PKP术中不同比例灌注骨水泥椎体生物力学分析  

Vertebral Biomechanics Analysis in PKP Operation with Different Proportion of Bone Cement Perfusion

作　　者：张立元[1] 张志国[2] 郝建英[1] 康发军[1] 邢文钊[2] 刘宏伟[1] 庞子轩 

机构地区：[1]河北省第七人民医院骨外科,河北定州073000 [2]河北医科大学第三医院骨伤科,河北石家庄050051

出　　处：《实用骨科杂志》2013年第9期811-814,共4页Journal of Practical Orthopaedics

摘　　要：目的 利用乙二胺四乙酸二钠（EDTA-Na2）脱钙法制备离体椎体骨质疏松模型,在万能材料试验机上垂直压缩制成椎体压缩骨折模型,行椎体后凸成形术（percutaneous kyphoplasty,PKP）后再进行生物力学实验,分析按照球囊扩张容积的不同比例灌注骨水泥后椎体的生物力学性能变化,为临床治疗提供参考性资料.方法 选取新鲜成年猪胸腰段椎体36个,甲醛浸泡24 h,再以EDTA-Na2脱钙20 d,制成骨质疏松椎体模型,随机分成A、B、C、D4组,每组9个椎体,检测各组椎体骨矿密度,并依次放在万能材料试验机上行垂直压缩,测出椎体最大压缩强度及压缩刚度,记录各组椎体压缩前、后的椎体前缘高度.之后将各组分别进行聚甲基丙烯酸甲酯灌注椎体成形,按照球囊扩张容积的不同比例灌注聚甲基丙烯酸甲酯,记录球囊扩张容积、球囊压力、成型后椎体前缘高度及骨水泥渗漏椎体个数.之后进行第二次加载测试,按初始方法压缩椎体,记录此时椎体最大压缩强度和刚度.结果 PKP前四组间的椎体前缘高度、骨密度、椎体最大压缩强度及压缩刚度均无统计学意义（P＞0.05）;各组在PKP前、后的椎体最大压缩强度和压缩刚度的比较有统计学意义（P＜0.01）;PKP后A、B组间的椎体最大压缩强度和刚度比较无统计学意义（P＞0.05）,A、B两组分别与C、D组间的椎体最大压缩强度和刚度的比较有统计学意义（P＜0.01）;PKP后四组间椎体高度恢复值比较无统计学意义（P＞0.05）;A、B两组的骨水泥渗漏率为0,C、D两组的骨水泥渗漏率分别为22.22%及44.44%.结论 PKP中按照球囊扩张容积的0.8～1倍灌注骨水泥即可有效恢复骨质疏松性压缩骨折椎体的生物力学性能,又能减少骨水泥的渗漏;PKP中按照球囊扩张容积的0.8～1倍灌注骨水泥可以部分恢复压缩椎体的高度,其与高比例灌注组无明显差别;球囊扩张容积可以作为PKP中骨Objective To analysis of the changes of biomechanical properties vertebral body after kyphoplasty （PKP） ac- cording to the different proportion of balloon volume and provide reference data for clinical treatment. Methods 36 fresh adult porcine thoracolumbar vertebral, were preserved in formaldehyde for 24 hours, then EDTA - Na2 for 20 days. All the samples were randomly divided into 4 groups, After detection of vertebral body bone mineral density （ BMD）, the vertebral body were placed vertically in the universal material testing machine, measure the vertebral body strength and stiffness, record anterior vertebral height of each vertebra. The vertebrae underwent PMMA kyphoplasty according to different proportion of balloon vol- ume. We record the balloon volume, the balloon pressure, the anterior height of vertebral body and bone cement leakage verte- bral number. Then the second biomechanical testing was done. Results After PKP, vertebral strength and stiffness were statis- tically significant different （P 〈 0.01 ） ;after PKP vertebral strength and stiffness between A and B were no statistic signifi- cance （P 〉 0.05） between A B and C D vertebral strength and stiffness were statistically significant （P 〈 0.01 ） ;After PKP four groups of vertebral height restoration were not statistically significant （ P 〉 0.05 ） ; the bone cement leakage of A and B was 0, the bone cement leakage rate of C was 22.22%, D was 44.44%. Conclusion In accordance with the balloon volume 0.8 1 times injection of bone cement can effectively restore the biomechanical properties of osteoporotic compression fractures vertebral body, but also can reduce the leakage of bone cement; In accordance with the balloon volume of 0.8 - 1 times the per- fusion of bone cement could be partially restored the height of vertebral body, with its high proportion of perfusion group showed no significant difference ; Balloon volume can be used as a reference index of bone cement perfusion dose.

关 键 词：EDTA-Na2 骨质疏松 椎体压缩性骨折 PKP 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]