| PVP治疗骨质疏松性椎体压缩性骨折过程中隐性失血及其危险因素分析 |
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投稿时间：2020-01-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 陆汉力 |
LU Han-li |
皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241000 |
Department of Traumatology and Orthopaedics, Yanjishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China |
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| 陶周善 |
TAO Zhou-shan |
皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241000 |
Department of Traumatology and Orthopaedics, Yanjishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China |
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| 马济民 |
MA Ji-min |
皖南医学院弋矶山医院关节骨科, 安徽 芜湖 241000 |
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| 朱孝峰 |
ZHU Xiao-feng |
皖南医学院弋矶山医院脊柱骨科, 安徽 芜湖 241000 |
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| 杨民 |
YANG Min |
皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241000 |
Department of Traumatology and Orthopaedics, Yanjishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China |
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| 丁国正 |
and DING Guo-zheng |
皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241000 |
Department of Traumatology and Orthopaedics, Yanjishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China |
dingguozheng@medmail.com.cn |
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| 期刊信息：《中国骨伤》2020年，第33卷，第5期，第445-448页 |
| DOI：10.12200/j.issn.1003-0034.2020.05.011 |
| 基金项目:弋矶山医院高峰基金项目及攀峰团队基金项目（编号：GF2019G04，PF2019005）；安徽省教育厅重点科研基金（编号：KJ2017A266）；安徽省自然科学基金（编号：1708085QH208） |
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中文摘要:
目的：探讨经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗过程中出现隐性失血（hidden blood loss，HBL）的影响因素。
方法：对2016年3月至2017年12月接受经皮椎体成形术治疗的125例（男55例，女70例）骨质疏松性椎体压缩性骨折的（osteoporotic vertebral compression fractures，OVCFs）临床资料进行回顾性分析。术前均行腰椎正侧位、双斜位及动力位X线片，腰椎CT、MRI及双能X射线骨密度仪（DXA）检查明确诊断。其中胸椎10例，胸腰椎89例，腰椎26例。单节段87例，双节段29例，3节段9例。67例患者椎体压缩高度比例<1/3，41例在1/3~2/3，17例>2/3。术前与术后3 d行血常规检查，分析HBL情况并探索其危险因素。
结果：125例患者隐性失血为（317±156）ml。经过多重线性回归分析发现糖尿病病史（P=0.011）、手术节段（P=0.036）、节段数量（P<0.001）、椎体高度丢失率（P=0.002）、椎体高度恢复率（P<0.001）和骨水泥渗漏率（P=0.003）与隐性失血呈正相关。同时，发现椎体高度丢失率高者失血量较椎体高度丢失率低者多，椎体高度恢复良好者失血量较椎体高度恢复不良者多，水泥泄漏也是增加隐性失血的重要因素。然而，骨密度（P=0.814），高血压病史（P=0.055）与隐性失血无显著相关性。
结论：OVCFs患者经过PVP治疗后隐性失血量较大，需要引起关注；同时糖尿病病史、手术节段、节段数量、骨水泥渗漏率、椎体高度丢失率和椎体高度恢复率是增加隐性失血量的危险因素。 |
| 【关键词】骨质疏松性骨折 椎体压缩性骨折 经皮椎体成形术 隐性失血 |
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| Analysis of hidden blood loss and its risk factors in the treatment of osteoporotic vertebral compression fractures with PVP |
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ABSTRACT
Objective: To investigate the influencing factors of hidden blood loss (HBL) during the treatment of percutaneous vertebroplasty (PVP).
Methods: The clinical data of 125 patients with osteoporotic vertebral compression fractures (OVCFs) treated with percutaneous vertebroplasty from March 2016 to December 2017 were retrospectively analyzed. All patients underwent X-rays of the AP and lateral lumbar spine,double oblique,and dynamic positions. Lumbar spine CT,MRI,and dual-energy X-ray bone densitometer (DXA) were used to confirm the diagnosis. There were 55 males and 70 females,10 cases of thoracic vertebrae,89 cases of thoracolumbar vertebrae,26 cases of lumbar vertebrae,87 cases with single segment,29 cases with double segment,and 9 cases with 3 segments. The vertebral compression height ratios of 67 patients were less than 1/3,and the ratios for 41 patients were from 1/3 to 2/3,for 17 patients were more than 2/3. Blood routine examination were performed before and 3 days after surgery to analyze hidden blood loss and to explore its risk factors.
Results: The average hidden blood loss was (317±156) ml in 125 patients. Multiple linear regression analysis revealed a history of diabetes(P=0.011),surgical segments(P=0.036),number of segments(P<0.001),vertebral height loss rate (P=0.002),vertebral height recovery rate (P<0.001) and bone cement leakage rate(P=0.003) were positively correlated with hidden blood loss. Moreover,it was found that the blood loss was higher in those with higher vertebral height loss rate than in those with lower vertebral height loss rate,and the blood loss was higher in those with good vertebral height recovery than those with poor vertebral height recovery. Additionally,the cement leakage was also an important factor in increasing hidden blood loss. However,there was no significant correlation between bone mineral density(P=0.814) or history of hypertension(P=0.055) and hidden blood loss.
Conclusion: Patients with OVCFs have a large amount of hidden blood loss after PVP treatment,which needs attention. At the same time,the history of diabetes,surgical segments,number of segments,bone cement leakage rate,vertebral height loss rate and vertebral height recovery rate are the risk factors for hidden blood loss. |
| KEY WORDS Osteoporotic fracture Vertebral compression fracture Percutaneous vertebroplasty Hidden blood loss |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陆汉力,陶周善,马济民,朱孝峰,杨民,丁国正.PVP治疗骨质疏松性椎体压缩性骨折过程中隐性失血及其危险因素分析[J].中国骨伤,2020,33(5):445~448 |
| 英文格式: | LU Han-li,TAO Zhou-shan,MA Ji-min,ZHU Xiao-feng,YANG Min,and DING Guo-zheng.Analysis of hidden blood loss and its risk factors in the treatment of osteoporotic vertebral compression fractures with PVP[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(5):445~448 |
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