中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (47): 7076-7082.doi: 10.3969/j.issn.2095-4344.2016.47.012

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

椎体后凸成形注入骨水泥治疗周壁破裂骨质疏松性胸腰椎骨折：2年随访

孙智勇，钱忠来，朱晓宇，陈康武，皮  斌，杨惠林
  

  1. 苏州大学附属第一医院骨科，江苏省苏州市  215006
  • 收稿日期:2016-10-15 出版日期:2016-11-18 发布日期:2016-11-18
  • 通讯作者: 杨惠林，博士，主任医师，教授，博士生导师，苏州大学附属第一医院骨科，江苏省苏州市 215006
  • 作者简介:孙智勇，男，1983年生，江苏省高邮市人，汉族，2009年广西医科大学毕业，硕士，主治医师，主要从事脊柱外科的相关研究。
  • 基金资助:

    江苏省临床医学研究中心基金资助项目(BL2012004)；国家自然科学基金资助项目(81301646)

Kyphoplasty with bone cement repairs osteoporotic thoracolumbar vertebral fractures associated with peripheral wall damage: a 2-year follow-up

Sun Zhi-yong, Qian Zhong-lai, Zhu Xiao-yu, Chen Kang-wu, Pi Bin, Yang Hui-lin
  

  1. Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • Received:2016-10-15 Online:2016-11-18 Published:2016-11-18
  • Contact: Yang Hui-lin, M.D., Chief physician, Professor, Doctoral supervisor, Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • About author:Sun Zhi-yong, Master, Attending physician, Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • Supported by:

    the Foundation of Jiangsu Provincial Clinical Medical Research Center, No. BL2012004; the National Natural Science Foundation of China, No. 81301646

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摘要：

文章快速阅读：

 

文题释义：
椎体后凸成形：是在椎体成形基础上发展出来的新技术，在“C”臂机透视下，经皮穿刺建立工作通道后置入可扩张球囊，在骨折椎体内形成空腔，使得骨水泥以高黏度、低压力的状态渗入椎体松质骨内；同时，球囊逐渐撑开压迫椎体内骨小梁使之形成相对致密的“骨壁”, 从而一定程度地封堵了骨水泥沿骨折裂缝和静脉丛渗漏的通道，因此椎体后凸成形较椎体成形的骨水泥渗漏率明显降低。
骨水泥治疗的具体机制：①骨水泥在骨折椎体内的凝固，释放聚合热，该过程会使痛觉神经末梢变性坏死；②骨水泥固化后椎体的强度和稳定性有了一定程度的增加；③脊柱力线部分恢复后，能消除骨折椎体内的异常应力；骨水泥渗透弥散入椎体骨小梁，减少骨折椎微动对神经末梢的刺激。

背景：椎体后凸成形注入骨水泥被广泛应用于骨质疏松性胸腰椎骨折的治疗，并已取得很好的效果，然而当骨折伴有椎体周壁破裂时因穿刺风险增大和骨水泥渗漏率增加而临床报道很少。
目的：分析应用椎体后凸成形注入骨水泥治疗周壁破裂骨质疏松性胸腰椎骨折的可行性，并评价其近期临床效果。
方法：纳入65例周壁破裂骨质疏松性胸腰椎压缩性骨折患者，其中男23例，女42例，平均年龄71.5岁，均进行椎体后凸成形注入骨水泥治疗。治疗前、治疗后即刻及治疗后1，6，24个月，随访观察目测类比评分、Oswestry功能障碍指数、后凸角、椎体前缘和中部高度变化及并发症发生情况。
结果与结论：与治疗前比较，所有患者治疗后即刻的目测类比评分、Oswestry功能障碍指数、后凸角均显著低于治疗前(P < 0.05)，椎体前缘和中部高度高于治疗前(P < 0.05)；治疗后1，6，24个月的目测类比评分、Oswestry功能障碍指数、后凸角、椎体前缘和中部高度与治疗后即刻比较差异均无显著性意义  (P > 0.05)。共有7例患者(10个椎体)发生骨水泥渗漏现象，未引起严重临床症状；未发生脊髓神经根受损、感染、出血、肺栓塞、休克、心脑血管意外。结果表明，椎体后凸成形注入骨水泥治疗周壁破裂骨质疏松性胸腰椎骨折安全可行，可显著提升椎体高度、缓解疼痛、纠正后凸畸形，近期疗效满意。

关键词: 生物材料, 骨生物材料, 椎体后凸成形, 骨水泥, 椎体骨折, 骨质疏松性骨折, 骨组织工程, 国家自然科学基金

Abstract:

BACKGROUND: Kyphoplasty with bone cement has achieved good therapeutic efficacy on osteoporotic thoracolumbar fractures; however, there is little report about its application in the repair of vertebral fractures associated with vertebral body wall damage, due to the risks of bone cement leakage and puncture.
OBJECTIVE: To evaluate the treatment outcomes of kyphoplasty with bone cement on osteoporotic thoracolumbar fractures associated with peripheral wall damage and to assess its short-term clinical effect.
METHODS: Sixty-five patients (42 females and 23 males, mean age=71.5 years) with osteoporotic thoracolumbar fractures associated with peripheral wall damage were enrolled and treated with kyphoplasty. The anterior and mid-vertebral body height, complications, visual analog scale scores and Oswestry disability index were observed before, immediately and 1, 6 and 24 months postoperatively.
RESULTS AND CONCLUSION: The visual analog scale scores, Oswestry disability index and Cobb angle were decreased significantly, and the anterior and mid-vertebral body height were increased significantly from pre- to post-operation (P < 0.05). All above improvements appeared to have no significant changes from post-operation to 2-year follow-up (P > 0.05). Cement leakage was detected in 7 cases (10 vertebrae), but did not cause severe clinical symptoms. There were no injuries to spinal nerve root and no complications of infection, bleeding, pulmonary embolism, stroke, or cardiac cerebral arrest. These findings indicate that kyphoplasty with bone cement is safe and feasible to treat osteoporotic thoracolumbar fractures associated with peripheral wall damage, leading to restoration of the vertebral height, reduction in pain, correction of the kyphotic deformity and satisfaction with the short-term curative effect.

Key words: Vertebroplasty, Osteoporotic Fractures, Tissue Engineering

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