摘要
目的探讨经皮椎体成形术(percutaneousvertebroplasty,PVP)灌注剂的调配方法与热效应及其临床效果。方法(1)用Palacos骨水泥加入适量造影剂调配灌注剂,将实验组和对照组制成圆柱形标本,测量聚合反应时温度变化,并行生物力学测试。(2)①用灌注剂在20只犬80个椎体上行PVP,术后CT扫描,于第1、2d分别随机取5只犬尸检,其余10只观察4周;②在5只猪10个椎体上取圆柱形骨块,形成空腔并注入灌注剂,测量灌注剂中心、边缘、椎体前缘、椎管前缘的温度变化,2周后取材观察灌注剂周缘骨组织坏死情况。(3)应用PVP治疗有疼痛症状的脊椎血管瘤、脊柱溶骨性转移瘤和骨髓瘤及脊椎骨质疏松性压缩骨折26例共35个椎体,术后行CT检查。结果(1)骨水泥单体、粉末和造影剂按5ml∶6g∶1ml的比例调匀后,可保持易于注射的稀薄糊状5min左右,且透视下显影清晰,灌注剂聚合放热过程和力学特性与对照组差异均无显著性意义。(2)①20只犬行PVP后均未发现肺栓塞表现,CT示椎管内常有渗漏,这与犬椎体的形态有关;②猪椎体内灌注剂平均最高中心温度为70.5℃、边缘为53.5℃、椎体前缘为40.8℃、椎管前缘为40.5℃,术后病理示灌注剂周缘有散在的骨细胞坏死灶。(3)26例PVP术后均未出现肺栓塞、神经损伤等并发症,术后CT示5例7个椎体存在渗漏,其中3例3个椎?
Objective To report an injectable cement for percutaneous vertebroplasty(PVP)and analyze the preliminary results of i ts application for painful haemangioma,osteolytic metastases or myelo ma,and osteoporotic compression fracture of spine.Methods 1)Polymethylmethacrylate(PMMA,Palacos)and a small amount of contrast medium(Omnipaque)were mixed to form a suitable mixture for PVP.Columnar specimens were prepared with cement mixture in the experimental group an d with monomer-to-powder mixture recommended by the manufacturer in t he control group.The changes of temp erature were measured and recorded during the period of polyme rization.The ultimate compressive stress and elastic modulus were mea-sured as well.2)a.Eighty PVP were performed in lumbar vertebrae of 20dogs with the above mentioned cement mixture.All of the dogs were e xamined with CT scan immediately,an d 10dogs were randomly selected for autopsy at the first and second day after intervention,the others were observed for 4weeks.b.Cavity defect were made in 10lumbar vertebr ae of 5pigs,which were also filled wi th the same cement mixture,and temperature probes were used to reco rd temperature elevations at the cem ent core,the bone-cement interface,the anterior cortex,and spinal canal.Postmortem histological examination was performed after 2weeks to e-valuate the necrotizing effect.3)PVP was performed for vertebral haem angioma in 4cases,osteolytic metastases in 9cases,multiple myeloma in 2cases,and osteoporotic vertebral compression fractures in 11cases.In this series of 26patients,PVP was done for pain relief related t o vertebral body lesions.The CT scan was obtained after intervention to a ssess the lesion filling and cement l eakage.After the procedure,the patient was placed supine and was asked to rem ain flat for 4hours prior to axial loading.Results1)Suitable cement was mixed with monomer,contrast med ium and powder according to the ratio of 5ml,1ml and 6g respec-tively,which could be injected easily in 5minutes with good opacity under fluoroscopy.There was no sig-nificant difference in temperature changes and biomechanical characte rs of the cement between the experiment al and control groups(P>0.05).2)a.There was no severe side effects related to cement in 20dogs,and no pulmonary embolic necrosis was found in autopsy.Cement leakage was frequent which occupied the spinal canal no mo re than 1/4of the median sagittal dia meter without major neurological complication.The epidural leaks we re related to the vertebral morpholo gy.b.The average peak temperatures were 70.5℃at the core,53.5℃at the in terface,40.8℃at the anterior corte x,and 40.5℃in the spinal canal.The temperature above 50℃lasted for 2.9minutes at the core,and 1.3minutes at the interface.In pathological examination,necrosis of osteocytes was found focally at t he periphery of the cement,and resid ual bone in this area showed signs of acti ve remodeling.3)The procedure was technically successful in all pa-tients,with an average injection am ount of 6.3ml cement per vertebral body.No clinically significant com-plications were noted.The 3slight e pidural leaks,1slight neural foram ina leak,and 5paravertebral leaks detected with CT had no clinical importance.Partial or complete pain relief was achieved in all patients as-sociated with improved mobility,an d 1patient experienced transitory worsening of pain followed by significant pain relief.Patients with vertebra l haemangioma or compression fractu res were discharged in 1-4days(average,1.6days)after the procedure.Of the 26patien ts,22were followed up from 6to 24mon ths(average,13.5months),partial or complete pain relief were sustained in 21cases,the other one experienced relapse of pain following partial pain relief,which was related to the deterioration of the metastases.Con-clusion Minimal invasive PVP is a valuable alternative in the treatment of painfu l vertebral haemangioma,osteoporotic vertebral fractures,and osteolytic metastases or myelom a,providing acute pain relief and ea rly mobilization in appropriate patien ts.[
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第6期323-330,共8页
Chinese Journal of Orthopaedics
