明胶海绵与利多卡因混合物在椎体成形术中防骨水泥渗漏的应用

Application of mixtures of gelatin sponge and lidocaine in preventing bone cement leakage during vertebroplasty

目的:比较预注射明胶海绵和利多卡因混合物应用于经皮穿刺椎体形成术(Percutaneous Vertebroplasty,PVP)中对于骨水泥渗漏及术后疗效的影响。方法:选取74例进行PVP手术治疗的患者,随机分为两组:观察组患者PVP手术中在骨水泥注射前预注射明胶海绵与利多卡因的混合物;对照组患者则进行常规PVP手术,穿刺后直接注入骨水泥。结果:(1)两组患者手术后3 d至1月内随访结果,VAS评分中观察组患者评分结果明显低于对照组患者(P<0.05);(2)两组患者术后1年内ODI评分比较,观察组患者得分(14.6±5.0)显著低于对照组患者(23.1±4.4),术后1年内治疗椎体再骨折发生率对照组为3.77%,而观察组未出现治疗椎体再骨折病例;(3)观察组患者出现S型渗漏2例,对照组患者出现B型渗漏2例、C型渗漏3例、S型渗漏2例(总渗漏率为13.2%)。结论:预注射明胶海绵与利多卡因混合物能够有效减少椎体成形术中骨水泥渗漏的发生,且对于患者疼痛缓解疗效更好,值得在临床上推广。

Objective To study the effect of pre-injection of the mixtures of gelatin sponge and lidocaine in percutaneous vertebroplasty（PVP） on postoperative therapeutic effect and bone cement leakage. Methods Seventy-four patients undergoing PVP were selected and randomly divided into observation group and control group. Patients in observation group were injected with the mixtures of gelatin sponge and lidocaine before the bone cement injection, while those in control group received conventional PVP and was injected with bone cement directly after acupuncture. Results The 3 days to 1 month of follow-up after operation showed that the scores of visual analogue scale in observation group were significantly lower than those in control group（P〈0.05）. In 1 year after operation, the Oswestry disability index（ODI） score of observation group was（14.6±5.0）,significantly lower than（23.1±4.4） of control group; and the incidences of vertebral refracture in control group and observation group were 3.77% and 0.00%, respectively. Two cases in observation group appeared type S leakage, while control group had 2 cases of type B leakage, 3 cases of type C leakage and 2 cases of type S leakage, with a total leakage rate of 13.2%. Conclusion The pre-injection of mixtures of gelatin sponge and lidocaine can effectively reduce the incidence of bone cement leakage in vertebroplasty and has better efficacy in alleviating patient＇s pain, worth of popularizing in the clinic.