治疗骨质疏松性椎体压缩骨折低温骨水泥的最佳灌注量  

Optimal perfusion volume of low-temperature bone cement for treatment of osteoporotic vertebral compression fractures

作　　者：郭二松 马朋朋[2] 张鑫[2] 张春林[2] 蔡明 苏峰[2] 刘肃[2] 李伟[2] 胡振顺[2] 张志敏[2] Guo Ersong;Ma Pengpeng;Zhang Xin;Zhang Chunlin;Cai Ming;Su Feng;Liu Su;Li Wei;Hu Zhenshun;Zhang Zhimin(Graduate School of Hebei Northern University,Zhangjiakou 075000,Hebei Province,China;Department of Orthopedics,First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei Province,China)

机构地区：[1]河北北方学院研究生院,河北省张家口市075000 [2]河北北方学院附属第一医院骨科,河北省张家口市075000

出　　处：《中国组织工程研究》2023年第16期2542-2547,共6页Chinese Journal of Tissue Engineering Research

基　　金：河北省医学科学研究课题(20220612),项目负责人:张鑫;张家口市级科技计划项目(2021061D),项目负责人:马朋朋。

摘　　要：背景:以往研究中恢复骨折椎体强度或刚度所需的骨水泥体积数据差异较大,可能是由于椎体在不同区域和个体之间体积大小差异、骨折前后体积差异、骨水泥体积和分布不对等引起。目的:通过生物力学研究探讨治疗椎体骨折所需的骨水泥灌注量。方法:选取8只成年绵羊,经筛选T8-L2椎体后最终获得50个椎体,建立骨质疏松性椎体压缩骨折模型,记录椎体初始强度和刚度、骨折后椎体前缘高度,使用有限元技术精确计算每个椎体骨折后体积,得出骨水泥注射体积。根据有限元分析结果,采用拉丁方设计,50个骨质疏松性椎体压缩骨折标本分为两阶段处理:第一阶段,经皮椎体后凸成形手术分别注射体积5%,10%,15%,20%的低温聚甲基丙烯酸甲酯骨水泥,每种体积5个标本;第二阶段,分别注射体积15%,16%,17%,18%,19%,20%的骨水泥,每种体积5个标本。将两阶段的标本置于万能试验机上进行压缩实验。结果与结论:①所有椎体术前高度、宽度、深度、脱钙前后骨密度、强度和刚度比较,差异均无显著性意义(P>0.05);②第一阶段:与术前比较,5%,10%,15%组术后椎体强度降低(P<0.05),20%组术后椎体强度升高(P<0.05),4组术后椎体刚度均降低(P<0.05);15%,20%组术后椎体强度与刚度均大于5%,10%组。③第二阶段:与术前比较,15%,16%,17%组术后椎体强度降低(P<0.05),18%,19%,20%组术后椎体强度升高(P<0.05);18%,19%,20%组术后椎体强度高于15%组(P<0.05)。与术前比较,各组术后椎体刚度均降低(P<0.05);6组间术后椎体刚度比较差异无显著性意义(P>0.05)。④结果表明,在保证骨水泥无渗漏前提下,在一定的范围内,使用占骨折椎体体积16%骨水泥联合双侧椎体后凸成形治疗,骨折椎体的生物力学和高度恢复为最佳。BACKGROUND:Previous studies reported the volume of bone cement needed to restore the strength or stiffness of the fractured vertebral body,and the data varied widely.Considering this difference may be due to the volume difference of vertebral body in different regions and individuals,the volume difference before and after fracture,and the unequal volume and distribution of bone cement.OBJECTIVE:To explore the amount of bone cement needed for the treatment of vertebral fractures using biomechanical study.METHODS:Eight adult sheep were selected and 50 vertebrae were finally obtained after screening T8-L2 vertebrae.Osteoporotic compression fractures were created through experiments,and the initial strength and stiffness of the vertebral body and the height of the anterior edge of the vertebral body after the fracture were recorded.The post-fracture volume of each vertebral body was accurately calculated by finite element technique to derive the cement injection volume.According to the finite element analysis results,using Latin square design,the 50 osteoporotic vertebral compression fracture specimens were divided into the first stage and the second stage.In the first stage,5%,10%,15%,and 20%polymethyl methacrylate bone cement was injected by volume of percutaneous kyphoplasty,5 specimens per volume.In the second stage,15%,16%,17%,18%,19%,and 20%of bone cement were injected by volume,5 specimens per volume.The two-stage specimens were placed on a universal testing machine for compression experiments.RESULTS AND CONCLUSION:(1)There was no significant difference in preoperative height,width and depth,bone mineral density,strength and stiffness before and after decalcification(P>0.05).(2)The first stage:Compared with preoperative data,postoperative vertebral strength decreased in 5%,10%,and 15%groups(P<0.05),and postoperative vertebral strength increased in 20%group(P<0.05).Postoperative vertebral stiffness in all four groups decreased(P<0.05);postoperative vertebral strength and stiffness were greater in 15%and 20%gro

关 键 词：经皮椎体后凸成形术 骨质疏松 椎体压缩骨折 骨水泥 有限元技术 低温骨水泥灌注技术 生物力学 绵羊 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学] R681.53