中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (10): 1477-1483.doi: 10.3969/j.issn.2095-4344.2201

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials •    下一篇

经皮穿刺椎体后凸成形中骨水泥渗漏入椎管与胸腰椎椎体后壁形态的关系

张  帅，王高举，王  清   

  1. 西南医科大学附属医院脊柱外科，四川省泸州市  646000
  • 收稿日期:2019-06-13 修回日期:2019-06-14 接受日期:2019-07-20 出版日期:2020-04-08 发布日期:2020-02-14
  • 通讯作者: 王清，教授。西南医科大学附属医院脊柱外科，四川省泸州市 646000
  • 作者简介:张帅，硕士，主治医师。

Relationship between thoracic and lumbar vertebral posterior wall morphology and bone cement leakage into the spinal canal during the percutaneous kyphoplasty

Zhang Shuai, Wang Gaoju, Wang Qing   

  1. Department of Spinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • Received:2019-06-13 Revised:2019-06-14 Accepted:2019-07-20 Online:2020-04-08 Published:2020-02-14
  • Contact: Wang Qing, Professor, Department of Spinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • About author:Zhang Shuai, Master, Attending physician, Department of Spinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China

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摘要：

文题释义：
经皮穿刺椎体后凸成形：是一种通过向脊柱骨折椎体内放置球囊撑开装置为骨水泥注射提供低压环境、协助骨折复位，矫正后凸畸形的手术技术。

背景：经皮穿刺椎体后凸成形术(percutaneous kyphoplasty，PKP)是治疗骨质疏松性椎体压缩骨折的有效方法，虽然临床效果满意，但骨水泥渗漏仍然为其主要并发症，既往文献报道骨水泥渗漏进入椎管的因素较多，但由于缺少对于胸、腰椎椎体后壁形态的观察，胸腰椎椎体后壁形态差异可能也是导致骨水泥渗漏进入椎管的重要因素之一。

目的：探讨胸、腰椎椎体后壁形态对骨质疏松性椎体压缩骨折患者行PKP术骨水泥渗漏入椎管的影响。

方法：选取行PKP术治疗的临床资料完整并同时具有T6-L5的CT平扫及三维重建影像资料的骨质疏松性椎体压缩骨折患者98例。采用CT三维重建及多平面重建技术测量非骨折椎体后壁凹入椎体的深度及相应椎体中矢状径，计算各椎体后壁凹入椎体深度占同一椎体中矢状径百分比。将测量椎体分为胸椎组(T6-T12)和腰椎组(L1-L5)进行比较观察。选择同期内行PKP手术治疗无CT三维重建资料的骨质疏松性椎体压缩骨折患者357例(548个椎体)，也分为胸椎组和腰椎组观察比较骨水泥渗漏侵占椎管程度。

结果与结论：①测量98例患者椎体后壁参数发现，椎体后壁凹入椎体深度在T6-T12逐渐加深，平均4.6 mm；L1-L5逐渐变浅，平均0.6 mm，椎体后壁凹入椎体深度占同一椎体中矢状径百分比T6-T12均为16%(1/6)；L1-L5平均为3%，腰椎较胸椎明显小于16%(1/6)；②观察同期行PKP手术治疗的357例患者发现：胸椎行PKP术骨水泥脉渗漏入椎管渗漏率为10.2%(31/304)，腰椎渗漏率为3.7%(9/244)。胸椎组骨水泥渗漏侵占椎管最大矢状径平均为(3.1±0.2) mm，侵占椎管面积平均为(30.8±0.3) mm2，椎管侵占率为(22.5±0.2)%；腰椎组骨水泥渗漏侵占椎管最大矢状径为(1.4±0.1) mm，侵占椎管面积为(14.9±0.2) mm2，椎管侵占率为(11.4±0.3)%，胸椎组骨水泥渗漏发生率、侵占椎管最大矢状径、面积明显大于腰椎组(P < 0.05)。③结果证实，中下胸椎行PKP术应尽量避免骨水泥分布达到椎体后16%(1/6)，因中下胸椎、腰椎椎体后壁凹入椎体深度差异会对PKP术骨水泥渗漏进入椎管的观察造成影响，可能是导致中下胸椎椎管内骨水泥渗漏率明显高于腰椎的原因之一。该试验获得西南医科大学附属医院伦理委员会批准(批准号：K2018008)。

