经皮椎体成形术治疗骨质疏松胸腰椎压缩性骨折

目的：探讨骨质疏松性胸腰椎压缩性骨折采用经皮椎体成形术治疗的临床效果。方法：选择我院2009-06～2011-06收治的骨质疏松性胸腰椎压缩性骨折的患者40例,采用PVP治疗,对其临床资料进行回顾性分析。结果：每个椎体平均注射骨水泥4.4 mL。骨水泥椎间盘在术中渗漏1例,术后无下肢神经损伤和血管栓塞症状发生。椎体前方腹腔渗漏1例,术后无特殊不适症状。36例患者术后第2 d即可在腰围保护下离床轻微活动,其它3～5 d陆续可离床活动。术前VAS平均得分（8.6±1.3）,术后平均为（2.1±1.0）,减异有统计学意义（P〈0.05）。行平均12个月的随访,无腰背痛加重或椎体高度丢失等情况发生,X线检查椎体内骨水泥无外漏,分布均匀。结论：骨质疏松胸腰椎压缩性骨折采用经皮椎体成形术治疗,可减轻患者疼痛反映,降低并发症发生率,改善病情,减少被残率,具有非常重要的临床意义。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的安全性和疗效。方法应用经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折30例,其中男8例、女22例,年龄55～86岁。共治疗40个椎体:单椎体23例,2个椎体4例,3个椎体3例。结果所有患者均顺利完成手术。手术时间35～138 min,术中球囊扩张压力200～300 psi(1 psi=6.89 kPa),骨水泥注射量2.5～5 ml。1例球囊术中破裂,1例发生椎旁渗漏,2例椎间隙渗漏,1例椎管内渗漏,未出现临床症状。1例术中出现血压、脉搏下降,对症处理后好转。患者疼痛症状得到明显缓解,未见神经损伤等并发症的发生。结论经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折可迅速缓解疼痛、有效恢复骨折椎体高度,明显减少骨水泥渗漏率,这种技术简单、微创、安全、疗效肯定。掌握好椎弓根穿刺、球囊扩张技术以及把握好骨水泥的推注时机等能有效降低并发症的发生。     

高龄胸腰椎骨质疏松压缩性骨折经皮椎体成形术治疗效果分析

目的探讨经皮椎体成形术治疗高龄胸腰椎骨质疏松压缩性骨折的效果。方法选择65例胸腰椎骨质疏松压缩性骨折高龄患者,按手术编号随机分为观察组与对照组,观察组33例应用经皮椎体成形术治疗,对照组32例采用非手术疗法,治疗3个月后,比较两组患者疼痛视觉模拟VAS评分,伤椎前后缘高度恢复情况、Cobb’s角矫正情况,并发症发生情况。结果治疗后两组VAS评分均较前降低,且观察组较对照组更明显,两组比较有统计学差异(P<0.05);治疗后观察组伤椎前后缘高度、Cobb’s角改善情况明显优于对照组,两组比较有统计学差异(P<0.05);而并发症发生情况两组比较无统计学差异(P>0.05)。结论经皮椎体成形术治疗高龄胸腰椎骨质疏松压缩性骨折效果肯定。     

经皮椎体成形术治疗骨质疏松性椎体压缩性骨折疗效分析

目的 探究经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法 选取2019年12月至2020年1 1月泰兴市中医院收治的154例OVCF患者作为研究对象,并按照随机数表法将其随机分为观察组(77例)与对照组(77例),观察组患者采用PVP治疗,对照组患者采用过伸复位治疗,对比观察两组患者疼痛程度、椎体功能、伤椎前缘高度、Cobb角以及并发症发生情况结果 术后1周及术后1、5个月,观察组患者视觉模拟评分法(VAS)评分及Oswestry功能障碍指数(ODI)评分均明显低于对照组(VAS:t=1.985、2.733、2.490,P=0.049、0.007、0.014;ODI:t=2.726、8.181、8.497,P=0.007、P<0.001、P<0.001);术后1个月,观察组患者伤椎前缘高度明显高于对照组(t=6.786,P <0.001),Cobb角明显小于对照组(t=20.927,P<0.001);观察组患者术后并发症发生率为5.19%,明显低于对照组患者的术后并发症发生率15.58%(χ²=4.464,...     

