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Percutaneous vertebroplasty in treatment of thoracolumbar compression fracture analysis of 29 cases

Author: Anonymous From: www.yourpaper.net Posted: 2010-05-02 16:30:11 Read:
Author: the party, for China, Zhang Dianying, Jiang Baoguo
[Abstract] Objective: To summarize the percutaneous vertebroplasty for compression fracture of thoracic and lumbar treatment effects, to investigate the imaging measurement method.Fracture of 29 patients with 35 vertebral [method] in 2006 March to 2007 June were followed up to Sky of undergraduate expansion vertebroplasty system in percutaneous vertebroplasty in treatment of thoracolumbar compression, before and after the operation, the lateral X-ray measurement and data analysis.[results] the postoperative follow-up was 8 to 24 months, average 16 months after fracture, vertebral midline M and trailing edge P ratio, the vertebral midline M and the vertebral midline NM ratio, and the anterior vertebral line A and the vertebral midline NM ratio has significant difference (P< 0.05); 3 cases patients after 3 ~ 12 months due to the Department of internal medicine disease death; significant pain relief after surgery, VAS score was 1.88 1.49; subjective satisfaction with treatment was 90%; Roland Morris disability questionnaire showed no patients with severe dysfunction; after standing time was (14.65 15.71) d, brace protection time was (56 23.23) d; local anesthesia tolerance level of 100%; 1 cases had no symptoms of spinal bone cement leakage.[conclusion]Sky expansion vertebroplasty system percutaneous vertebroplasty for thoracolumbar vertebral fracture compressibility of good therapeutic effect, pain and function recovered satisfactorily, preoperative lateral radiographs of the anterior vertebral line A and line M and fracture vertebral line P and the vertebral midline NM ratio for effective imaging measurement.
[Key words] vertebroplasty; vertebral fracture; morphology; complications
Abstract:[Objective]To analyze 29 cases of vertebral fractures treated with percutaneous vertebroplasty (PVP).[Method]Twenty nine patients (35 vertebral bodies) undergoing percutaneous vertebroplasty from March 2006 to June 2007 and followed up for 8-24 months (average 16 months) were observed and analyzed.[Result]The ratio of M line (middle height of the vertebral body of fractured vertebra to) P line (post edge height of the vertebral body) of fractured vertebra and the ratios of A line (anterior edge height of the vertebral body) and M line to NM line (M line of the next vertebral body) had statistical differences (P< 0.05).Three patients died of other diseases 3-12 months post operation.Pain relief was obvious, average VAS score was 1.88 1.49.Satisfaction rate was 90%.According to the Roland Morris questionnaire, no patient had severe dysfunction in this group.Average standing time was 14.65 15.71 days post operation.Average cast protection was 56 23.23 days.The tolerance of local anesthesIA was 100%.One case had bone cement leakage in the spinal canal but with no symptom.[Conclusion]PVP by sky system can improve pain relief and life quality in patient with vertebral fracture.The ratios of A and M line of fractured vertebral body to P line of fracture vertebral body and M line of next vertebral body are efficient indexes of morphology.
Key words:vertebroplasty; vertebral fracture; morphology; complication
Thoracic and lumbar vertebral compression fracture is a common clinical fracture type.The general data of patients, operation mode, operation time, anesthesia and tolerance, vertebral shape restoration radiology index, pain recovery index, subjective treatment satisfaction, dysfunction score, postoperative recovery, postoperative complications of percutaneous vertebral body forming a comprehensive analysis of the effect of therapy, the related experiences in diagnosis and treatment.
1 materials and methods
1.1 clinical cases
Fractures in patients with a total of 29 vertebral bodies in 35 cases from March June to 2007 2006 in our department and the Sky expansion vertebroplasty system in percutaneous vertebroplasty in treatment of thoracolumbar compression, the ratio of male to female =5 : 24, averaged (72 7.19) (56 ~ 85) years old.Multiple vertebral fractures in 5 cases; T6 to L4 vertebral body were involved, in which T12 and L1 fracture were 23 cases, accounting for 73.1% of the total number of vertebral disease.Combining with the history and preoperative X-ray, MRI scan diagnosis, if necessary, to determine the fracture is fresh or old fracture.
1.2 operation and follow-up
This group of patients under general anesthesia, the simple local anesthesia or local anesthesia intravenous intensified anesthesia percutaneous vertebroplasty system support Sky expansion, injection of bone cement vertebroplasty.The average postoperative 1 weeks in 2008 March for discharge, follow-up time point, a comprehensive analysis of operation data, and follow-up of patients postoperative recovery, pain and dysfunction score analysis.
