高低黏度骨水泥在椎体成形术中发生渗漏的原因分析

Analysis of the causes of leakage of high and low viscosity bone cement in vertebroplasty

目的比较在椎体成形术中使用高黏度骨水泥(high-viscosity bone cement,HV)及普通骨水泥后的渗漏发生情况并分析其可能原因。方法按照纳入、排除标准,纳入120例椎体骨折患者,随机分为HV组和普通骨水泥对照组(对照组),每组60例。术前常规行骨密度、X线、MRI检查,明确责任椎体。在治疗中实行单盲,采用标准的经皮椎体成形术,在HV组的伤椎内注入HV,对照组中注入普通骨水泥(聚甲基丙烯酸甲酯骨水泥),术中记录骨水泥的注入量、发生渗漏的部位。术后复查X线及CT,判断骨水泥渗漏的部位、体积、与周围组织的关系。骨水泥渗漏的评价指标以椎体数表示,指标的观察由独立的、未参与前期治疗的研究者完成。结果 HV组共69个责任椎体,其中10个椎体发生骨水泥渗漏,发生率14.5%;对照组共72个责任椎体,其中29个椎体发生骨水泥渗漏,发生率40.27%。对照组患者术后骨水泥总渗漏率和静脉渗漏率均明显高于HV组,差异有显著性(P<0.05),两组患者的椎间盘渗漏率、椎管内渗漏率和椎旁渗漏率比较差异无显著性(P>0.05)。结论 HV可有效降低骨水泥渗漏的风险,提高椎体成形术的安全性。

Objective By using high viscosity vertebroplasty with bone cement, ordinary two different filling materials, the comparison of two kinds of cement leakage rate, analysis of the causes, prevention and control measures. Method According to the inclusion and exclusion criteria, 120 patients were enrolled, according to the general condition of patients （gender, age, vertebral number） by an independent researcher 120 patients were randomly divided into high viscosity bone cement group （ HV group） and normal control group （control group）. Preoperative bone mineral density, X-ray, MRI examination, fresh and clear responsibility of vertebral fracture. Result In group HV, 69 vertebrae, vertebral bone cement leakage occurred in 10,the incidence rate was 14.5%; group C, 72 vertebrae, vertebral bone cement leakage occurred in 29, the incidence of 40.27%. Two groups of patients with postoperative bone cement leakage rate and total venous leakage rate has certain difference （P〈0.05）, with statistical significance, the disc leakage rate of the two groups of patients, spinal canal leakage and paravertebral leakage rate but more obvious difference （P〈0.05）, without statistical significance. Conclusion The characteristics of high viscosity bone cement is a moment of high viscosity, continuous injection and low heat release effect, can effectively reduce the patients with bone