中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (30): 4763-4768.doi: 10.3969/j.issn.2095-4344.2017.30.002

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

椎体成形治疗中骨水泥渗漏的因素与临床分析

陈家麟1,陈  晞1,杨  军1,王  俊1,耿天勇1,安成玲2,胡婷业2
  

  1. 滁州市第一人民医院,1骨科,2介入科,安徽省滁州市  239000
  • 收稿日期:2017-05-09 出版日期:2017-10-28 发布日期:2017-11-07
  • 作者简介:陈家麟,男,1964年生,福建省福州市人,汉族,2008年东南大学医学院毕业,硕士,主任医师,主要从事脊柱与创伤外科工作。
  • 基金资助:
    安徽省滁州市科技局科研指导项目(201403)

Cement leakage factors in clinical vertebroplasty

Chen Jia-lin1, Chen Xi1, Yang Jun1, Wang Jun1, Geng Tian-yong1, An Cheng-ling2, Hu Ting-ye2 
  

  1. 1Department of Orthopedics, 2Department of Intervention, the First People's Hospital of Chuzhou, Chuzhou 239000, Anhui Province, China
  • Received:2017-05-09 Online:2017-10-28 Published:2017-11-07
  • About author:Chen Jia-lin, Master, Chief physician, Department of Orthopedics, the First People's Hospital of Chuzhou, Chuzhou 239000, Anhui Province, China
  • Supported by:
    the Scientific and Technology Guiding Project of Chuzhou Municipal Science and Technology Department, No. 201403

摘要:

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文题释义:
黏滞性流体:骨水泥是具有一定流动性的黏滞性流体,随时间变化而具有不同黏滞度。流体的物理特征就是具有流动性,力学上表现为它们在静止时不能承受切向应力,流体变形所需的阻力非常小。当流体形状改变时,流体各层之间还存在一定的运动阻力称为流体的黏滞性。
骨水泥“玻璃珠效应”:即骨水泥只有支撑骨折椎体作用而无固化骨折椎体作用,由于硬化的骨水泥弹性模量远高于骨质疏松骨折椎体,此“玻璃珠”长期效应对于骨质疏松骨折椎体来说是有害的,它因无固化骨折椎体作用,而不能稳定椎体,故不能促进骨质疏松骨折椎体的愈合,甚至可导致新的骨折,使临床止痛疗效降低或复发。
 
背景:椎体成形术及椎体后凸成形术是治疗老年骨质疏松性椎体压缩性骨折的重要方法。由于骨水泥自身具有一定流动性以及椎体骨折情况不同,治疗过程中骨水泥渗漏率依然较高。
目的:通过理论探讨和临床分析,研究骨水泥渗漏相关原理以及有效预防方法。
方法:根据术者习惯,将162例骨质疏松性椎体压缩骨折患者(186个椎体)分为3组。A组:64例78个椎体用普通推杆骨水泥成形术工具套件进行椎体成形术;B组:57例65个椎体用带骨水泥泵手柄连杆骨水泥成形术工具套件行椎体成形术;C组:41例43个椎体用带球囊扩张椎体后凸成形术工具套件行椎体后凸成形术。观察3组骨水泥渗漏情况。
结果与结论:①术后出现骨水泥渗漏25个椎体,发生率为13%(25/186);②A组骨水泥渗漏11个椎体,渗漏率为14%(11/78),B组骨水泥渗漏8个椎体,渗漏率为12%(8/65),C组骨水泥渗漏6个椎体,渗漏率为14%(6/43)。3组骨水泥渗漏率统计学比较差异无显著性意义(P > 0.05);③骨水泥渗漏原因具有不完全可控性,渗漏位置也有一定随机性。严密谨慎的影像学监测是预防骨水泥渗漏的直观方法。

关键词: 生物材料, 骨生物材料, 经皮椎体成形术, 骨质疏松, 脊柱骨折, 骨水泥渗漏, 并发症

Abstract:

BACKGROUND: Vertebroplasty (PVP) and kyphoplasty (PKP) are important methods for the treatment of osteoporotic vertebral compression fractures in the elderly. Although bone cement has certain liquidity and vertebral fractures are often in different situations, bone cement leakage rate is still high.
OBJECTIVE: Based on the theoretical discussion and clinical analysis, to study the theoretical causes of bone cement leakage and effective prevention methods.
METHODS: A total of 162 cases (186 vertebrae) were treated with three methods of vertebroplasty. Group A: 64 cases with 78 vertebrae were treated with conventional cemented vertebroplasty; Group B: 57 cases with 65 vertebrae were treated with cemented vertebroplasty using cement pump; Group C: 41 cases with 43 vertebrae were treated with balloon kyphoplasty. The leakage of bone cement was observed in three groups.
RESULTS AND CONCLUSION: Of the 186 vertebrae, postoperative bone cement leakage occurred in 25 vertebrae, with the leakage rate of 13% (25/186). Group A had bone cement leakage in 11 vertebrae, and the leakage rate was 14% (11/78). Group B had bone cement leakage in 8 vertebrae, and the leakage rate was 12% (8/65). Group C had bone cement leakage in 6 vertebrae, and the leakage rate was 14% (6/43). There was no significant difference among the three groups in the leakage rate of bone cement (P > 0.05). That is to say, the causes of bone cement leakage are not completely controllable, and the leakage position has some randomness. Strict and careful imaging monitoring is an intuitive method to prevent bone cement leakage.

Key words: Kyphoplasty, Osteoporotic Fractures, Bone Cements, Tissue Engineering

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