中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (16): 3007-3010.doi: 10.3969/j.issn.1673-8225.2010.16.039

• 生物材料临床实践 clinical practice of biomaterials • 上一篇    下一篇

不同充填材料应用于经皮椎体成形术的效果及影像特征

赵  刚1，刘宏建2，周英杰1   

  1. 1河南省洛阳正骨医院脊柱外二科，河南省洛阳市 471002；2郑州大学第一附属医院骨科，河南省郑州市  450052
  • 出版日期:2010-04-16 发布日期:2010-04-16
  • 作者简介:赵 刚★，男，1974年生，山西省昔阳县人，汉族，2006年郑州大学毕业，硕士，主治医师，主要从事脊柱外科方面的研究。 lyzgzg@live.cn
  • 基金资助:

    河南省科技攻关项目(0524410045)。

Effect of different filling materials on percutaneous vertebroplasty and the image characteristics

Zhao Gang1, Liu Hong-jian2, Zhou Ying-jie1   

  1. 1 Second Department of Spine Surgery, Luoyang Orthopedics Hospital, Luoyang  471002, Henan Province, China; 2 Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou   450052, Henan Province, China
  • Online:2010-04-16 Published:2010-04-16
  • About author:Zhao Gang★, Master, Attending physician, Second Department of Spine Surgery, Luoyang Orthopedics Hospital, Luoyang 471002, Henan Province, China lyzgzg@live.cn
  • Supported by:

     Science and Technique Foundation of Henan Province, No. 0524410045*

PDF

441

被引次数

25

摘要：

背景：现在应用于治疗骨质疏松性压缩骨折的填充材料主要为聚甲基丙烯酸，但聚甲基丙烯酸为永久性异物，不能促进骨再生，随着时间的延长机械性能有下降的可能，学者们正在积极寻找新型的填充材料替代聚甲基丙烯酸。
目的：观察不同充填材料在骨质疏松压缩骨折山羊模型上行经皮椎体成形术的效果及影像表现。
方法：应用适当的机械压力造成骨质疏松山羊三节段椎体骨折模型，在G形臂X射线机监视下，选取骨折椎体行经皮椎体成形术，分别充填聚甲基丙烯酸、自固化磷酸钙人工骨和重组人骨形态发生蛋白2/自固化磷酸钙人工骨。
结果与结论： ①12只山羊36个椎体的经皮椎体成形术均成功，3种材料的充填量差异无显著性意义(P > 0.05)，均为(3.5± 1.8) mL；聚甲基丙烯酸推注阻力较大，可操作时间短，术中显影较好，自固化磷酸钙人工骨和重组人骨形态发生蛋白2/自固化磷酸钙人工骨推注阻力较小，可操作时间长；无渗漏占位。②术后第2天CT扫描结果显示，3种充填材料不规则分布于椎体内，呈斑片状高密度影，36个椎体中有6个椎体出现渗漏，其中4例系聚甲基丙烯酸所致，1例系自固化磷酸钙人工骨所致，1例系重组人骨形态发生蛋白2/自固化磷酸钙人工骨所致。③扫描电镜观察示聚甲基丙烯酸组所有材料与宿主骨之间不能紧密结合，自固化磷酸钙人工骨和重组人骨形态发生蛋白2/自固化磷酸钙人工骨和宿主骨均紧密结合，无界膜形成。结果提示重组人骨形态发生蛋白2/自固化磷酸钙人工骨具有可操作性长，发生骨替代时间较短，有利于永久性重建脊柱稳定性。

关键词: 经皮椎体成形术, 聚甲基丙烯酸甲酯, 磷酸钙人工骨, 重组人类骨形态发生蛋白2/磷酸钙人工骨, 山羊, 骨质疏松, 生物材料

Abstract:

BACKGROUND: Now the filling material which is used for the treatment of osteoporotic compression fractures is mainly polymethacrylic acid (PMMA), but the PMMA as a permanent foreign body cannot promote bone regeneration, and has a downward extension of the possibility of mechanical properties with time prolonging, so a new type of filling material used to substitute PMMA is looking.
OBJECTIVE: To investigate the effect and image characteristics of different filling materials on percutaneous vertebroplasty performing on a goat model of osteoporotic compression fracture.
METHODS: Three vertebral fracture models were established on osteoporosis goats by using an appropriate mechanical stress. Under the G-arm X-ray machine, the fractured vertebrae was performed with percutaneous vertebroplasty and then filled with polymethyl methacrylate (PMMA), self-setting calcium phosphate cement (CPC) and recombinant human bone morphogenetic protein-2 (rhBMP-2) /self-calcium phosphate cement.
RESULTS AND CONCLUSION:  ① A total of 36 vertebral bodies of 12 goats were successfully performed with percutaneous vertebroplasty, and there was no significant difference in filling quantity among three materials (3.5±1.8) mL (P > 0.05). Bolus resistance of PMMA was strong, but operative time was short, and the image was great; the bolus resistance of self-CPC and rhBMP-2/self-CPC was weak, operative time was long, but there was no leakage placeholde. ② CT scanning results on the 2nd day after surgery demonstrated that the three materials were disorderly distributed in the vertebral body, showing high-density patching shaping. Six out of 36 vertebral bodies were leakage, which was induced by PMMA (n = 4), self-CPC (n = 1), and rhBMP-2/self-CPC (n = 1). ③ Scanning electron microscope indicated that all materials in the PMMA group were not able to closely bind with host bone, but self-CPC and rhBMP-2/self-CPC were able to closely bind with host bone. The results suggested that rhBMP-2/self-CPC is characterized by long-term operation, short time of bone substitute, and stabilization of reconstructed spine.

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