高黏度骨水泥在经皮椎体成形术中的应用

Application of high viscosity bone cement in percutaneous vertebroplasty

目的 探讨应用高黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折的效果。方法 2006年4月至10月，应用高黏度骨水泥及其椎体成形系统治疗骨质疏松性椎体压缩性骨折23例，共31个椎体。男6例，女17例；年龄59-83岁，平均67．3岁。术中采用体位复位，局部麻醉，从椎体压缩严重侧单侧穿刺，经椎弓根人路，每个椎体注射骨水泥3．0-6．5ml，平均（4．7±1．0）ml。对患者手术前后的疼痛行视觉类比评分（Visual Analogue scale，VAS），并对手术前后VAS进行配对t检验。观察术中及术后并发症（包括骨水泥渗漏、肺栓塞、脊髓及神经根损伤和感染等）的发生情况。除常规X线检查外，手术前后常规行腰椎CT扫描。结果 术后随访1-7个月，平均3．7个月，患者背部疼痛均明显缓解或消失。术前的VAS平均为（7．57±1．10）分，术后第3天平均为（3．17±0．87）分（t=18．72，P〈0．01），术后1周平均为（2．43±0．65）分（t=20．73，P〈0．01），术后1个月平均为（2．26±0．66）分（t=22．42，P〈0．01），手术前后差异均有统计学意义。有2例发生椎体旁骨水泥渗漏，无骨水泥毒性反应、肺栓塞、感染和神经损伤等并发症发生。结论 高黏度骨水泥及其椎体成形系统具有瞬间高黏度、可注射时间长、定向可控注射、低聚合温度、操作简单和低放射暴露等优点，大大降低骨水泥渗漏的风险，手术安全性高，适用于老年骨质疏松性椎体压缩性骨折的治疗。

Objective To investigate the clinical efficacy of high viscosity bone cement in the treatment of osteoporotic vertebral compression fractures. Methods 23 osteoporotic vertebral compression fratures in 31 vertebras, were treated with high viscosity bone cement from April to October 2006, including 6 males and 17 females aged from 59 to 83 years old （average 67.3 years old）. After postural reduction and local anesthesia, the pedicle of severe sides of compressed vertebras were punctured before bone cement injected into the compressed vertebra, whose volume ranged from 3.0 to 6.5 ml [average （4.7±1.0） ml]. The pain were evaluated with Visual Analogue scale （VAS） and the data was analyzed by paired-samples t test. Complications as cement leakage, pulmonary cement emboli, spinal cord or nerve root injury and infection etc were being investigated during the procedure. The X-ray plus CT scan were employed pre- and postoperatively. Results The postoperative follow-ups ranged from 1 to 7 months （average 3.7 months）. Back pain was effectively relieved after operation in all cases. The VAS was （7.57±1.10） points preoperatively, （3.17± 0.87） points in 3 d postoperatively（t=18.72, P〈 0.01）, （2.43±0.65） points in 1 week postoperatively（t=20.73, P〈 0.01 ） and （2.26±0.66） points in 1 month postoperatively（t=22.42, P〈 0.01 ）. The difference was of statistical significance pre- and postoperatively. The cement leakage occurred in 2 cases. No any other complications happened. Conclusion The high viscosity bone cement can be employed safely for the treatment of osteoporotic vertebral body compression fractures in elder patients, including many merits as high viscosity, long time for injection, easy-controlled directionally and low polymerizing temperature.