影响椎体成形术后骨水泥椎体内弥散的因素分析
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摘要
目的探讨影响椎体成形术(PVP)后骨水泥椎体内弥散的影响因素。方法回顾性分析就诊于延安大学附属医院关节外科的80例行PVP的骨质疏松性椎体压缩性骨折(OVCF)患者的临床资料,根据患者术后CT检测骨水泥弥散情况将患者分为骨水泥弥散充分组(观察组)和骨水泥弥散不佳组(对照组),每组40例,同时根据骨水泥注射量、骨折至手术时间、椎体压缩程度分为各亚组,观察比较2组患者骨水泥分布情况、骨水泥灌注量、骨水泥弥散体积和骨水泥弥散系数,同时比较不同因素下各亚组骨水泥弥散系数变化情况。结果 2组患者在入口侧达到上下终板、在中心平面过椎体中线、弥散特征及骨水泥形状方面差异具有统计学意义(P<0.05)。2组患者在骨水泥灌注量比较差异无统计学意义(P>0.05),而在骨水泥弥散体积和骨水泥弥散系数比较差异显著(P<0.05)。随着骨水泥灌注量增加,骨折时间延长及椎体压缩程度增加,患者骨水泥弥散系数逐渐降低,对比2组之间的骨水泥弥散系数表明,差异无统计学意义(P>0.05)。结论骨水泥灌注量、骨折时间及椎体压缩程度均为PVP术后骨水泥椎体内弥散的影响因素。
Objective To explore the influencing factors of bone cement diffusion in the vertebral body after vertebroplasty( PVP). Methods Retrospective analysis was made on the clinical data of 80 OVCF patients who underwent PVP. In accordance with the bone cement diffusion status after vertebroplasty detected by CT scanning,the patients were divided into the full bone cement diffusion group( or the observation group) and the poor bone cement diffusion group( or the control group),each consisting of 40 patients,and the two groups were further divided into subgroups according to the amount of bone cement injection,the interval between bone fracture and surgery and the seriousness of vertebral compression. Then,the bone cement injection amount,bone cement distribution,bone cement diffusion volume and bone cement diffusion coefficient were closely observed and compared between the groups. At the same time,the changes in bone cement diffusion coefficient in the subgroups under different conditions were also compared between the subgroups. Results There were significant differences in the aspects of the upper and lower end plates at the entrance side,the center plane over the vertebral center line,the diffusion features and the bone cement shapes,when comparisons were made between the two groups( P < 0. 05). However,there were no significant differences in the amount of bone cement injection between the two groups( P >0. 05),while significant differences could be seen in the volume and coefficient of bone cement diffusion( P < 0. 05). With the increase of bone cement injection amount,the increased length of fracture time and the increased seriousness of vertebral compression,the bone cement diffusion coefficient decreased gradually,and comparison of the diffusion coefficient indicated that there was no statistical significance between the subgroups( P > 0. 05). Conclusion Bone cement injection amount,fracture time and seriousness of vertebral compression were all influencing factors of bone cement diffusion in the vertebral body.
Objective To explore the influencing factors of bone cement diffusion in the vertebral body after vertebroplasty( PVP). Methods Retrospective analysis was made on the clinical data of 80 OVCF patients who underwent PVP. In accordance with the bone cement diffusion status after vertebroplasty detected by CT scanning,the patients were divided into the full bone cement diffusion group( or the observation group) and the poor bone cement diffusion group( or the control group),each consisting of 40 patients,and the two groups were further divided into subgroups according to the amount of bone cement injection,the interval between bone fracture and surgery and the seriousness of vertebral compression. Then,the bone cement injection amount,bone cement distribution,bone cement diffusion volume and bone cement diffusion coefficient were closely observed and compared between the groups. At the same time,the changes in bone cement diffusion coefficient in the subgroups under different conditions were also compared between the subgroups. Results There were significant differences in the aspects of the upper and lower end plates at the entrance side,the center plane over the vertebral center line,the diffusion features and the bone cement shapes,when comparisons were made between the two groups( P < 0. 05). However,there were no significant differences in the amount of bone cement injection between the two groups( P >0. 05),while significant differences could be seen in the volume and coefficient of bone cement diffusion( P < 0. 05). With the increase of bone cement injection amount,the increased length of fracture time and the increased seriousness of vertebral compression,the bone cement diffusion coefficient decreased gradually,and comparison of the diffusion coefficient indicated that there was no statistical significance between the subgroups( P > 0. 05). Conclusion Bone cement injection amount,fracture time and seriousness of vertebral compression were all influencing factors of bone cement diffusion in the vertebral body.
引文
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[9]李洪德,王宏,李传贵,等.探讨单发骨质疏松性椎体压缩骨折PVP术后围术期相邻椎体骨折的可能性及特点[J].中国医学影像技术,2012,28(9):1732-1735.DOI:10.13929/j.1003-3289.2012.09.033.
[10]余伟波,梁德,江晓兵,等.经皮治疗有无裂隙骨质疏松椎体压缩骨折骨水泥分布及渗漏率比较[J].广东医学,2016,37(24):3678-3682.DOI:10.3969/j.issn.1001-9448.2016.24.010.
