中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (2): 165-170.doi: 10.3969/j.issn.2095-4344.0001

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

改良骨水泥推注套管治疗骨质疏松椎体压缩性骨折可减少骨水泥渗漏

张志强，杨建东，冯新民，王永祥，陶玉平，蔡  俊，张  亮
  

  1. 江苏省苏北人民医院脊柱外科，扬州大学临床医学院，江苏省扬州市  225001
  • 收稿日期:2017-08-19 出版日期:2018-01-18 发布日期:2018-01-18
  • 通讯作者: 杨建东，博士，主任医师，江苏省扬州市 225001
  • 作者简介:张志强，男，1980年生，江苏省扬州市人，汉族，博士，副主任医师，主要从事脊柱外科研究。
  • 基金资助:
    江苏省卫生厅十二五科教兴卫医学重点人才依托课题(RC2011162)

A modified working tube can reduce bone cement leakage in the treatment of osteoporotic vertebral compression fracture

Zhang Zhi-qiang, Yang Jian-dong, Feng Xin-min, Wang Yong-xiang, Tao Yu-ping, Cai Jun, Zhang Liang

 
  

  1. Department of Orthopaedics, People’s Hospital of Subei, Yangzhou 225001, Suzhou Province, China
  • Received:2017-08-19 Online:2018-01-18 Published:2018-01-18
  • Contact: Yang Jian-dong, M.D., Chief physician, Department of Orthopaedics, People’s Hospital of Subei, Yangzhou 225001, Suzhou Province, China
  • About author:Zhang Zhi-qiang, M.D., Associate chief physician, Department of Orthopaedics, People’s Hospital of Subei, Yangzhou 225001, Suzhou Province, China
  • Supported by:
    the Health and Medicine Project for Talents of Jiangsu Provincial Health Department during the 12th Five-Year Plan, No. RC2011162

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摘要：

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文题释义：
骨水泥注射治疗骨质疏松性椎体压缩骨折的原理：可能与骨水泥聚合产生高热破坏椎体内神经末梢；骨水泥弥散入椎体骨折断端间隙及椎体骨小梁，减少伤椎微动对神经末梢的刺激；术后脊柱力线部分恢复等机制有关。
改良椎体成形骨水泥推注套管：在椎体成治疗中，先使用普通的骨水泥工具进行骨水泥灌注，当发现骨水泥并没有向预计的靶区弥散时，更换改良的推注套管，使注射套管末端的侧方开口指向靶区，继续进行骨水泥灌注，推注骨水泥的整个过程应在高质量的透视监控下进行。
椎体成形：临床全称为经皮穿刺椎体成形，属于微创手术，是通过向病变椎体内注入骨水泥(聚丙烯酸甲酯)或人工骨达到强化椎体的技术。1984年由Deramond发明并首次应用，1987年法国医师Galibert首次应用于椎体血管瘤的治疗，1994年美国首次报道将椎体成形应用于骨质疏松性椎体骨折的治疗。
 
背景：椎体成形治疗骨质疏松性的椎体压缩性骨折的疗效显著，但存在骨水泥渗漏问题。
目的：分析改良椎体成形骨水泥推注套管治疗胸腰椎骨质疏松性椎体压缩骨折的优势。
方法：纳入121例胸腰椎骨质疏松性椎体压缩骨折患者，其中男49例，女72例，年龄62-90岁，分2组治疗：对照组62例进行传统的椎体成形骨水泥注射治疗；试验组59例进行改良的椎体成形骨水泥推注套管治疗，将传统骨水泥注射套管末端开口改为侧方开口，通过旋转套管达到控制骨水泥注射的方向。对比治疗前后的目测类比评分；治疗后1 d，通过X射线观察两组骨水泥渗漏情况。
结果与结论：两组治疗后1 d、1个月的目测类比评分均较治疗前明显降低(P < 0.05)，但两组间不同时间的目测类比评分比较差异无显著性意义；两组共13例患者发生骨水泥渗漏，其中试验组3例，对照组10例，试验组骨水泥渗漏率低于对照组(4.6%，14.9%，P < 0.05)。结果表明，应用改良椎体成形骨水泥推注套管治疗胸腰椎骨质疏松性椎体压缩骨折，可降低骨水泥渗漏的发生率。

关键词: 生物材料, 骨科材料, 椎体成形, 改良骨水泥推注套管, 骨水泥渗漏, 骨质疏松性椎体压缩骨折

Abstract:

BACKGROUND: Vertebroplasty is an effective treatment for osteoporotic vertebral compression fractures (OVCF), but it is nagged by bone cement leakage.
OBJECTIVE: To summarize the clinical outcome of modified self-making working tube in percutaneous vertebroplasty (PVP) for treatment of thoracolumbar OVCF.
METHODS: Modified PVP working tube was designed to have a lateral gap at the sleeve tail, which could control the cement diffuse direction though rotating the working tube. Totally 121 thoracolumbar OVCF patients were enrolled, including 49 males and 72 females, aged 62-90 years, and then divided into two groups: 59 patients were treated with modified PVP in test group, and the other 62 patients experienced conventional PVP in control group. In the test group, a lateral gap instead of the conventional gap at the sleeve tail was made to control the direction of bone cement injection by rotating the sleeve. The visual analogue scale scores were compared before and after operation; radiographic examination was performed to detect bone cement leakage at 1 day postoperatively.
RESULTS AND CONCLUSION: There were significant differences between the preoperative and postoperative visual analogue scale scores in the two groups (P < 0.05), but there was no significant difference between the two groups. There were 3 cases of bone cement leakage in the test group and 10 cases of bone cement leakage in the control group. Modified PVP working tube had significant lower rate of bone cement leakage than traditional PVP (14.9% vs. 4.6%, P < 0.05). Therefore, the modified PVP working tube is an effective tool to decrease the incidence of bone cement leakage in the treatment of thoracolumbar OVCF.

Key words: Vertebroplasty, Osteoporotic Fractures, Tissue Engineering

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