Measurement of 1.3 images
Before and after the operation were taken to fracture of thoracic and lumbar vertebrae as the center and lateral X-ray, choose the lateral radiographs are indicators on the morphology of vertebral fracture restore imaging evaluation (Figure 1): anterior vertebral line (A line), vertebral posterior line (P line), the vertebral midline (M line), the vertebral midline (NM line).Before the operation, the patients with X-ray, M, P by A, NM line P line, NM measurement, choose line as the standard line, A, M and P, NM, the calculation of relative height ratio (recorded as APP, ANM, respectively, MPP, MNM), and test of paired data difference overall sex and correlation.Preoperative pre representative, after taking post.
2 results in
2.1 operation data
Anesthesia for
Local anesthesia intravenous intensified anesthesia in 21 cases, only local anesthesia in 5 cases, 3 cases of intravenous inhalational anesthesia; general anesthesia patients had multiple fractures during operation completed.The overall average operation time (except for N=28, and 1 cases of tibial plateau fractures) was (74.21 42.42) (28 ~ 190) min, the single vertebral single vertebroplasty average operation time (N=27) (53.74 23.39) (28 ~ 145) min.Simple vertebroplasty in patients, only 1 cases of bleeding amount to about 50 ml, due to long-term use of aspirin induced, Yu bleeding were within 10 ml, negligible.
2.2 radiographic measurement
2.2.1 by paired t test before and after surgery, anterior vertebral line preA= (20.26 4.88) mm, postA= (23.43 4.86) mm (t=-3.466, P=0.002< 0.01), the vertebral midline preM= (16.82 4) mm, postM= (20.90 3.16) mm (t=-6.369, P=0.000< 0.01) had significant difference; at the same time, as the recovery rate compared to standard numerical vertebral line preP= (27.20 5.55) mm, postP= (31.16 4.60) mm (t=-5.259, P=0.000< 0.01), preoperative and postoperative X-ray showed the amplification rate difference.
2.2.2 numerical analysis the correlation matching before and after surgery, preoperative and postoperative A, M, P and line were significantly correlated (P< 0.01); at the same time, the vertebral line with the vertebral midline ratio of prePNM=1.055 0.159, postPNM=1.084 0.107, before and after the operation showed significant correlation (R=0.684, P=0.000< 0.01), tips fracture of vertebral line with the vertebral midline value variation in measured before and after operation with high consistency.
2.2.3 by paired t test analysis, the following 3 groups: numerical and there are significant differences between before and after operation respectively for the vertebral midline and posterior line ratio, preMPP=0.622 0.115, postMPP=0.674 0.070 (t=-2.228, P=0.036< 0.05); before and after the vertebral midline and lower vertebral fracture in line ratio, preMNM=0.656 0.152, postMNM=0.729 0.091 (t=-2.626, P=0.015< 0.05); after the anterior vertebral line with the vertebral midline ratio, preANM=0.707 0.105, postANM=0.772 0.080 (t=-2.667, P=0.014< 0.05); prompt the vertebral body line as a standard, the anterior vertebral line and the midline of the recovery rate had significant changes in fracture, vertebral line as a standard, fracture the vertebral midline recovery rate had significant changes.
Follow-up of 2.3 postoperative
3 patients died in this group of patients, all female, age and cause of death were 74 years, 10 months, postoperative liver cirrhosis; 71 years, 1 years after surgery, acute myocardial infarction; 67 years, 3 months after operation, the pancreatic cancer.No serious complications.Pain VAS score, 12 patients still feel back pain, accounting for the total follow-up 48% patients, were mild pain, only 1 earth fault NSAID use.All the patients were followed up for VAS score was 1.88 1.49 (0 ~ 4).Treatment satisfaction, subjective evaluation of 16 cases of patients, operation treatment is satisfactory, basically satisfactory in 10 cases, accounting for 90% of the total number of patients.All patients were followed up for Roland Morris disability questionnaire survey, a score of 0 to 8 is divided into 21 cases, accounting for the total follow-up to 80.7%; scores of 9 to 16 in 5 cases, accounting for the total follow-up were 19.3%, 17 and 24 in 0 cases, showed that patients without severe dysfunction.After standing time was (14.65 15.71) d (3 ~ 60 d), 67% patients after 1 weeks with a standing with.Postoperative brace protection time was (56 23.23) d (10 ~ 90 d), 75% patients have been removed to restore the daily activities of waist.Local anesthesia tolerance, all (26/26) the local anesthesia or local anesthesia intravenous intensified anesthesia patients expressed tolerance to this form of anesthesia, 61.5% patients with local anesthesia (16/26) expressed discomfort with the prone position, but all (26/26) using local anesthesia or local anesthesia intravenous anesthesia is represented as strong again this operation may choose the same way of anesthesia.2.4 operation complications
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