冰点温度下骨水泥结合通道重建处理椎体后凸成形术中骨水泥渗漏  

The establishment of bone cement combined with bone cement channel at freezing temperature was used to treat further leakage of bone cement in kyphoplasty

作　　者：英吉林 海涌[3] 张海东 肖斌[2] 吴优 王凯伦 Ying Jilin;Hai Yong;Zhang Haidong;Xiao Bin;Wu You;Wang Kailun(Graduate School,Capital Medical University,Beijing 100069,China;Department of Orthopaedics,Beijing Puren Hospital,Beijing 100062,China;Department of Orthopaedics,Chaoyang Hospital,Capital Medical University,Beijing 100023,China)

机构地区：[1]首都医科大学研究生院,北京100069 [2]北京市普仁医院骨科,北京100062 [3]首都医科大学附属朝阳医院骨科,北京100023

出　　处：《中华骨科杂志》2025年第2期86-93,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用冰点温度下骨水泥结合通道重建处理椎体后凸成形术(percutaneous kyphoplasty,PKP)中骨水泥渗漏的临床价值。方法回顾性分析2019年4月至2023年4月在北京市普仁医院接受PKP治疗的261例胸腰段骨质疏松性椎体压缩性骨折患者资料,根据处理PKP骨水泥渗漏的方法分为冰点组(利用冰点温度下骨水泥结合骨水泥通道重建处理)和温度梯度组(利用温度梯度的方法处理)。冰点组128例,男37例、女91例,年龄(75.57±4.60)岁(范围65~85岁),骨折位置:T 1018例、T 1130例、T 1244例、L 123例、L 213例;温度梯度组133例,男36例、女97例,年龄(75.66±4.51)岁(范围65~85岁),骨折位置:T 1017例、T 1132例、T 1251例、L 122例、L 211例。比较两组患者的术中出血量、手术时间、椎体内骨水泥面积、骨水泥渗漏面积、骨水泥渗漏面积增加量、骨水泥可推注时间及注射困难发生率,以及手术前、术后、末次随访的疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎体后凸角、受伤椎体前缘高度及其手术前后的差值。结果所有患者均获得连续3个月的随访。冰点组术中出血量、初次骨水泥渗漏面积分别为(9.48±2.64)ml、(32.56±7.05)mm 2,温度梯度组分别为(9.04±2.25)ml、(32.86±7.00)mm 2,差异均无统计学意义(P>0.05);冰点组的手术时间、椎体内骨水泥面积、骨水泥最终渗漏面积、骨水泥渗漏增加量分别为(55.08±4.13)min、(1175.45±117.11)mm 2、(35.84±8.67)mm 2、0.00(0.00,13.32)mm 2,温度梯度组分别为(53.02±3.96)min、(823.70±144.79)mm 2、(73.38±29.16)mm 2、44.39(20.13,56.61)mm 2,差异均有统计学意义(P<0.05)。冰点组术后即刻和术后3个月椎体前缘高度分别为(21.54±2.06)mm和(21.24±2.33)mm,均高于温度梯度组的(21.10±1.60)mm和(18.92±1.51)mm,差异有统计学意义(P<0.05);冰点组术后即刻和术后3个月VAS评分分别为(2.29±0.62)分�ObjectiveTo analyze the clinical value of delayed solidification of cement at freezing point combined with establishment of cement channels in the treatment of further leakage of cement in percutaneous kyphoplasty(PKP).MethodsA retrospective analysis was performed for the medical records of 261 patients with osteoporotic vertebral fracture in the thoracolumbar segment who underwent PKP treatment in Beijing Puren Hospital from April 2019 to April 2023.According to the method of dealing with PKP cement leakage,it was divided into freezing point group(using bone cement combined with cement channel reconstruction treatment at freezing point temperature)and temperature gradient group(using temperature gradient method).There were 128 cases in the freezing point group,including 37 males and 91 females,aged 75.57±4.60 years(range,65-85 years),and fracture locations were 18 cases in T 10,30 cases in T 11,44 cases in T 12,23 cases in L 1 and 13 cases in L 2.There were 133 cases in the temperature gradient group,including 36 males and 97 females,aged 75.66±4.51 years(range,65-85 years),and fracture locations were 17 cases in T 10,32 cases in T 11,51 cases in T 12,22 cases in L 1,and 11 cases in L 2.The intraoperative blood loss,operation time,intravertebral cement area,cement leakage area,cement leakage area increase,cement bolus time and incidence of injection difficulty,as well as the pain visual analogue scale(VAS),Oswestry disability index(ODI),kyphosis angle,the height of the anterior edge of the injured vertebral body and the difference between it before and after surgery were compared.ResultsAll patients were followed up for 3 consecutive months.The intraoperative blood loss and initial cement leakage area were 9.48±2.64 ml and 32.56±7.05 mm 2 in the freezing point group and 9.04±2.25 ml and 32.86±7.00 mm 2 in the temperature gradient group,respectively,and the difference was not statistically significant(P>0.05);The operation time,the area of bone cement in the vertebral body,the final leakage area of bone cem

关 键 词：椎体后凸成形术 转变温度 骨水泥成形术 骨水泥渗漏 

分 类 号：R687.3[医药卫生—骨科学]