防腐标本椎体成形术中间歇推注法预防骨水泥渗漏  

Reduction of cement leakage by sequential polymethylmethacrylate application in vertebroplasty of embalmed vertebral body

作　　者：黄习彬 齐向北[1] 李军科[1] 王大鹏[1] 刘士昭[1] 

机构地区：[1]河北医科大学第三医院骨科河北省骨科生物力学重点实验室,石家庄050051

出　　处：《中华实验外科杂志》2015年第12期3127-3129,共3页Chinese Journal of Experimental Surgery

基　　金：河北省自然科学基金资助项目（H2012206068）

摘　　要：目的观察间歇推注法在椎体成形术中的应用及对骨水泥渗漏的预防作用。方法选取7具防腐尸体标本，游离（T8一L5）椎体，共获得70个完整标本（其中10个做预实验），制成压缩骨折模型，随机分成A、B、C3组，A组连续推注骨水泥3ml；B组先推注0．5ml骨水泥，间歇1rain后再推注2．5ml；c组每推注0．5瑚骨水泥均需间歇1min，共推注3ml用时6．5min。术后CT扫描，评定A、B、C3组骨水泥渗漏的发生率及分析骨水泥的分布规律；同时采用精密量筒测量各组平均骨水泥渗漏体积。结果C组骨水泥渗漏率为15％（3／20），明显低于A组的75％（15／20）和B组的55％（11／20），差异有统计学意义（r=14．95，P〈0．05）；C组骨水泥渗漏体积（0．2000±0．1000）ml，明显低于A组的（0．7667±0．3331）ml和B组（0．5818±0．3250）ml，差异有统计学意义（F=4．24，P〈0．05）；骨水泥渗漏的位置按发生率高低依次为：椎旁软组织渗漏（56．76％），椎间盘渗漏（24．32％），椎旁血管渗漏（13．5l％），椎管内渗漏（5．41％）；同时CT扫描显示：c组椎体内骨水泥分布较A、B组更加均匀。结论间歇推注法是一种简单、易于操作的手术方法，使骨水泥分布更加均匀，明显降低骨水泥渗漏的发生率。Objective To evaluate the prevention of bone cement leakage by sequential polymeth- ylmethacrylate （PMMA） application in percutaneous vertebroplasty （PVP）. Methods Seventy vertebrae （T8 -L5 ）, of which 10 did pre -test, harvested from each of seven elderly embalmed samples were made into compression fracture models and randomly divided into three groups. Three injection techniques of 3 ml PMMA were assessed： injection in one single step （group A） ; injection of 0. 5 ml at the first and 2. 5 ml at the second step with 1 min latency in - between （ group B） ; sequential injection of 0. 5 ml with 1 min la- tency between the sequences （group C） for 6. 5 min. The cement leakage rate and distribution of cement were assessed with the reference of postoperative CT scan. Simultaneously leakage volume of each group was measured quantitatively. Results The leakage rate was significantly lower in group C （ 15% ） than in group A （75%） and group B （55%） （χ2 = 14.95,P〈0.05）. The cement leakage volume in group C [ （0. 200 0 ±0. 100 0） ml] was significantly less than in group A [ （0. 766 7 ±0. 333 1 ） ml] and group B [ （0. 581 8 ±0. 325 0） ml] （F = 4. 2d,P 〈 0. 05 ）. The predilection site of cement leakage was as fol- lows： paraspinal soft tissue leakage （56. 76% ）, disc leakage （24. 32% ）, paravertebral vascular leakage （ 13.51% ）, and intravertebral leakage （5.41%）. CT scan displayed the cement distribution in group C was more uniform and regular than in groups A and B. Conclusion The sequential cement injection is a simple and easy approach to distribute cement uniformly and reduce significantly the risk for leakage.

关 键 词：骨质疏松性椎体压缩骨折 椎体成形术 骨水泥渗漏 

分 类 号：R683.2[医药卫生—骨科学]