椎体成形术后心肺功能变化的实验研究

An experimental study of cardiopulmonary function change after vertebroplasty

目的:通过向犬椎体灌注自固化磷酸钙骨水泥(autosetting calcium phosphate cement,ACPC)或聚甲基丙烯酸甲酯骨水泥(polymethylmethacrylate,PMMA)观察椎体成形术后犬血液动力学和血气变化以及肺栓塞情况。方法:选用15只成年健康犬,分成3组,插管全麻,经侧前方腹膜后入路暴露L2椎体,经椎体侧方钻孔。一组不灌注骨水泥,其余两组分别将1ml ACPC或PMMA注入椎体,记录术前和术后0.5、15、30、60和120min时各组犬的心率、股动脉血压和血气分析值;然后处死犬,取肺组织标本进行光镜和电镜检查观察肺栓塞情况。结果:单纯钻孔和灌注ACPC对犬的心率和血压没有明显的影响,灌注PMMA没有明显改变犬的基础心率,但引起了显著性的低血压反应。3组椎体成形术后血气分析值与术前比较皆无明显变化。肺组织光镜和电镜检查证实灌注ACPC和PMMA都可见到小血管内有脂肪小球,但未发现肺组织有明显病理变化。结论:选择ACPC作为椎体成形术的灌注材料可以避免应用PMMA的低血压反应,但仍有脂肪栓塞的危险。

Objective：To investigate the changes of hemodynamics,blood gas and pulmonary fat embolism in dogs after vertebroplasty injection of autosetting calcium phosphate cement （ACPC） or polymethylmethacrylate （PMMA）.Method：Fifieen healthy adult dogs were divided into three groups.The second lumbar vertebra of each dog was exposed through anterior retroperitoneal approach and one hole was drilled from lateral direction.lml ACPC or lml PMMA were injected into vertebrae body in two groups respectively and no cement in the other group.Heart rate,femoral arterial pressure and blood gas values were recorded before operation,and 0.5min,15min,30min,60min and 120min after operation respectively.The lung specimens were subjected to postmortem histological evaluation by optical and electron microscopy.Result：Neither injection of cement nor ACPC had effect on heart rate or blood pressure.Injection of PMMA didn＇t change heart rate but brought about fall in arterial pressure.Blood gas values didn＇t change significantly in either group.Histological examination found fat globelets in pulmonary vessels after vertebroplasty,but no signifcant pathological changes were noted.Conclusion：As for a type of injectable material in vertebroplasty,ACPC can avoid hypotension,but yet has the potential risk of fat embolism.