腰椎QCT与骨质疏松性胸腰椎骨折伤椎骨造影弥散度的关联性

发布时间：2018-01-20 17:05

本文关键词： 骨质疏松胸椎腰椎聚甲基异丁烯酸组织工程骨科植入物脊柱植入物椎体骨折腰椎QCT 对比剂弥散骨水泥渗漏　出处：《中国组织工程研究》2017年19期 　论文类型：期刊论文

【摘要】：背景:骨质疏松性胸腰椎骨折目前临床通常采用经皮穿刺椎体成形术治疗,该术式具有操作难度不大,手术时间短,创伤较小,康复快,止痛疗效确切等多项优点,但其存在骨水泥渗漏而引起的神经压迫症状甚至肺栓塞等并发症,制约其发展。如何降低骨水泥的渗漏,是目前研究的热点。目的:分析腰椎QCT值与骨质疏松性胸腰椎骨折伤椎对比剂的弥散分布的关联性。方法:选取60例行经皮穿刺椎体成形术治疗的骨质疏松性胸腰椎骨折患者,术前行腰椎QCT检查,术中往椎体内注射对比剂,正侧位C臂X光机透视,了解不同骨密度值患者对比剂弥散分布情况以及骨水泥在椎体内弥散分布及渗漏等情况,分析腰椎QCT值与伤椎对比剂弥散分布及骨水泥渗漏的关联性。结果与结论:(1)60例共110个伤椎中对比剂弥散超过椎体中线74椎,占67.3%。低骨量组、骨质疏松组、严重骨质疏松组各组间对比剂弥散度比较差异有统计学意义(P0.05);(2)经单侧或双侧入路椎体成形式注入骨水泥,不同骨密度患者组间骨水泥渗漏情况比较无显著差异(P0.05)。(3)结果显示,对比剂在骨质疏松性胸腰椎骨折伤椎中的弥散分布与腰椎QCT值有一定关系,QCT值低的患者比QCT值较高的患者伤椎对比剂弥漫分布更充分,但骨水泥渗漏的发生与QCT值高低无明显相关,说明根据QCT值结合对比剂分布选择不同穿刺术式伤椎注入骨水泥可减少其渗漏,提高椎体成形术的安全性。
[Abstract]:Background: percutaneous vertebroplasty is commonly used in the treatment of osteoporotic thoracolumbar fractures. The operation is not difficult, the operation time is short, the trauma is small, and the recovery is fast. There are many advantages such as exact analgesic effect, but there are some complications such as nerve compression caused by bone cement leakage and even pulmonary embolism, which restrict its development and how to reduce the leakage of bone cement. Objective: to analyze the relationship between QCT value of lumbar vertebrae and diffusive distribution of vertebral contrast agents in osteoporotic thoracolumbar fractures. Sixty patients with osteoporotic thoracolumbar fracture treated by percutaneous vertebroplasty were selected. Lumbar QCT was performed before operation, contrast agent was injected into the vertebral body during the operation, and C-arm X-ray machine fluoroscopy was performed in the positive and lateral position. Objective: to investigate the distribution of contrast agent diffusion in patients with different bone mineral density (BMD) and the distribution and leakage of bone cement in vertebral body. To analyze the correlation between QCT value of lumbar vertebrae and diffusive distribution of contrast agent and bone cement leakage in injured vertebrae. Results and conclusion the diffusivity of contrast agent in 60 cases of 110 injured vertebrae was more than 74 vertebrae in the midline of vertebral body. The diffusivity of contrast agent in low bone mass group, osteoporosis group and severe osteoporosis group was significantly different (P 0.05). The results showed that there was no significant difference in the leakage of bone cement between the different BMD groups (P 0.05. 05%, P < 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). The diffusive distribution of contrast agents in the injured vertebrae of osteoporotic thoracolumbar fractures was more fully distributed in the patients with lower QCT value than in the patients with higher QCT value. However, the occurrence of bone cement leakage was not significantly related to the QCT value, which indicated that according to the QCT value combined with contrast agent distribution, different puncture injury vertebrae injection can reduce the leakage of bone cement. To improve the safety of vertebroplasty.
【作者单位】：广西中医药大学第一附属医院骨科;广西中医药大学;广西医科大学第一附属医院康复医学科;
【基金】：广西科学研究与技术开发计划课题(桂科攻10124001B-38) 广西壮族自治区卫生和计划生育委员会课题(合同号:Z2014119) 广西中医药大学第一附属医院青年科学基金项目(GZYQJ2014016,GZYQJ2014015)~~
【分类号】：R580;R683
【正文快照】： 0引言Introduction随着老龄化社会的到来,骨质疏松性椎体压缩性骨折(osteoporosis vertebral compression fracture,OCVR)的发病率随之迅速增高。严重的骨质疏松症患者在较轻的外力作用下即可出现椎体压缩性骨折,甚至出现脊髓神经损伤,传统的保守治疗需卧床较长时间,限制了自

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