中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (25): 4657-4660.doi: 10.3969/j.issn.1673-8225.2010.25.024

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

骨质疏松性椎体压缩骨折患者经皮椎体成形注入黏丝期骨水泥后的再骨折

孙  辉，臧学慧，高立华，肖平国   

  1. 南方医科大学附属南海人民医院骨科，广东省佛山市  528200
  • 出版日期:2010-06-18 发布日期:2010-06-18
  • 作者简介:孙 辉★，男，1974年生，河北省遵化市人，汉族，2008年广州医学院毕业，硕士，主要从事生物材料与生物力学的研究。 uranus-uraeus@163.com

Refracture following percutaneous vertebroplasty through polymethyl methacrylate injection in the paste period for osteoporotic vertebral compression fractures

Sun Hui, Zang Xue-hui, Gao Li-hua, Xiao Ping-guo   

  1. Department of Orthopedics, Nanhai People’s Hospital, Southern Medical University, Foshan  528200, Guangdong Province, China
  • Online:2010-06-18 Published:2010-06-18
  • About author:Sun Hui★, Master, Department of Orthopedics, Nanhai People’s Hospital, Southern Medical University, Foshan 528200, Guangdong Province, China uranus-uraeus@163.com

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410

被引次数

39

摘要：

背景：目前经皮椎体成形术已成为治疗骨质疏松性椎体压缩骨折的首选方法，但其骨水泥注入后邻近椎体骨折并发症也在逐年增加，椎体成形过程中常采用黏丝期骨水泥注射，而骨水泥注射时状态可影响其在椎体内分布。
目的：回顾性分析骨质疏松性椎体压缩骨折经皮椎体成形注入黏丝期骨水泥后再骨折的原因。
方法：2006-07/2009-11对112例骨质疏松性椎体压缩骨折行经皮椎体成形术，术中DSA机透视引导下经单侧或双侧椎弓根入路，调配聚甲基丙烯酸甲酯骨水泥至黏丝期后经工作通道注入，并观察疗效。
结果与结论：每个椎体注入骨水泥2.4~6.0 mL，平均(3.40±1.02) mL。术中骨水泥渗漏至椎旁14例，椎间隙内15例。患者术后全部得到随访，随访时间6~15个月，平均(9.61±2.82)个月，未发现特殊的材料和宿主反应，29例患者疼痛再发，其中15例经MRI证实手术相邻椎体发生新鲜骨折，再次给予经皮椎体成形手术后疼痛症状缓解。结果提示经皮椎体成形注入黏丝期的骨水泥后应力集中、术中灌注剂渗漏椎间隙等综合因素增加了术后相邻椎体再次发生骨折的危险，寻找理想的骨水泥替代物将成为今后临床研究的方向。

关键词: 骨水泥, 骨质疏松性椎体压缩骨折, 骨质疏松, 经皮椎体成形术, 生物材料

Abstract:

BACKGROUND: Percutaneous vertebroplasty (PVP) has been the first choice to treat osteoporotic vertebral compression fractures (OVCF). However, the complications of adjacent vertebral body following cement placement are increasing. Bone cement in the paste period is commonly used in vertebroplasty, and status of bone cement can influence distribution in the vertebral body.
OBJECTIVE: To analyze the causes for second fracture following PVP through injection of polymethyl methacrylate (PMMA) in the paste period in treatment of OVCF.
METHODS: Between July 2006 and November 2009, PVP was performed in 112 patients with OVCF．Under the guidance of digital subtraction angiography (DSA), a needle was advanced into the vertebral body via a unipedicular or bipedicular approach. PMMA was injected in the paste period. Curative effect was observed.
RESULTS AND CONCLUSION: A total of 2.4-6.0 mL per body was injected with an average volume of (3.40±1.02) mL. Bone cement leaked to the lateral vertebrae in 14 cases and to intervertebral space in 15 cases．The average follow-up period was 6-15 months with an average period of (9.61±2.82) months. There were no specific reactions of materials and host or clinical symptoms. A total of 29 cases developed secondary back pain and 15 cases were new adjacent vertebral body fracture based on the MRI findings．The symptoms were relieved through secondary PVP. Results show that stress concentration and bone cement leakage to intervertebral space increase risks for secondary fracture after PVP. Therefore, optimal bone cement substitute should be developed in future studies．

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