网袋灌注骨水泥技术治疗合并椎体裂隙征老年骨质疏松性胸腰椎压缩骨折的有效性和安全性。方法回顾性分析自2012-03—2015-04采用骨填充网袋灌注骨水泥技术治疗的26例(33椎)合并椎体裂隙征骨质疏松性胸腰椎压缩骨折。比较术前、术后3 d、末次随访时VAS评分、ODI指数、伤椎Cobb角、伤椎前缘高度比值、伤椎中部高度比值。结果 2例(3椎)出现骨水泥渗漏,2个椎体为椎间盘渗漏,1个为椎体前方渗漏,骨水泥渗漏率为9.09%。本组获得平均26.7(11~49)个月随访。术后3 d、末次随访时VAS评分、ODI指数、伤椎Cobb角、伤椎前缘高度比值、伤椎中部高度比值较术前明显改善,差异有统计学意义(P0.05);但术后3 d与末次随访时比较差异无统计学意义(P0.05)。结论采用骨填充网袋灌注骨水泥技术治疗合并椎体裂隙征骨质疏松性胸腰椎压缩骨折可有效缓解患者疼痛,部分恢复骨折椎体高度,矫正骨折后凸畸形,且骨水泥渗漏率较低,临床疗效满意。     

PKP治疗老年骨质疏松性胸腰椎压缩骨折疗效分析

目的探讨经皮椎体后凸成形术(PKP)治疗老年骨质疏松性胸腰椎压缩骨折的临床疗效。方法回顾性分析2015-08—2018-10采用PKP治疗的71例老年骨质疏松性胸腰椎压缩骨折,比较术前及末次随访时疼痛VAS评分、椎体前缘高度、椎体中央高度、伤椎Cobb角。结果 71例均获得平均11(6~21)个月随访,1例发生骨水泥渗漏。末次随访时VAS评分较术前明显降低,椎体前缘高度较术前增加,椎体中央高度较术前增加,伤椎Cobb角较术前减小,差异有统计学意义(P <0.05)。结论 PKP治疗老年骨质疏松性胸腰椎压缩骨折切口小,术后疼痛缓解明显,椎体高度恢复良好,后凸畸形矫正满意。     

手法复位PVP与单纯PKP手术治疗骨质疏松性胸腰段脊柱压缩骨折的疗效比较

目的比较手法复位经皮椎体成形术(PVP)与单纯经皮椎体后凸成形术(PKP)治疗骨质疏松性胸腰段脊柱压缩骨折的临床疗效。方法回顾性分析自2018-01—2018-12诊治的74例骨质疏松性胸腰段脊柱压缩骨折,39例采用手法复位PVP手术治疗(PVP组),35例采用单纯PKP手术治疗(PKP组)。比较2组术后3 d疼痛VAS评分、ODI指数、伤椎前缘高度、伤椎Cobb角。结果 PVP组4例出现骨水泥渗漏,PKP组2例出现骨水泥渗漏,均未出现严重的神经压迫、损伤症状。PVP组与PKP组术后3 d疼痛VAS评分、ODI指数、伤椎前缘高度、伤椎Cobb角均较术前明显改善,差异有统计学意义(P 0.05)。PVP组术后3 d疼痛VAS评分、ODI指数、伤椎前缘高度、伤椎Cobb角与PKP组比较差异无统计学意义(P0.05)。结论手法复位PVP与单纯PKP手术治疗骨质疏松性胸腰段脊柱压缩骨折均可有效恢复伤椎高度及形态,矫正脊柱后凸畸形,具有良好的安全性及有效性。     

PKP与高粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折的疗效比较

目的比较经皮椎体后凸成形术(PKP)与高粘度骨水泥经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的临床效果。方法纳入自2012-02—2016-04诊治的100例骨质疏松性椎体压缩骨折,行PKP治疗者50例(PKP组),行高粘度骨水泥PVP治疗者50例(PVP组)。比较2组术后VAS评分、ODI指数、伤椎前缘高度压缩比值、伤椎前缘高度恢复比值,以及骨水泥渗漏率。结果 2组术后VAS评分、ODI指数、伤椎前缘高度压缩比值较术前明显降低,差异有统计学意义(P0.05)。但2组术后各时间点VAS评分、ODI指数差异无统计学意义(P0.05)。PKP组术后3 d、12个月伤椎前缘高度压缩比值低于PVP组,伤椎前缘高度恢复比值高于PVP组,差异有统计学意义(P0.05)。PVP组骨水泥渗漏发生率低于PKP组,差异有统计学意义(P0.05)。结论 PKP、高粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折可明显减轻患者疼痛,改善患者功能障碍程度,PKP术后椎体高度恢复效果更优,而高粘度PVP骨水泥渗漏率较低。     