ORCID: 0000-0003-0148-2980(王清)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程


关键词: 骨质疏松性椎体压缩骨折, 椎体后壁形态, 椎体后凸成形术, 椎管内骨水泥渗漏, CT三维重建, 多平面重建技术, 椎管形态, 横突-椎弓根穿刺, 骨密度, 椎体内静脉系统

Abstract:

BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective method for treating osteoporotic vertebral compression fracture. Although satisfactory clinical outcomes can be achieved, bone cement leakage is still one of the main complications of PKP. Based on previous studies, there are many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphology of different vertebral bodies may be an important reason for bone cement leakage into spinal canal.

OBJECTIVE: To investigate the effect of thoracic and lumbar vertebral posterior wall morphology in the patients with osteoporotic vertebral compression fracture on bone cement leakage into the spinal canal during the PKP.

METHODS: The clinical data of osteoporotic vertebral compression fracture patients with PKP were selected. There were 98 osteoporotic vertebral compression fracture patients with CT scan and three-dimensional reconstruction image data from T6 to L5. The three-dimensional reconstruction of CT and multiplanar reconstruction were used to measure the depth of the concave vertebral posterior wall (OC) and the corresponding middle-sagittal diameter of the vertebra (PC) of the non-fractured vertebral body, the ratio of OC to PC was calculated. All subjects were divided into thoracic group (T6-T12) and lumbar group (L1-L5) based on the location of measured vertebral, and the differences of the OC between groups were compared. 357 patients (548 vertebrae) with osteoporotic vertebral compression fracture without CT three-dimensional reconstruction underwent PKP within the same period. They were also divided into thoracic vertebra and lumbar vertebra groups. The degree of bone cement leakage into the spinal canal was compared between thoracic and lumbar vertebra groups.

RESULTS AND CONCLUSION: (1) The morphological parameters of posterior vertebral wall in 98 patients showed that the depth of the concave vertebral posterior wall gradually (OC) deepened from T6 to T12, with an average of 4.6 mm. The depth became gradually shallow from L1 to L5, with an average of 0.6 mm. The ratio of the depth of the concave vertebral posterior wall to the corresponding middle-sagittal diameter of the vertebra was approximately 16% (1/6) from T6 to T12. The average value of ratios from L1 to L5 was 3%. The ratios in lumbar vertebra were significantly decreased compared with thoracic vertebra (16%, 1/6). (2) Results form 357 patients who underwent PKP at the same time showed that the rate of bone cement leakage into spinal canal was 10.2% (31/304) in the thoracic vertebra group during the PKP, and the rate of lumbar vertebra group was 3.7% (9/244). In the thoracic group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (3.1±0.2) mm, the average maximal area of the bone cement intruded spinal canal was (30.8±0.3) mm2, and the spinal canal encroachment rate was (22.5±0.2)%. In the lumbar group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (1.4±0.1) mm, the average maximal area of the bone cement intruded spinal canal was (14.9±0.2) mm2, and the spinal canal encroachment rate was (11.4±0.3)%. There was significant difference between thoracic and lumbar groups (P < 0.05). (3) The above results imply that due to the presence of OC structure in the middle and lower thoracic vertebra, it is possible to reduce the occurrence of bone cement leakage into spinal canal through avoiding bone cement distribution over the posterior 1/6 (16%) of vertebral body in PKP. The effect of the difference between thoracic and lumbar vertebral posterior wall morphology in osteoporotic vertebral compression fracture patients on bone cement leakage into the spinal canal during the PKP may be one of the reasons why the rate of bone cement leakage into spinal canal in thoracic vertebra significantly higher than that in lumbar vertebra. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (approval No. K2018008).

Key words: osteoporotic vertebral compression fracture, vertebral posterior wall morphology, percutaneous kyphoplasty, bone cement leakage into spinal canal, three-dimensional CT reconstruction, multiplanar reconstruction, morphology of spinal canal, transverse-pedicle approach, bone mineral density, intravertebral venous system

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