小空腔技术在椎体成形术中应用的实验研究

发布时间：2018-06-06 08:05

本文选题：小空腔技术 + 椎体成形术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:经皮椎体成形术(percutaneous vertebroplasty,PVP)自问世以来,在临床得到广泛应用,作为一种微创治疗因骨质疏松造成的椎体压缩骨折的技术,它具有住院时间短、花费少等优点。但由于椎体骨折严重程度不一,骨水泥推注量多少不一,骨水泥自身具有流动性等因素的存在,椎体成形术的相关并发症也越来越引起人们重视。骨水泥渗漏与邻近椎体骨折是椎体成形术中最主要的并发症,而骨水泥渗漏又可引起肺栓塞,严重危及患者生命。因此,在PVP中减少骨水泥渗漏是每一个临床医师都要面对的问题。我们将离体防腐椎体标本作为实验对象,研究小空腔技术是否可应用于椎体成形术以及其预防骨水泥渗漏的作用。方法:选用同一地区、种族、平均年龄65岁(62-68岁)的防腐尸体标本5具,每具防腐尸体取T8--L5椎体,所有防腐椎体标本均行X线扫描,以排除骨折、肿瘤、先天性畸形,将椎旁肌肉等软组织切除,两端切除椎间盘,制成完整单个游离椎体标本,用0STEOCOREⅢ型双能X线数字闪烁式二维全身骨密度仪(Dual Emission X—ray Absorptiometry DEXA)测量骨密度,从50个椎体中选取骨密度相近的48个进行实验(余2个行预实验)。将分好组的单个椎体放在生物力学实验机(长春试验机研究所,CSS44020)上下钢板之间,先预载100N压力,作用时间5min,以消除防腐标本松弛、蠕变的影响,接着以5 mm/min的速度进行垂直加载,当垂直载荷达到最高值并开始下降后即停止,制成压缩骨折模型。A组行传统椎体成形术,B组行小空腔技术椎体成形术,即在推注骨水泥之前,通过工作套筒插入鼻异物钳至椎体中前1/3处,随后360度旋转鼻异物钳,通过操纵手柄压迫骨质周围的组织,最终在椎体内创建一个不规则的锥形小空腔,小空腔创建完毕后,置入骨水泥推注器推注骨水泥。所有标本行椎体成形术均采用经单侧椎弓根入路缓慢匀速(2ml/min)注入相同厂家、相同量(2.5ml)的骨水泥。术后行CT扫描评定A,B两组椎体骨水泥渗漏的发生率,同时采用精密量筒测量各组骨水泥平均渗漏体积。应用SPSS 21.0统计软件分析。渗漏率结果以率(%)表示,采用行×列表χ2检验比较两组差异;骨水泥渗漏体积以均数±标准差(-x±s)表示,采用两均数比较的t检验;以P0.05为差异有统计学意义。结果:1小空腔技术椎体成形术(B组)骨水泥渗漏率为20.8%(5/24)明显低于传统椎体成形术(PVP)(A组)的58.3%(14/24),两组渗漏率差异有统计学意义(χ2=7.056,P0.05)。两均数比较的t检验分析显示:B组骨水泥渗漏平均体积(0.23±0.02)ml明显低于A组(0.77±0.06)ml,差异有统计学意义(t=18.732,P0.05);2术后CT扫描显示,A组椎体内骨水泥分布欠佳;B组椎体内骨水泥较A组分布均匀、有规律;3术后CT扫描示,共19个椎体发生骨水泥渗漏,发生率为39.6%(19/48)。结论:椎体成形术中人为创建小空腔,模拟了经皮球囊撑开椎体成形术,利用小空腔的体积,使推注的骨水泥首先在小空腔内聚集,小空腔容纳了部分骨水泥,不会使椎体在推注骨水泥时产生瞬间高压。鼻异物钳在椎体中旋转一圈,掉落的骨松质人为的对骨水泥渗漏通道进行封闭,同时对小空腔周围的骨组织进行压实,骨水泥渗漏相应减少,渗漏体积也随之减少。本实验证实小空腔技术是一种简单、易于操作的手术方法,利用椎体成形术前创建的小空腔,使骨水泥在椎体内分布更加均匀,明显降低椎体成形术中骨水泥的渗漏率和渗漏量。然而,由于样本数较少且采用的是离体标本,我们目前的结论是有限的,需要进一步的实验室和临床研究来证实我们当前的结果。
[Abstract]:Objective: percutaneous vertebroplasty (PVP) has been widely used in clinical practice since it was asked. As a minimally invasive technique for the treatment of vertebral compression fracture caused by osteoporosis, it has the advantages of short hospitalization time and less cost, but the amount of bone cement is different because of the different severity of vertebral body fracture. Cement has its own fluidity and other factors, and the complications related to vertebroplasty are becoming more and more important. Bone cement leakage and adjacent vertebral fractures are the most important complications in vertebroplasty, and bone cement leakage can cause pulmonary embolism, which seriously endangers the patient's life. Therefore, reducing the leakage of bone cement in PVP is every one. One of the problems to be faced by a clinician. We use the isolated anticorrosive vertebral specimen as an experimental object to study whether the small cavity technique can be applied to vertebroplasty and the effect of its prevention of bone cement leakage. Method: select 5 antiseptic corpses of the same area, race, average age 65 (62-68 years old), each antiseptic corpse to take T8--L5 Vertebral body, all specimens of the anticorrosive vertebral body were scanned by X-ray to remove the fracture, tumor, congenital malformation, excise the soft tissues such as the paravertebral muscles, excise the intervertebral discs at both ends, and make a complete single free vertebra specimen, and measure the bone with the Dual Emission X ray Absorptiometry DEXA of the two energy X-ray digital scintillator (Emission X - ray Absorptiometry DEXA). The density, 48 specimens of similar bone density were selected from 50 vertebrae (2 pre experiments). The single vertebral body of the divided group was placed