单侧椎弓根旁入路骨填充网袋椎体成形术治疗骨质疏松性胸腰椎压缩骨折的疗效观察

目的比较单侧椎弓根旁入路骨填充网袋椎体成形术(BKP)与单侧椎弓根入路经皮球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性胸腰椎压缩性骨折的疗效。方法回顾性分析自2015-07—2017-12诊治的75例骨质疏松性胸腰椎压缩骨折。36行单侧椎弓根旁入路BKP手术治疗(BKP组),39例行单侧椎弓根入路PKP手术治疗(PKP组)。比较2组手术时间、术中透视次数、骨水泥注入量、骨水泥充盈情况、骨水泥渗漏情况、邻椎再骨折数,术后3 d、术后6个月疼痛VAS评分、ODI指数、伤椎Cobb角、伤椎前缘高度。结果 75例均获得随访,随访时间平均12个月。BKP组和PKP组手术时间、术后邻椎再骨折数比较差异无统计学意义(P0.05)。与PKP组相比,BKP组术中透视次数较少、骨水泥注入量较多、骨水泥充盈评价较优、骨水泥渗漏例数较少,差异有统计学意义(P 0.05)。2组术后3 d、术后6个月疼痛VAS评分、ODI指数、伤椎Cobb角、伤椎前缘高度比较差异无统计学意义(P0.05)。结论单侧椎弓根旁入路BKP术治疗骨质疏松性胸腰椎压缩骨折可以减少术中透视次数、获得更好的骨水泥充盈度,并能显著降低骨水泥渗漏发生率、改善胸腰椎压缩性骨折患者疼痛症状、恢复并维持伤椎高度、矫正后凸畸形、增加伤椎生物力学稳定性。     

PKP治疗多节段胸腰椎骨质疏松性椎体压缩骨折疗效观察

目的观察经皮椎体后凸成形术(PKP)治疗多节段胸腰椎骨质疏松性椎体压缩骨折的疗效。方法回顾性分析自2014-03—2016-01采用PKP治疗的30例多节段胸腰椎骨质疏松性椎体压缩骨折。记录骨水泥注入总量,观察术后并发症发生情况,比较术前、术后1 d、末次随访时VAS评分、ODI指数、Cobb角。结果 30例(67椎)骨水泥注入总量为364.5 ml,单个椎体骨水泥注入量为(5.44±0.78)ml。术后4个椎体出现骨水泥渗漏(渗漏率5.97%),椎间隙渗漏1例,椎旁渗漏3例。30例获得6~8(7.05±0.85)个月随访。末次随访时1例相邻节段椎体骨折,再骨折率为3.3%。术后1 d VAS评分、ODI指数明显低于术前,且末次随访时VAS评分、ODI指数低于术后1 d,差异有统计学意义(P0.05)。术后1 d Cobb角小于术前,末次随访时Cobb角大于术后1 d,差异有统计学意义(P0.05);但末次随访与术前Cobb角比较差异无统计学意义(P0.05)。结论 PKP是治疗多节段胸腰椎骨质疏松性椎体压缩骨折的有效方法,其短期疗效明显。     

经皮椎体后凸成形术后椎体高度与临床疗效的相关性研究

目的探讨骨质疏松性胸腰椎压缩骨折经皮椎体成形(PKP)术后椎体高度恢复程度与术后临床疗效的相关性。方法纳入自2010-01—2010-12行PKP手术治疗的36例骨质疏松性胸腰椎压缩骨折,计算术后3 d椎体高度恢复比的平均值,高于平均值的患者纳入A组,低于或等于平均值的患者纳入B组。比较2组术前、术后3 d、术后1年、术后5年的VAS评分、ODI指数、SF-36评分、伤椎Cobb角、伤椎椎体前缘高度。结果所有患者均成功完成手术,未出现一过性低血压、肺栓塞、感染、血肿、神经损伤等并发症。36例术后3 d的VAS评分、ODI指数、SF-36评分、伤椎Cobb角、伤椎椎体前缘高度较术前明显改善,差异有统计学意义(P0.05)。A、B组术后3 d、1年、5年的VAS评分、ODI指数、SF-36评分、伤椎Cobb角、伤椎椎体前缘高度比较差异无统计学意义(P0.05)。结论 PKP是治疗老年骨质疏松性椎体压缩骨折的有效术式,可缓解骨折引起的疼痛,对椎体高度的恢复及局部畸形的矫正也有一定的效果。但椎体高度恢复的程度与患者症状缓解、术后其他椎体再骨折的发生无明确的相关性。     

Epidural anesthesia: step by step to success

Besides pain management in obstetric patients epidural anaesthesia plays a major role in the perioperative setting. Especially the technique of thoracic epidural anaesthesia (TEA) provides better postoperative analgesia when compared with systemic pain therapy. TEA is associated with improved outcome in high-risk patients and patients undergoing extensive surgery. An acute pain management service is required to guarantee high effectiveness and a low complication rate. TEA is an important part of a multimodal perioperative concept, especially in fast-track surgery, which means advantages for patients outcome and hospitals economics.     

