椎体成形术中骨水泥靶向封填及二次推注技术的临床应用  

Clinical application of targeted sealing with high viscosity bone cement and secondary injection of low viscosity bone cement in vertebroplasty

作　　者：刘成洲 贾宝欣[1] 高晓强[1] 李文银[1] 刘爱国[1] 任聪慧[1] LIU Cheng-zhou;JIA Bao-xin;GAO Xiao-qiang;LI Wen-yin;LIU Ai-guo;REN Cong-hui(People's Hospital of Linqu County,Linqu262600,Shandong,China)

机构地区：[1]临朐县人民医院,山东临朐262600

出　　处：《中国骨伤》2023年第1期38-42,共5页China Journal of Orthopaedics and Traumatology

基　　金：潍坊市卫生健康委员会科研项目(编号:wfwsjk_2020_027)。

摘　　要：目的:观察椎体成形术中高粘度骨水泥靶向封填、低粘度骨水泥二次推注技术在骨折线累及椎体边缘中的应用效果。方法:选取2019年1月至2021年9月因骨质疏松性椎体压缩性骨折行椎体成形术治疗的老年患者作为筛选对象,通过相关标准及进一步CT检查筛选出56例存在骨折线累及椎体前壁或上下终板者纳入研究。其中男21例,女35例,年龄67~89(76.58±9.68)岁;56例患者术中均进行了骨水泥二次推注。首次推注仅用少量高粘度骨水泥对椎体边缘裂口进行靶向封填,二次推注时应用低粘度骨水泥均匀注满椎体。记录手术时间、骨水泥用量、骨水泥渗漏情况,采用视觉模拟评分(visual analogue scale,VAS)评估疼痛缓解情况。结果:所有患者顺利完成手术,手术时间(50.41±10.30)min,骨水泥注入量(3.64±1.29)ml;56例病例获得了3个月以上随访。术前VAS为(7.21±2.41)分,术后3 d降低为(2.81±0.97)分(P<0.05)。56例患者中2例(3.57%)发生骨水泥渗漏,其中1例向椎旁静脉渗漏,1例在封堵椎体裂口时通过裂口向椎旁轻度渗漏,2例患者均无明显临床症状。结论:在椎体成形术中对于存在椎体前壁或终板破裂者,可采用高粘度骨水泥靶向封填、低粘度骨水泥二次推注技术以减少术中骨水泥渗漏发生,提高手术安全性。Objective To observe the clinical efficacy of targeted sealing with high viscosity bone cement and secondary injection of low viscosity bone cement in the treatment of OVCFs patients with the fracture lines involved vertebral body margin.Methods The elderly patients who underwent vertebroplasty for osteoporotic vertebral compression fractures from January 2019 to September 2021 were selected as the screening objects.Through relevant standards and further CT examination,56 patients with fracture lines involving the anterior wall or upper and lower endplates of the vertebral body were selected for the study.There were 21 males and 35 females,aged from 67 to 89 years old with an average of(76.58±9.68)years.All 56 patients underwent secondary injection of bone cement during operation.Only a small amount of high viscosity cement was targeted to seal the edge of the vertebral body for the first time,and low viscosity cement was injected to the vertebral bodies during second bolus with well-distributed.The operation time,bone cement volume and bone cement leakage were recorded,and the pain relief was evaluated by visual analogue scale(VAS).Results All patients were followed up for more than 3 months and the surgeries were successfully complete.The operation time was(50.41±10.30)min and the bone cement volume was(3.64±1.29)ml.The preoperative VAS was(7.21±2.41)points,which decreased significantly to(2.81±0.97)points 3 days after operation(P<0.05).Among the 56 patients,2 cases(3.57%)had bone cement leakage,1 case leaked to the paravertebral vein,and 1 case slightly bulged to the paravertebral through the crack when plugging the vertebral crack.Both patients had no obvious clinical symptoms.Conclusion In vertebroplasty surgery,targeted sealing of high viscosity bone cement and secondary injection of low viscosity bone cement can reduce intraoperative bone cement leakage and improve the safety of operation.

关 键 词：椎体成形术 骨水泥 靶向封填 二次推注 

分 类 号：R683.2[医药卫生—骨科学]