应用弯角椎体成形装置修复胸腰段骨质疏松性椎体压缩骨折  

Curved vertebroplasty device for thoracolumbar osteoporotic vertebral compression fractures

作　　者：熊森[1] 毛克亚[1] 韩振川 张雅宾[1] 王旭翾[1] 李修璨 

机构地区：[1]解放军总医院骨科,北京市100853

出　　处：《中国组织工程研究》2016年第17期2496-2502,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(51372276)~~

摘　　要：背景:国内目前在椎体增强技术(椎体成形及椎体后凸成形)中所使用的骨填充物输送管道其头端是平直、无法弯曲的。修复过程中,一般会选择在椎体内部采用对称地注入骨填充物的方式来保持椎体生物力学上的受力平衡,而传统的骨填充物输送管只能用于同侧椎体骨填充。目的:探讨应用弯角椎体成形装置修复胸腰段骨质疏松性椎体压缩骨折的可行性。方法:纳入60例骨质疏松性压缩骨折患者,共72个椎体,其中8例为双节段,2例为3节段椎体骨折。全部应用弯角输送通道行经皮椎体成形术,记录手术时间、术中出血量、影像学资料,进行前瞻性自身对照,采用改良Oswestry功能障碍指数、目测类比评分和简易生活质量测定量表(WHOQOL-BREF)评价骨折修复效果,随访6个月-2年。结果与结论:160例患者骨折修复手术均顺利完成,50例单椎体手术时间为20-45 min,平均27 min;272个椎体中单个椎体骨水泥注入量为4.2-9.5 m L,平均6.4 m L。骨水泥分布未出现偏向单侧分布情况,未出现相关严重渗漏并发症;3治疗后1 d患者目测类比评分及ODI均较治疗前显著改善(P<0.05);末次随访时与治疗后1 d相比,差异无显著性意义(P>0.05);4治疗前生活质量良好患者比例占27%,治疗后1个月和末次随访时增至87%和92%,差异有显著性意义(P<0.05);5结果提示,应用弯角椎体成形装置行单侧椎弓根穿刺,可确保椎体骨水泥双侧对称分布,修复效果满意,是一种可行、简单、安全的新方法。BACKGROUND：Currently,the cement delivery device used in vertebral augmentation vertebral augmentation（vertebroplasty and kyphoplasty） has flat tips that cannot be bent.During surgery,we always choose injection cement by symmetric way to keep the balance of power on the biomechanics of the vertebral body,while the traditional cement delivery tube can only be used in ipsilateral vertebral body.OBJECTIVE：To evaluate the feasibility of curved vertebroplasty device for the treatment of thoracolumbar osteoporotic vertebral compression fractures.METHODS：Sixty patients（72 vertebral bodies） with osteoporotic vertebral compression fractures were enrolled,including 8 cases of double-level vertebral fractures and 2 cases of three-level vertebral fractures.All operations applied curved delivery device in percutaneous vertebroplasty.We recorded operation time,intraoperative blood loss,and X-ray imaging data through prospective self control study.Treatment effect was evaluated with modified Oswestry disability index,Visual Analogue Scale scores and the World Health Organization Quality of Life assessment.The patients were followed up for 6 months to 2 years.RESULTS AND CONCLUSION：（1） Surgery was performed successfully on all 60 patients.The average operation time was 27 minutes（20-45 minutes） for 50 cases by unilateral transpedicular approach.（2） The mean amount of bone cement in every single vertebral of all 72 vertebrae was averagely 6.4 m L（4.2-9.5 m L）.Bone cement distribution had not been found to be biased one-sided without severe leakage.（3） Visual Analogue Scale score and Oswestry disability index were significantly improved at 1 day after treatment（P〈0.05）.During the final follow-up,no significant difference was detected as compared with 1 day postoperatively（P〉0.05）.（4） The ratio of good quality of life in 1 month than postoperatively（87%） and in the last follow-up（92%） was significantly greater compared with the preoperative ratio（27%）（P〈0.05）.（5

关 键 词：椎体成形术 骨质疏松性骨折 生物力学 随访研究 组织工程 骨科植入物 脊柱植入物 骨质疏松性椎体压缩骨折 弯角 新技术 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]