新型可注射磷酸钙骨水泥在椎体后凸成形术中的生物力学评价  

Biomechanical evaluation of a novel injectable calcium phosphate cement for use in kyphoplasty

作　　者：邹华章[1] 廖威明[2] 段昕[2] 陈建伟[3] 叶建东[4] 

机构地区：[1]广州医学院港湾医院骨科,510700 [2]中山大学附属第一医院骨科 [3]中山大学骨科研究所 [4]华南理工大学材料学院

出　　处：《中华生物医学工程杂志》2011年第2期151-155,共5页Chinese Journal of Biomedical Engineering

基　　金：国家科技部“十一五”重大支撑项目（2006BA116803）

摘　　要：目的 评价一种新型可注射磷酸钙骨水泥（CPC）在椎体后凸成形术中的体外生物力学性能,以探讨该材料能否有效替代聚甲基丙烯酸甲酯骨水泥（PMMA）应用于经皮椎体后凸成形术.方法 取老年尸体共20个胸腰椎新鲜标本（T11～L3）,经双能X线吸收骨密度仪测试骨密度后完全随机分为CPC组和PMMA组.在材料试验机上制成椎体压缩骨折模型并测量两组椎体初始的强度和刚度,然后分别用CPC和PMMA两种材料行椎体后凸成形术,再次测量术后两组椎体的强度和刚度.结果 两种骨水泥都具有良好的可注射性,CPC固化后不放热,PMMA固化有明显放热反应,体外工作时间CPC长于PMMA,X线显影效果CPC优于PMMA.椎体后凸成形术后PMMA组椎体最大载荷（4.80±1.957）kN、抗压强度（4.794±1.683）kPa,均较术前明显增加,差异有统计学意义（P＜0.05）.刚度高于骨折前,但差异无统计学意义（P＞0.05）.CPC组椎体后凸成形术后最大载荷（3.412±1.078）kN、抗压强度（3.477±0.689）kPa,稍高于骨折前,差异无统计学意义（P＞0.05）.而刚度（918±201）N/mm,低于骨折前,差异有统计学意义（P＜0.05）.结论 新型CPC在椎体后凸成形术中能有效恢复椎体的生物力学性能,可望在椎体后凸成形术中作为PMMA的理想替代材料.Objective To evaluate the biomechanical properties of a novel injectable calcium phosphate cement （CPC） in kyphoplasty model and to explore the feasibility for its use as an alternative to polymethylmethacrylate（PMMA）in percutaneous kyphoplasty. Methods A total of 20 fresh specimens of thoracolumbar vertebrae （T11-L3） were collected from four elderly cadavers. The specimens were randomized into CPC group and PMMA group after bone mineral density test by dual - energy X-ray absorptiometry. Models of vertebral compression fracture were established using these specimens, and were measured for initial level of strength and stiffness on MTS material testing device. Vertebral kyphoplasty was performed on these models using CPC or PMMA. Thereafter, the models were re-evaluated for strength and stiffness. Results The both types of cements showed good injectablility.Obvious exothermicity during solidification was seen with PMMA but not with CPC. Moreover, CPC showed longer working time ex-vivo and better X-ray visibility, as compared with PMMA. Compared with before kyphoplasty,the PMMC group showed higher levels in postoperative maximum load [（4.80±1.957）kN, P〈0.05] , compression strength [（4.794±1.683） kPa, P〈0.05] and stiffness [（2046±762）N/mm, not statistically significant] , while the CPC group showed higher levels in postoperative maximum load [（3.412？1.078）kN] and compression strength[（3.477？.689）kPa] （both P〉0.05） , and lower stiffness[（918？01） N/mm,P〈0.05）]. The maximum load, compression strength and stiffness of PMMA were obviously higher than those of CPC group after kyphoplasty （f〈0.05）.Conclusions The novel injectable CPC appears effective for restoring the biomechanical properties of vertebrae, and can be an ideal replacement for PMMA in percutaneous kyphoplasty.

关 键 词：椎体成形术 磷酸钙类 生物力学 聚甲基丙烯酸甲酯 骨质疏松症 

分 类 号：R687.3[医药卫生—骨科学]