[11]王振斌,涂来勇,卡哈尔.艾肯木,等.椎体骨折线内骨水泥弥散情况在经皮椎体成形中的作用[J].中国组织工程研究,2015,19(21):3281-3286.DOI:10.3969/j.issn.2095-4344.2015.21.001.
[12]赵玉波,张庆明.椎体成形术中骨水泥弥散分布等级的量效关系[J].中国骨与关节损伤杂志,2015,30(1):63-65.DOI:10.7531/j.issn.1672-9935.2015.01.020.
[13]钟远鸣,苏之盟,覃海飚,等.椎体成形术骨水泥弥散情况对再发骨折的影响[J].重庆医学,2016,45(6):752-755.DOI:10.3969/j.issn.1671-8348.2016.06.010.
[14]俞武良,陆建猛,韦勇力,等.经皮椎体成形术中椎体内骨水泥分布范围对疗效的影响[J].中国矫形外科杂志,2015,23(20):1836-1840.DOI:10.3977/j.issn.1005-8478.2015.20.03.
[15]吴强,莫世赞,包拥政,等.椎体成形治疗后骨水泥在椎体内弥散的影响因素[J].中国组织工程研究,2014,18(43):6922-6928.DOI:10.3969/j.issn.2095-4344.2014.43.006.
[16]曾希银,王璨,王永强.不同黏度骨水泥治疗骨质疏松性椎体压缩骨折的疗效对比[J].海军医学杂志,2017,38(4):368-370.DOI:10.3969/j.issn.1009-0754.2017.04.026.
[2]刘齐元,崔威,颜华儒,等.不同术式治疗脊柱胸腰段压缩性骨折的近期及长期疗效对比[J].湖南师范大学学报(医学版),2015,12(3):90-92.
[3]彭永德.骨质疏松症研究年度报告(2012-8至2013-8)[J].中华内分泌代谢杂志,2014,30(8):639-642.DOI:10.3760/cma.j.issn.1000-6699.2014.08.002.
[4]唐朝阳,张保亮,肖东民,等.经皮穿刺椎体成形术治疗骨质疏松性椎体压缩性骨折不愈合[J].医学临床研究,2014,31(6):1171-1176.DOI:10.3969/j.issn.1671-7171.2014.06.048.
[5]江晓兵,莫凌,梁德,等.骨水泥在椎体骨折线内弥散情况对椎体成形术治疗效果的影响[J].中国脊柱脊髓杂志,2014,24(2):144-149.DOI:10.3969/j.issn.1004-406X.2014.02.09.
[6]张勇,刘敏,李键,等.单侧穿刺椎体成形术中骨水泥不同弥散范围对疗效的影响[J].临床骨科杂志,2016,19(4):437-440.DOI:10.3969/j.issn.1008-0287.2016.04.022.
[7]毕博,宋洁富,荆志振,等.多发性骨质疏松性椎体压缩骨折预防性椎体强化效果分析[J].中国药物与临床,2015,15(4):553-556.DOI:10.11655/zgywylc2015.04.050.
[8]陈同林,雍宜民,彭银平,等.骨折线内骨水泥弥散状况对经皮椎体成形治疗的影响[J].中国组织工程研究,2015,19(21):3287-3291.DOI:10.3969/j.issn.2095-4344.2015.21.002.
[9]李洪德,王宏,李传贵,等.探讨单发骨质疏松性椎体压缩骨折PVP术后围术期相邻椎体骨折的可能性及特点[J].中国医学影像技术,2012,28(9):1732-1735.DOI:10.13929/j.1003-3289.2012.09.033.
[10]余伟波,梁德,江晓兵,等.经皮治疗有无裂隙骨质疏松椎体压缩骨折骨水泥分布及渗漏率比较[J].广东医学,2016,37(24):3678-3682.DOI:10.3969/j.issn.1001-9448.2016.24.010.
[11]王振斌,涂来勇,卡哈尔.艾肯木,等.椎体骨折线内骨水泥弥散情况在经皮椎体成形中的作用[J].中国组织工程研究,2015,19(21):3281-3286.DOI:10.3969/j.issn.2095-4344.2015.21.001.
[12]赵玉波,张庆明.椎体成形术中骨水泥弥散分布等级的量效关系[J].中国骨与关节损伤杂志,2015,30(1):63-65.DOI:10.7531/j.issn.1672-9935.2015.01.020.
[13]钟远鸣,苏之盟,覃海飚,等.椎体成形术骨水泥弥散情况对再发骨折的影响[J].重庆医学,2016,45(6):752-755.DOI:10.3969/j.issn.1671-8348.2016.06.010.
[14]俞武良,陆建猛,韦勇力,等.经皮椎体成形术中椎体内骨水泥分布范围对疗效的影响[J].中国矫形外科杂志,2015,23(20):1836-1840.DOI:10.3977/j.issn.1005-8478.2015.20.03.
[15]吴强,莫世赞,包拥政,等.椎体成形治疗后骨水泥在椎体内弥散的影响因素[J].中国组织工程研究,2014,18(43):6922-6928.DOI:10.3969/j.issn.2095-4344.2014.43.006.
[16]曾希银,王璨,王永强.不同黏度骨水泥治疗骨质疏松性椎体压缩骨折的疗效对比[J].海军医学杂志,2017,38(4):368-370.DOI:10.3969/j.issn.1009-0754.2017.04.026.