选择性应用陶瓷人工骨在椎体后凸成形中预防骨水泥渗漏的作用

Cement leakage prevention in kyphoplasty by selectively applying bioceramic bone granules

目的在椎体后凸成形术中选择性使用陶瓷人工骨粒,观察其预防骨水泥渗漏的作用。方法选择西安交通大学医学院第一附属医院骨科自2009年6月～2011年5月116例椎体新鲜骨折患者,CT显示椎体前侧壁有不同程度的破裂,按随机原则分为两组:常规组采用传统的经皮球囊扩张椎体后凸成形术(PKP)方法,人工骨组在其基础上使用陶瓷人工骨粒,并记录人工骨粒填塞量、骨水泥注入量和渗漏发生率及后果;评估手术前后的疼痛程度(VAS法),测量椎体前缘高度压缩率(Lee法),测量椎体后凸角度(Cobb法),术后复查CT观察骨水泥渗漏情况。结果所有患者均顺利完成手术。人工骨组治疗58例,置入人工骨粒(2.83±1.67)g,骨水泥注射量为(3.74±0.66)mL,术中发现骨水泥渗漏2例,发生率为3.4%;手术前后VAS评分改善6.14±0.95,椎体前缘高度压缩率改善(21.74±1.99)%,椎体后凸角度改善23.72°±2.33°;术后CT可见椎体前侧方人工骨粒填充良好。常规组治疗58例,骨水泥注射量为(4.01±0.61)mL,术中发现骨水泥渗漏8例,发生率为13.8%;手术前后VAS评分改善6.00±0.94,椎体前缘高度压缩率改善(21.29±2.01)%,椎体后凸角度改善22.74°±2.00°。两组发生渗漏患者均无明显临床不适。SPSS17.0统计软件分析两组骨水泥注射量及骨水泥渗漏率差异有统计学意义(P<0.05),而VAS评分改善、椎体前缘高度压缩率改善及Cobb角改善情况两组间差异无统计学意义(P>0.05)。结论将陶瓷人工骨粒选择性应用于椎体后凸成形术中,在保证疗效的同时,能有效减少骨水泥的注入量,降低骨水泥渗漏的发生。

Objective To selectively apply calcium phosphate cement to percutaneous kyphoplasty(PKP) to study its effect in preventing cement leakage.Methods From June 2009 to May 2011,a total of 116 patients with fresh vertebral fracture in which vertebral body anterior lateral wall was defected to different degrees by CT scan were randomly allocated into two groups.The control group was treated with normal PKP procedure and the experiment group with PKP in addition to bioceramic bone granules.We recorded the weight of bone granules,the volume of cement injection and leakage rate and outcome.We assessed pain severity(VAS scale) and the height compression rate of anterior vertebrae(Lee method),measured kyphosis angle(Cobb method) before and after surgery;CT scans were taken to observe the postoperative cement leakage.Results PKP was successfully performed in all the patients.Fifty-eight cases were chosen in the experiment group planted with bioceramic bone granules(2.83±1.67 g,bone cement volume of 3.74±0.66 mL).There were totally 5 cement extrusions,with a leakage rate of 3.4%.The average VAS improvement after operation was 6.14±0.95;anterior vertebral height compression rate was improved by 21.74±1.99%,and kyphotic angle was improved by 23.72±2.33.Postoperative CT scan showed that bone granules were filled well in the anterior of vertebrae.Another 58 cases were treated in the control group with bone cement volume of 4.01±0.61 mL.There were 8(13.8%) leakages out of 58.Analysis with SPSS 17.0 statistic software showed significant differences in bone cement planted and cement leakage rate between the two groups(P<0.05).However,the two groups did not significantly differ in VAS scores,restoration rate of anterior vertebral height or kyphosis angle(P>0.05). Conclusion Our findings suggest that bioceramic bone granules selectively applied to PKP not only is effective but also can reduce the volume of cement injection and decrease the incidence of cement leakage.