高粘度骨水泥减少椎体成形术中骨水泥渗漏的研究

发布时间：2018-03-20 11:24

  本文选题：椎体成形术　切入点：高粘度骨水泥　出处：《中国人民解放军医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的：了解在椎体成形术中高粘度骨水泥的使用是否能够降低骨水泥渗漏的发生率。方法：本课题分两大部分：第一部分回顾性分析解放军总医院脊柱外科过去2年间68例行经皮椎体成形术患者(均使用常规低粘度骨水泥)的术后影像学资料,了解经皮椎体成形术术中骨水泥渗漏的发生率及好发节段;第二大部分分为两小部分：1.体外尸体标本实验：选取新鲜老年男性椎体标本24个,制作椎体压缩骨折模型后随机分为2组,分别经椎弓根注入高、低粘度骨水泥4 ml,使用B.A.Georgy评级方法来评估两组的骨水泥渗漏发生情况,同时测量两组标本压缩的椎体前缘高度的恢复情况；2.动物实验：选取平均体重45kg的雌性长白猪16头并随机分为两组,分别向已制备骨缺损模型的手术椎体内注入高、低粘度骨水泥2.0ml,术后1个月时行X光平片检查和CT平扫评估并比较两组骨水泥渗漏情况;并分别于术前、术后1个月、术后3个月抽取两组长白猪下腔静脉血送检钙、磷、镁离子浓度；待术后3个月时处死动物并取标本,制备骨缺损椎体不脱钙硬切片并行Geimsa染色观察两组标本骨-骨水泥界面,并取心肌、肝脏、肾脏标本行HE染色观察。结果：第一部分,回顾性病例分析结果提示：使用常规低粘度骨水泥的椎体成形术其骨水泥渗漏的发生率为52.7%,好发节段为胸12和腰1。第二部分体外尸体标本实验中,高粘度骨水泥组骨水泥渗漏的B.A.Georgy评级结果为：Ⅰ级8个,Ⅱ级3个,Ⅲ级1个；低粘度骨水泥组：Ⅰ级2个,Ⅱ级6个,Ⅲ级4个。两组椎体前缘高度的恢复情况分别为：高粘度骨水泥组94.3%,低粘度骨水泥组93.5%;动物实验中,高低粘度骨水泥渗漏的B.A.Georgy评级结果：Ⅰ级6个,Ⅱ级2个,Ⅲ级0个;低粘度骨水泥组：Ⅰ级1个,Ⅱ级4个,Ⅲ级3个；两组术前、术后1个月和术后3个月3个时间点静脉血清钙磷镁离子浓度无统计学差别;两组不脱钙硬切片染色提示两组骨水泥的骨-骨水泥界面新骨长入及骨-骨水泥贴合情况均良好。结论：常规椎体成形术的骨水泥渗漏发生率较高,相关并发症较多：与低粘度骨水泥相比,高粘度骨水泥可减少椎体成形术中的骨水泥渗漏,具有较高的安全性,从而减少了骨水泥渗漏所引起的相关并发症,具有较高的安全性;其在恢复椎体前缘高度方面与低粘度骨水泥相比并无优势。另外其在生物相容性方面(对骨代谢的影响和骨-骨水泥界面情况)并无统计学差异,提示高粘度骨水泥不失为将来椎体成形术的一个很好的选择。
[Abstract]:Objective: to understand whether the use of high viscosity bone cement in vertebroplasty can reduce the incidence of bone cement leakage. Methods: this subject is divided into two parts: the first part is a retrospective analysis of the past spinal surgery in PLA General Hospital. The imaging data of 68 patients with percutaneous vertebroplasty (all of whom were treated with conventional low viscosity bone cement) during the past two years, To understand the incidence of bone cement leakage during percutaneous vertebroplasty and the predilection segment. The second part was divided into two small parts: 1. In vitro cadavers: 24 fresh old male vertebrae specimens were selected. The model of vertebral compression fracture was randomly divided into two groups. The bone cement with high and low viscosity was injected into the pedicle of vertebrae at 4 ml. The incidence of bone cement leakage was evaluated by B.A. Georgy rating method. Animal experiment: 16 female Landrace pigs with an average weight of 45kg were selected and randomly divided into two groups. Low viscosity bone cement 2.0 ml, X ray plain film and CT scan were used to evaluate and compare the two groups of bone cement leakage at 1 month after operation, and two groups of pig inferior vena cava blood were sampled before, 1 month and 3 months after operation for calcium and phosphorus, respectively. Mg ~ (2 +) concentration, the animals were killed and the specimens were taken at 3 months after operation, the undecalcified vertebrae sections were prepared and Geimsa staining was used to observe the bone-bone cement interface between the two groups, and the myocardium and liver were taken out. The kidney specimens were observed by HE staining. Results: the first part, The results of retrospective case analysis showed that the incidence of bone cement leakage in vertebroplasty with conventional low viscosity bone cement was 52.7%, and the predilection segments were thoracic 12 and lumbar 1.In the second part of the experiment of cadaveric specimens in vitro, the incidence of bone cement leakage was 52.7%. The results of B.A.Georgy rating of bone cement leakage in high viscosity bone cement group were as follows: grade 鈪，

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