Kifoplastija perkutanja għal ksur torakolumbari osteoporotiku senili

Il-kifoplasty perkutanja (PKP) hija teknika ta' intervent minimament invażiva. Billi tifforma kavità fil-ġisem vertebrali u tinjetta siment tal-għadam, il-ġisem vertebrali mġarrab jista 'jiġi reset u d-deformità kyphotic tista' tiġi kkoreġuta. , li tista 'żżid is-saħħa u l-istabbiltà tal-ġisem vertebrali, u tnaqqas malajr l-uġigħ ikkawżat minn ksur tal-kompressjoni vertebrali 1,2. Aħna wettaqna kyphoplasty perkutanja fuq 28 każ ta 'ksur tal-kompressjoni vertebrali osteoporotiċi (OVCF) b'total ta' 32 korp vertebrali. Ir-riżultati kliniċi riċenti kienu sodisfaċenti, u r-rapport huwa kif ġej.

1Dejta klinika

1.1 Informazzjoni ġenerali It-28 pazjent f'dan il-grupp kienu kollha pazjenti bi ksur tal-kompressjoni vertebrali osteoporotiċi rikoverati fl-isptar tagħna, inklużi 6 irġiel u 22 mara; ta' 54-85 sena, b'medja ta' 73.1 sena; manifestazzjonijiet kliniċi ta' uġigħ fid-dahar baxx, Diffikultà biex timxi wieqfa, kyphosis, it-tul tal-marda 3d-8w. Films tar-raġġi X, eżamijiet CT u MR saru qabel l-operazzjoni, u d-dijanjosi kienet ksur tal-kompressjoni vertebrali osteoporotika, u ksur ikkawżat minn mard ieħor ġew esklużi. Films tar-raġġi X ġew riveduti wara l-operazzjoni. Fosthom, kien hemm 24 każ ta 'ksur wieħed tal-kompressjoni tal-ġisem vertebrali u 4 każijiet ta' ksur 2 tal-ġisem vertebrali; segmenti involuti: vertebri T63, vertebri T72, vertebri T82, vertebri T91, vertebri T102, vertebri T113, vertebri T128, vertebri L16, vertebri L24, u vertebri L31. Ma kien hemm l-ebda sintomi u sinjali ta 'kompressjoni tas-sinsla tad-dahar u ta' l-għeruq tan-nervituri.

1.3 Operating techniques Local anesthesia was used, prone position, and the thoracic puncture needle was inserted into the vertebral body through the pedicle, and the lumbar spine was inserted into the vertebral body through the pedicle. The X-ray is kept parallel to the endplate of the vertebral body. The shape of the pedicles on both sides must be symmetrical, and the distance from the spinous process must be the same. Mark the projections of the skin of the bilateral pedicles. Routine sterilization and laying of sheets, after local anesthesia, the puncture needle is pierced from the outer upper edge of the pedicle projection circle to the inner and lower sides, and the depth of piercing into the bone is about 3.0 cm. The needle tip should still be located in the pedicle projection circle. 10 o'clock on the side, 2 o'clock on the right. The lateral view shows that the puncture needle is located in the center of the pedicle. Under fluoroscopy, the guide needle continues to be drilled from the outside of the pedicle (thoracic spine) or from the inside of the pedicle (lumbar spine). When the lateral view shows that the needle tip reaches the posterior wall of the vertebral body, the front view shows that the needle tip is located at the medial edge of the pedicle shadow, indicating that the needle insertion direction is correct, and it can continue to drill for 2-3 mm and then stop. Pull out the inner core of the puncture needle, insert the guide needle, pull out the puncture needle, and place the expansion sleeve and the working sleeve along the guide needle in sequence, so that the front end of the working sleeve is located 2-3 mm in front of the posterior cortex of the vertebral body. The bone drill is slowly drilled through the working cannula, so that the tip of the drill bit reaches the anterior edge of the vertebral body in the lateral position, and is close to the edge of the spinous process in the frontal position. It is inclined forward and downward, located at the anterior 3/4 of the vertebral body, and the contralateral puncture and balloon placement are completed in the same way. Connect the injection device, fill the balloon with contrast agent to expand the balloon, the C-arm machine monitors the balloon expansion and fracture reduction, and stops increasing the pressure when the vertebral body is fully reduced or the balloon reaches the cortex around the vertebral body, and the pressure generally does not exceed 300psi. The volume of one airbag should not exceed 3ml. The balloon was removed, and the bone cement in the drawing stage was injected into the vertebral body under fluoroscopy to prevent leakage of the bone cement.

2 Riżultati tat-trattament

2.1 Kundizzjonijiet intraoperattivi u ta 'wara l-operazzjoni Wara l-operazzjoni, il-pazjenti tpoġġew f'pożizzjoni supina għal 6 sigħat, u 24 siegħa wara, qamu u mxew fuq l-art. F'dan il-grupp, 28 pazjent ma kellhom l-ebda kumplikazzjonijiet intraoperattivi bħal emboliżmu pulmonari u pressjoni baxxa, u l-ebda mewt intraoperattiva. X-raġġi ta 'wara l-operazzjoni wrew ammont żgħir ta' tnixxija tas-siment tal-għadam fin-naħat laterali u anterjuri tal-ġisem vertebrali, iżda ħadd minnhom ma kkawża sintomi kliniċi, u ma nstabet l-ebda korriment tal-għeruq tan-nervituri u tas-sinsla tad-dahar.

2.2 Titjib tas-sintomi wara l-operazzjoni 28 pazjent ġew segwiti għal 1-5 xhur, b'medja ta' 3 xhur. Inkiseb serħan sħiħ mill-uġigħ f'20 każijiet u serħan parzjali mill-uġigħ fi 8 każijiet. L-iskala analoga viżwali (VAS) 3 għall-kejl tal-uġigħ kliniku ġiet żviluppata biex tqabbel pazjenti b'uġigħ fid-dahar baxx qabel u wara l-kirurġija. 0 punti: 0cm, l-ebda uġigħ, l-ebda uġigħ; 2 punti: 1-3cm, uġigħ ħafif, ma jaffettwax ix-xogħol u l-ħajja; 4 punti: 4-6cm, uġigħ moderat, jaffettwa x-xogħol, iżda ma jaffettwax il-ħajja; 6 punti: 7-10cm, uġigħ qawwi, uġigħ qawwi, li jaffettwaw ix-xogħol u l-ħajja. Qabel u wara t-trattament, il-pazjenti mmarkaw linja ta '10cm skond l-uġigħ tagħhom stess. Ir-riżultati wrew li kien hemm differenza sinifikanti fil-punteġġ VAS qabel u wara l-kirurġija.

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