α-氰基丙烯酸正丁酯黏合剂预防经皮椎体后凸成形术中骨水泥渗漏的效果

Effect of N-butyl cyanoacrylate adhesive in preventing bone cement leakage during percutaneous kyphoplasty

目的探讨α-氰基丙烯酸正丁酯(NBCA)黏合剂预防经皮椎体后凸成形术(PKP)中骨水泥渗漏的效果。方法选用80枚离体猪胸腰椎,经脱钙、力学机压缩椎体制作骨质疏松性椎体压缩骨折模型,按照随机数表法分为常规PKP组和胶水组,每组40枚;再根据骨水泥注射量的不同细分为高剂量组和低剂量组,每组20枚。常规PKP组采用传统手术方法行PKP,胶水组在骨水泥注入前先用自行设计的椎体裂隙喷涂工具进行NBCA预处理封闭椎体内裂隙,再注入骨水泥。统计椎体内骨水泥分布形态、骨水泥渗漏率和椎体骨水泥渗漏数量。结果胶水组和常规PKP组脱钙后骨密度在高剂量组和低剂量组组间及组内比较,差异均无统计学意义(P>0.05)。胶水组和常规PKP组高剂量骨水泥注射弥散效果均优于低剂量骨水泥注射(P<0.05),但是组间弥散效果等级比较,差异无统计学意义(P>0.05)。胶水低剂量组骨水泥渗漏率低于常规PKP低剂量组(P<0.05),胶水高剂量组骨水泥渗漏率低于常规PKP高剂量组(P<0.05)。结论NBCA黏合剂预处理椎体不影响骨水泥在椎体内的弥散分布,能有效降低PKP术中骨水泥渗漏率,高剂量骨水泥弥散效果更好,但其渗漏风险也高。

Objective To explore the effect of N-butyl cyanoacrylate(NBCA)adhesive in preventing bone cement leakage during percutaneous kyphoplasty(PKP).Methods A total of 80 isolated porcine thoracolumbar vertebrae were selected to make the osteopolitic vertebral compression fracture model by decalcification and mechanical machine compression,and then divided into the conventional PKP group and the glue group according to random number table method,with 40 pieces in each group.Each group was further divided into the high-dose group and the low-dose group according to different injection doses of bone cement,with 20 pieces in each subgroup.The conventional PKP group performed PKP using traditional surgical methods,and the glue group was pretreated with NBCA pretreatment to close the intravertebral fissures with a self-designed vertebral fracture spraying tool before the cement injection,and then injected with bone cement.The distribution pattern of bone cement in vertebral body,the leakage rate of bone cement and the number of bone cement leakage in vertebral body were counted.Results There was no significant difference in bone mineral density of the glue group and the conventional PKP group after decalcification between or within the high-dose group and the low-dose group(P>0.05).The diffusion effect of high-dose cement injection was better than that of low-dose cement injection in the glue group and the conventional PKP group(P>0.05),but there was no statistically significant difference in the diffusion effect between the groups(P<0.05).The leakage rate of bone cement in the low-dose glue group was lower than that in the low-dose conventional PKP group(P<0.05),and the leakage rate of bone cement in the high-dose glue group was lower than that in the high-dose conventional PKP group(P<0.05).Conclusion The pretreatment of vertebra with NBCA adhesive does not affect the diffusion distribution of bone cement in vertebra,which can effectively reduce the leakage rate of bone cement in PKP operation,and the diffusion effect of high-dose bone cement is better,but the leakage risk is also high.