between the upper and lower plates of the biomechanics experiment machine (Changchun test institute, CSS44020), and the 100N pressure was preloaded and the action time was 5min to eliminate the effect of the relaxation and creep of the anticorrosive specimen, then the speed of 5 mm/min. When the vertical load is loaded vertically, when the vertical load reaches the highest value and begins to fall, the compression fracture model.A group is made by traditional vertebroplasty, and the small cavity technique vertebroplasty is performed in group B, that is, before inserting the bone cement, inserting the nose foreign body forceps to the anterior 1/3 through the work sleeve, and then using the 360 degree rotating nose foreign body forceps, through exercises. The longitudinal handle oppressed the tissue around the bone and finally created an irregular conical cavity in the vertebral body. After the small cavity was established, the bone cement was inserted into the bone cement. All the specimens were treated with the same manufacturer, the same amount (2.5ml) of the bone cement after the single lateral pedicle approach (2ml/min). The incidence of bone cement leakage in A and B two groups was evaluated by CT scan, and the average leakage volume of bone cement in each group was measured by precision cylinder. The results were analyzed with SPSS 21 statistical software. The results of leakage rate were indicated by rate (%), and two groups were compared by line x list 2 test. The leakage volume of bone cement was represented by mean number + standard deviation (-x + s), and two T test compared with P0.05; results: 1 small cavity technique vertebroplasty (group B) bone cement leakage rate was 20.8% (5/24) significantly lower than that of traditional vertebroplasty (PVP) (group A) 58.3% (14/24), two groups of leakage rates were statistically significant (x 2=7.056, P0.05). Two average comparison of t test analysis showed: B group bone The average volume of cement leakage (0.23 + 0.02) ml was significantly lower than that of group A (0.77 + 0.06) ml, and the difference was statistically significant (t=18.732, P0.05). After 2, CT scan showed that the distribution of bone cement in group A was not good, and the bone cement in group B was distributed evenly compared with the A group, and the cement leakage in 19 vertebrae was 39.6% (19/48) in 19 vertebrae. Conclusion: in vertebroplasty, the small cavity is created artificially, and the percutaneous balloon valvuloplasty is simulated, and the volume of the small cavity is used to make the injected bone cement first gather in the small cavity, and the small cavity holds the part of the cement, which will not cause the transient high pressure when the vertebral body is pushed into the bone cement. The nose foreign body forceps rotates one circle and falls in the vertebral body. It is verified that the small cavity technique is a simple and easy operation method to use the small cavity created before the vertebral body forming to make the bone cement in the vertebral body. The internal distribution is more uniform, obviously reducing the leakage and leakage of bone cement in vertebroplasty. However, our current conclusion is limited due to the small number of samples and the use of isolated specimens. Further laboratory and clinical studies are needed to confirm our current results.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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