Bipolar enucleation of the prostate—step by step

Bipolar enucleation of prostate (BipolEP) is a useful method for treatment of benign prostatic hyperplasia (BPH). Compared with conventional transurethral resection, the enucleation technique has several advantages. However, since the cost of laser equipment used for enucleation is relatively high, enucleation using bipolar devices has been attempted by many previous surgeons. We consider bipolar enucleation is an effective and safe procedure, and we would like to share our experience of equipment settings and procedures through this article. We will introduce the equipment and settings of BipolEP and then present the actual step-by-step procedures and surgical tips. First, circular incisions are made on bladder neck and mucosa at the level of verumontanum. Then, enucleation is performed in the order of median and lateral lobes as in laser enucleation. Haemostasis should be done throughout the procedure. After enucleation and haemostasis, prostatic tissue is evacuated by morcellator. Currently, there are several types of electrode and morcellator systems. In our experience, BipolEP has a steep learning curve but it is safe and effective procedure for managing BPH. In particular, effective haemostasis is the greatest advantage of BipolEP when compared to traditional TUR or laser enucleation.     

Transcatheter aortic valve implantation transapical: step by step

Transcatheter aortic valve implantation (T-AVI) has been introduced into clinical practice to treat high-risk elderly patients with aortic stenosis. T-AVI can be performed by using a retrograde transfemoral (TF), transsubclavian, transaortic, and/or antegrade transapical (TA) approach. For TA-AVI, CE mark approval was granted in 2008 for the Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis with the Ascendra delivery system and in 2010 for the second-generation Edwards SAPIEN XT prosthesis and the Ascendra II delivery system, with 23-mm and 26-mm valves. In 2011, CE mark approval has been granted for TA-AVI by using the SAPIEN XT 29-mm prosthesis. Several other devices from different companies (Jenavalve, Jena Valve Inc, Munich, Germany; Embracer, Medtronic Inc, Guilford, CT; Accurate, Symetis Inc, Geneva, Switzerland) have passed "first in man trials" successfully and are being evaluated within multicenter pivotal studies. In this article we will focus on specific aspects of the TA technique for AVI.     

Laparoscopic radical cystoprostatectomy: a technique illustrated step by step

OBJECTIVES: Laparoscopic surgery is expanding among urologists as a minimally invasive treatment and may now be applied to treat neoplasms of the pelvic organs. Laparoscopic cystoprostatectomy has still not been well codified and illustrated. We describe a technique of laparoscopic radical cystoprostatectomy that we have developed in 10 patients after practicing in laparoscopic radical prostatectomy. METHODS: Between June 2001 and July 2002, 10 men with bladder cancer underwent laparoscopic cystoprostatectomy with urinary diversion. This report details step by step our 5-port transperitoneal technique with primary access to the seminal vesicles and Denonvillier's fascia, ureters detection after umbilical arteries incision, endopelvic fascia incision and dorsal vein complex control before division of the vesical and prostatic fibrovascular pedicles with a harmonic scalpel. RESULTS: We performed 6 orthotopic ileal neobladders, 2 sigmoid ureterostomies and 2 cutaneous ureterostomies. In all cases no conversion to open surgery was necessary. The mean time to perform the laparoscopic radical cystoprostatectomy, including the lymph node dissection, was 166 minutes (range 150-180). Mean estimated blood loss was 310 ml (range 220-440). Mean hospital stay was 8.1 days (range 7-9) for ileal orthotopic neobladder, 8 days (range 7-9) for sigmoid ureterostomy and 5 days for cutaneous ureterostomy. The mean follow up is 12.3 months (range 5-18). Two patients respectively with stage T2bN0 G2-3 and stage pT1N0 (plus carcinoma in situ) G3 transitional cell carcinoma and surgical margins tumor free had diffusive metastatic disease after 6 months. The other 8 patients are free from disease. CONCLUSIONS: Laparoscopic radical cystectomy is still an operation for pioneers but this procedure may be not strictly relegated to a few academic centers. In our opinion laparoscopic cystoprostatectomy is a feasible, fast, safe and easy procedure and urinary diversion may be performed with a laparoscopic, open or combined approach without reducing the advantages of laparoscopy.