明胶海绵碎屑预填注在椎体后凸成形术中预防骨水泥渗漏的作用  

Application of gelatin sponge debris pre-perfusion in percutaneous kyphoplasty for vertebral fracture with cortical rupture

作　　者：何磊 钱宇[1] 吕佐[1] 何伟[1] 李修成[1] He Lei;Qian Yu;Lyu Zuo;He Wei;Li Xiucheng(Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing 312000, China)

机构地区：[1]绍兴市人民医院(浙江大学绍兴医院)骨科,312000

出　　处：《中华骨科杂志》2019年第19期1173-1179,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81871801).

摘　　要：目的探讨明胶海绵碎屑预填注在伴皮质骨破裂的椎体骨质疏松骨折椎体后凸成形术(percutaneous kyphoplasty,PKP)术中预防骨水泥渗漏的作用。方法 2014年1月至2016年7月采用PKP治疗伴皮质骨破裂的骨质疏松性椎体骨折(osteoperotic vertebral compression fracture,OVCF)256例(294个节段),男92例(106个节段),女164例(188个节段)。119例132个节段在注射骨水泥前使用明胶海绵碎屑预填注,年龄(74.4±7.7)岁;137例162节段不使用明胶海绵碎屑预填注,年龄(73.3±6.4)岁。比较两组骨水泥渗漏发生率、手术前后疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、伤椎前缘高度及伤椎后凸角的变化。结果明胶海绵组骨水泥渗漏发生率12.6%(15/119),其中终板型渗漏发生率3.4%(4/119)、侧壁型渗漏发生率0.8%(1/119)、前壁型渗漏发生率1.7%(2/119)、后壁型渗漏发生率5.0%(6/119)、混合型渗漏发生率1.7%(2/119);非明胶海绵组骨水泥渗漏发生率23.4%(32/137),其中终板型渗漏发生率4.4%(6/137)、侧壁型渗漏发生率5.1%(7/137)、前壁型渗漏发生率5.1%(7/137)、后壁型渗漏发生率5.8%(8/137)、混合型渗漏发生率2.9%(4/137)。两组骨水泥总渗漏率的差异有统计学意义(χ^2=4.912,P=0.027),各型渗漏率的差异均无统计学意义(P>0.05)。两组患者术后症状均获得改善,术后1、3、6个月VAS评分及ODI指数均较术前改善(P<0.05),但术前、术后各随访时点的组间差异均无统计学意义(P>0.05)。明胶海绵组与非明胶海绵组术前伤椎前缘高度[(17.3±3.2) mm,(17.5±5.4) mm]、术前伤椎后凸角(18.9°±2.0°,18.7°±2.3°)、术后伤椎前缘高度[(22.7±3.6) mm,(22.4±5.4) mm]、术后伤椎后凸角(11.2°±1.4°,11.9°±1.8°)的组间差异均无统计学意义(P>0.05)。结论明胶海绵碎屑预填注可有效降低伴椎体皮质骨破裂的OVCF患者PKP术后骨水泥渗漏的发生率,对PKP术后症状改善�Objective To investigate the preventive effects of gelatin sponge debris pre-filling on bone cement leakage during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture with cortical bone rupture. Methods The data of 256 cases (294 segments) of osteoporotic vertebral compression fracture (OVCF) treated with PKP from January 2014 to July 2016 were retrospectively analyzed. There were 106 segments in 92 males and 188 segments in 164 females. In 119 cases, a total of 132 segments were pre-filled with gelatin sponge debris before bone cement injection. The average age was 74.4±7.7 years. In 137 cases, 162 segments were not pre-filled with gelatin sponge debris, with average age of 73.3±6.4 years. The incidences of cement leakage, visual analogue scale (VAS), Oswestry disability index (ODI), the change of anterior vertebral height and kyphosis angle before and after operation were compared between the two groups. Results In gelatin sponge group, the incidence of cement leakage was 12.6%(15/119), including 3.4%(4/119), 0.8%(1/119), 1.7%(2/119), 5.0%(6/119) and 1.7%(2/119) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The incidence of cement leakage in non-gelatin sponge group was 23.4%(32/137), including 4.4%(6/137), 5.1%(7/137), 5.1%(7/137), 5.8%(8/137) and 2.9%(4/137) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The difference of total cement leakage rate between the two groups was significant (χ2=4.912, P=0.027). There was no significant difference in leakage rates among different types (P>0.05). Postoperative symptoms were improved in both groups. VAS score and ODI index were improved at 1, 3 and 6 months after operation (P<0.05). However, there was no significant difference in VAS score and ODI index at preoperative and post-operative follow-up between groups. There were no significant difference between the two groups in the height of the anterior edge of the injured vertebra before operation (

关 键 词：脊柱 椎体后凸成形术 骨质疏松性骨折 明胶海绵 吸收性 

分 类 号：R687.3[医药卫生—骨科学]