经皮椎体成形术中骨水泥填充对患者凝血功能的影响(英文)  

Effects of bone cement implantation during percutaneous vertebroplasty on coagulation functions

作　　者：姚晓光[1] 申勇[1] 张英泽[1] 张迪[1] 张男[1] 姚双全[1] 刘连涛[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,河北省石家庄市050051

出　　处：《中国组织工程研究与临床康复》2009年第51期10197-10200,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:探讨经皮椎体成形术中骨水泥对骨质疏松性椎体压缩患者凝血功能的影响及临床意义。方法:选择2006-12/2007-12河北医科大学第三医院骨质疏松性椎体压缩骨折患者24例,男6例,女18例;年龄48～83岁,平均69岁。脊柱骨折部位为T5～L3,共44个椎体,其中胸椎20个椎体,腰椎24个椎体。采用C形臂X射线机透视引导下行经皮椎体成形术,注射聚甲基丙烯酸甲酯(骨水泥)。分别对其注入骨水泥前10min,注入骨水泥后10min,30min,1h,2h,3h凝血功能相关指标进行检测,包括血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、鱼精蛋白副凝固试验(3P试验)及血浆D-二聚体(D-D)含量。结果:经皮椎体成形术中注入骨水泥10min后凝血酶原时间缩短、纤维蛋白原增高、3P试验的阳性率升高和D-D含量增高,1h时达到高峰后开始下降。注入骨水泥后10min,30min,1h,2h四个时段与注入骨水泥前相比较差异具有显著性意义(P<0.05)。活化的部分凝血活酶时间、凝血酶时间在各时段与注入骨水泥前相比较差异均无显著性意义(P>0.05)。3h后骨水泥对这些指标的影响基本消除,各项指标与注入骨水泥前相比较差异均无显著性意义(P>0.05)。结论:经皮椎体成形术中骨水泥填充会引起患者的一过性高凝状态,在注入骨水泥后的3h内需严密监测病情,以防血栓性疾病发生。OBJECTIVE：To evaluate the curative effect and clinical significance of bone cement on coagulation functions during percutaneous vertebroplasty in patients with osteoporotic spinal compression fractures.METHODS：A total of 24 patients,comprising 18 females and 6 males,aged 69 years averagely （range 48-83 years）,with 44 osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty in Department of Spinal Surgery,Third Hospital of Hebei Medical University between December 2006 and December 2007.The fracture segment was within T5-L3 （20 thoracic vertebrae and 24 lumbar vertebrae）.Under the guidance of C-arm fluoroscopy,bone marrow biopsy needle was inserted percutaneously via transpedicular way into the fractured vertebrae.Polymethylmethacrylate （PMMA,bone cement） was injected into the fractured vertebrae.The relative parameters were observed in all patients 10 minutes before,10 minutes,30 minutes,1 hour,2 hours and 3 hours after bone cement implantation,including prothrombin time （PT）,activated partial thromboplastin time （APTT）,thrombin time （TT）,fibrinogen （FIB）,plasma protamine paracoagulation test （3P test）,and D-dipolymer （D-D）.RESULTS：PT was decreased,and FIB,3P test,D-D were increased 10 minutes after bone cement implantation in percutaneous vertebroplasty peaked at 1 hour and gradually decreased afterward;moreover,there were significant difference between bone cement preimplantation and 10 minutes,30 minutes,1 hour,2 hours and 3 hours after bone cement implantation （P 0.05）,but no difference was observed in APTT and TT （P 0.05）.The influence of bone cement on the parameters was vanished in 3 hours after bone cement implantation,and all indexes were similar to pre-implantation （P 0.05）.CONCLUSION：Bone cement implantation causes temporal hypercoagulabale state in percutaneous vertebroplasty.It is important to monitor blood clotting state in 3 hours after bone cement implantation in order to avoid thrombus disease.

关 键 词：经皮椎体成形术 骨质疏松 脊柱骨折 骨水泥 凝血功能 

分 类 号：R318[医药卫生—生物医学工程]