PVP治疗骨质疏松性椎体压缩性骨折研究进展

【摘要】 骨质疏松性椎体压缩性骨折 (OVCF) 主要由椎体骨量减少、骨微结构退化、骨强度降低并受外力或不受外力作用所致, 临床表现为持续性腰背部疼痛? 肢体活动受限等, 是导致患者残疾或死亡的重要原因之一, 其患病率随着人口老龄化的不断加剧而升高, 且治愈后再发骨折率较高。 经皮椎体成形术 (PVP) 是 OVCF常用的微创治疗方法, 能够有效减轻患者腰背部疼痛, 促进椎体功能恢复。 基于此, 本文主要对 PVP 在 OVCF治疗中的应用研究进展进行综述, 以期进一步指导 PVP 的临床应用。     

骨质疏松性胸腰椎压缩性骨折经皮球囊后凸成形术的应用临床观察

目的探讨经皮球囊后凸成形术应用于骨质疏松性胸腰椎压缩性骨折的临床疗效。方法选取2012年~2013年治疗的11例骨质疏松性胸腰椎压缩性骨折患者,随访6个月至1年,观察患者的术后恢复情况。结果所有患者伤椎高度无丢失现象,疼痛感消失,脊柱活动度恢复伤前水平。结论应用经皮球囊后凸成形术治疗骨质疏松性胸腰椎压缩性骨折,不仅可解除或缓解疼痛症状,而且可以促使病人早下床活动,提高患者生活质量。     

单侧经皮椎体后凸成形术治疗多发性骨质疏松性椎体压缩性骨折

采用经皮单侧球囊扩张椎体后凸成形术治疗老年多发性骨质疏松性椎体压缩性骨折27例,其中获得随访22例。分析22例手术效果,认为该方法治疗安全、有效,创伤小,并发症少。     

经皮椎体后凸成形术治疗新鲜骨质疏松性椎体压缩性骨折的临床分析

目的 初步分析经皮脊柱后凸成形术治疗新鲜椎体压缩骨折的临床疗效.方法 对30例平均年龄72(65～81)岁的患者进行了可控性的前瞻性研究,所有病例均为孤立的胸腰椎(T8～L4)骨质疏松性椎体压缩性骨折且不伴神经功能障碍,且均予以球囊扩张的经皮脊柱后凸成形术.术后平均随访12个月.结果 通过经皮脊柱后凸成形术,患者的脊柱后凸角有显著改善,从术前的平均12.5°变为术后平均6.6°.患者的疼痛视觉模拟评分(Visual Analog Scale;VAS)也于此同时由术前的平均8.2降到术后的1.6.结论 经皮脊柱后凸成形术的应用对新鲜骨质疏松性椎体压缩性椎体骨折的患者具有良好的临床效果.     

椎体骨质疏松性骨折两种椎体成形术的疗效比较

 目的 比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松椎体压缩性骨折的疗效。方法 选取2017-01至2019-12医院收治的因骨质疏松椎体骨折行PVP或PKP治疗的老年患者共112例(132椎),根据选择术式的不同分为PVP组和PKP组,其中PVP组伤椎68个,PKP组伤椎64个。记录两种不同术式手术前后 VAS 评分、伤椎椎体增加高度、骨水泥注入量、手术时间、骨水泥渗漏情况。结果 PVP 组和PKP组术前和术后1 d的VAS评分比较,差异无统计学意义。PKP组术后修复伤椎高度为(11.5±3.2)mm,明显高于PVP组的(2.1±1.3)mm,差异有统计学意义(P<0.05)。PKP组骨水泥注入量也明显多于PVP组,两组比较差异有统计学意义(P<0.05)。PVP 组术中骨水泥渗漏 23个椎体(33.8%),PKP 组渗漏12个椎体(18.8%),PVP 组并发症高于PKP 组。结论 两种手术方式均能达到很好的止痛效果。但PKP恢复椎体高度上优于PVP,骨水泥注入量多,渗漏率低,临床治疗更有优势。     

双球囊组合扩张术治疗贲门失弛缓症的临床研究

目的　评价双球囊组合扩张术治疗贲门失弛缓症的疗效及其价值。方法　采用双球囊组合扩张术治疗贲门失弛缓症患者 5 2例。结果　近期有效率 10 0 % ,远期有效率 ,1次扩张 96 % ,2次扩张 10 0 %。结论　双球囊组合扩张术是治疗贲门失弛缓症安全有效 ,易于操作的方法。     

经皮球囊肺动脉瓣成形术的临床应用

目的:观察经皮球囊成形术治疗肺动脉瓣狭窄的疗效和安全性。方法:男性4例,女性2例,年龄8～19岁,平均11.7岁,均行经皮肺动脉瓣球囊成形术治疗。结果:肺动脉至右心室平均收缩压差由术前9.1kPa降至术后3.6kPa。结论:经皮肺动脉瓣球囊成形术是治疗肺动脉瓣狭窄的首选方法。     

Randomized Clinical Trial of Cutting Balloon Angioplasty versus High-Pressure Balloon Angioplasty in Hemodialysis Arteriovenous Fistula Stenoses Resistant to Conventional Balloon Angioplasty

PurposeTo compare the efficacy and safety of cutting balloon angioplasty (CBA) versus high-pressure balloon angioplasty (HPBA) for the treatment of hemodialysis autogenous fistula stenoses resistant to conventional percutaneous transluminal angioplasty (PTA).Materials and MethodsIn a prospective, randomized clinical trial involving patients with dysfunctional, stenotic hemodialysis arteriovenous fistulas (AVFs), patients were randomized to receive CBA or HPBA if conventional PTA had suboptimal results (ie, residual stenosis > 30%). A total of 516 patients consented to participate in the study from October 2008 to September 2011, 85% of whom (n = 439) had technically successful conventional PTA. The remaining 71 patients (mean age, 60 y; 49 men) with suboptimal PTA results were eventually randomized: 36 to the CBA arm and 35 to the HPBA arm. Primary and secondary target lesion patencies were determined by Kaplan–Meier analysis.ResultsClinical success rates were 100% in both arms. Primary target lesion patency rates at 6 months were 66.4% and 39.9% for CBA and HPBA, respectively (P = .01). Secondary target lesion patency rates at 6 months were 96.5% for CBA and 80.0% for HPBA (P = .03). There was a single major complication of venous perforation following CBA. The 30-day mortality rate was 1.4%, with one non–procedure-related death in the HPBA group.ConclusionsPrimary and secondary target lesion patency rates of CBA were statistically superior to those of HPBA following suboptimal conventional PTA. For AVF stenoses resistant to conventional PTA, CBA may be a better second-line treatment given its superior patency rates.     

胶囊阻塞法经皮经肝总动脉作肝栓塞术

本文报道了12例胶囊阻塞法经皮经肝总动脉作肝栓塞的病例,介绍了这一新技术的具体操作方法,该技术的特点在于导管在肝总动脉水平便可作肝栓塞治疗,而不致胃十二指肠动脉栓塞,从而使得肝固有动脉超选择插管不能的肝肿瘤患者行肝栓塞成为可能。本文对2例典型病例进行了详细介绍,还就该技术的作用机理、安全性及使用价值等作了讨论。     

Percutaneous Treatment of Intrahepatic Biliary Leak: A Modified Occlusion Balloon Technique

Purpose

To report a novel modified occlusion balloon technique to treat biliary leaks.

Methods

A 22-year-old female patient underwent liver transplantation with biliary-enteric anastomosis. She developed thrombosis of the common hepatic artery and extensive ischemia in the left hepatic lobe. Resection of segments II and III was performed and a biliary-cutaneous leak originating at the resection plane was identified in the early postoperative period. Initial treatment with percutaneous transhepatic drainage was unsuccessful. Therefore, an angioplasty balloon was coaxially inserted within the biliary drain and positioned close to the leak.

Results

The fistula output abruptly decreased after the procedure and stopped on the 7th day. At the 3-week follow-up, cholangiography revealed complete resolution of the leakage.

Conclusion

This novel modified occlusion balloon technique was effective and safe. However, greater experience and more cases are necessary to validate the technique.

     

Balloon Dilatation: A Helpful Technique for Removal of a Stuck Dialysis Line

We describe a useful technique for the removal of an irretrievable/stuck long-term intravenous catheter. The alternative would have meant removing it surgically or snaring it in a case of extremely difficult venous access. The process we used was effective in this particular case.     

Use of Cutting Balloon in the Treatment of Urethral Stricture: A Novel Technique

The peripheral cutting balloon has been used to treat various nonvascular strictures as well as vascular stenosis. In this article, we describe for the first time the use of the cutting balloon in the treatment of patients with urethral stricture. Four patients with bulbar urethral stricture were included in the study. All strictures were successfully dilated with the cutting balloon, and patients were free of symptoms at 6-month follow-up. Cutting-balloon dilatation is a safe, easy-to-perform, and effective treatment for patients with tight urethral strictures.     

ET技术早期评价高脂血症患者颈动脉弹性的临床研究

目的:应用血管回声跟踪(ET)技术早期评价高脂血症分型组患者颈动脉弹性功能.材料和方法:筛选高脂血症患者42例,按血脂异常(类型)分为高胆固醇血症组(16例)、高三酰甘油血症组(13例)和混合型高脂血症组(13例),同期随机选取正常对照组30例,采用ET技术测量颈总动脉弹性参数,并分析各参数与血胆固醇、三酰甘油含量及病程之间的关系.结果:①高脂血症组β、EP、PWVβ和AI较正常对照组明显增高(P<0.05);AC较正常对照组降低(P<0.05).②混合型高脂血症组与高胆固醇组血症和高三酰甘油血症组相比,β、EP、PWVβ和AI增高(P<0.05),AC降低(P<0.05);而与高胆固醇血症组、高三酰甘油血症相比,各参数差异无统计学意义(P>0.05).③血胆固醇、三酰甘油水平及高脂血症的病程与β、EP、AI和PWVβ呈显著正相关,与AC存在负相关.结论:应用ET技术可准确评价高脂血症患者颈动脉弹性功能发生的早期改变.