本文關(guān)鍵詞： 骨質(zhì)疏松 胸椎 腰椎 聚甲基異丁烯酸 組織工程 骨科植入物 脊柱植入物 椎體骨折 腰椎QCT 對(duì)比劑彌散 骨水泥滲漏　出處：《中國(guó)組織工程研究》2017年19期 　論文類型：期刊論文

【摘要】：背景:骨質(zhì)疏松性胸腰椎骨折目前臨床通常采用經(jīng)皮穿刺椎體成形術(shù)治療,該術(shù)式具有操作難度不大,手術(shù)時(shí)間短,創(chuàng)傷較小,康復(fù)快,止痛療效確切等多項(xiàng)優(yōu)點(diǎn),但其存在骨水泥滲漏而引起的神經(jīng)壓迫癥狀甚至肺栓塞等并發(fā)癥,制約其發(fā)展。如何降低骨水泥的滲漏,是目前研究的熱點(diǎn)。目的:分析腰椎QCT值與骨質(zhì)疏松性胸腰椎骨折傷椎對(duì)比劑的彌散分布的關(guān)聯(lián)性。方法:選取60例行經(jīng)皮穿刺椎體成形術(shù)治療的骨質(zhì)疏松性胸腰椎骨折患者,術(shù)前行腰椎QCT檢查,術(shù)中往椎體內(nèi)注射對(duì)比劑,正側(cè)位C臂X光機(jī)透視,了解不同骨密度值患者對(duì)比劑彌散分布情況以及骨水泥在椎體內(nèi)彌散分布及滲漏等情況,分析腰椎QCT值與傷椎對(duì)比劑彌散分布及骨水泥滲漏的關(guān)聯(lián)性。結(jié)果與結(jié)論:(1)60例共110個(gè)傷椎中對(duì)比劑彌散超過(guò)椎體中線74椎,占67.3%。低骨量組、骨質(zhì)疏松組、嚴(yán)重骨質(zhì)疏松組各組間對(duì)比劑彌散度比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);(2)經(jīng)單側(cè)或雙側(cè)入路椎體成形式注入骨水泥,不同骨密度患者組間骨水泥滲漏情況比較無(wú)顯著差異(P0.05)。(3)結(jié)果顯示,對(duì)比劑在骨質(zhì)疏松性胸腰椎骨折傷椎中的彌散分布與腰椎QCT值有一定關(guān)系,QCT值低的患者比QCT值較高的患者傷椎對(duì)比劑彌漫分布更充分,但骨水泥滲漏的發(fā)生與QCT值高低無(wú)明顯相關(guān),說(shuō)明根據(jù)QCT值結(jié)合對(duì)比劑分布選擇不同穿刺術(shù)式傷椎注入骨水泥可減少其滲漏,提高椎體成形術(shù)的安全性。
[Abstract]:Background: percutaneous vertebroplasty is commonly used in the treatment of osteoporotic thoracolumbar fractures. The operation is not difficult, the operation time is short, the trauma is small, and the recovery is fast. There are many advantages such as exact analgesic effect, but there are some complications such as nerve compression caused by bone cement leakage and even pulmonary embolism, which restrict its development and how to reduce the leakage of bone cement. Objective: to analyze the relationship between QCT value of lumbar vertebrae and diffusive distribution of vertebral contrast agents in osteoporotic thoracolumbar fractures. Sixty patients with osteoporotic thoracolumbar fracture treated by percutaneous vertebroplasty were selected. Lumbar QCT was performed before operation, contrast agent was injected into the vertebral body during the operation, and C-arm X-ray machine fluoroscopy was performed in the positive and lateral position. Objective: to investigate the distribution of contrast agent diffusion in patients with different bone mineral density (BMD) and the distribution and leakage of bone cement in vertebral body. To analyze the correlation between QCT value of lumbar vertebrae and diffusive distribution of contrast agent and bone cement leakage in injured vertebrae. Results and conclusion the diffusivity of contrast agent in 60 cases of 110 injured vertebrae was more than 74 vertebrae in the midline of vertebral body. The diffusivity of contrast agent in low bone mass group, osteoporosis group and severe osteoporosis group was significantly different (P 0.05). The results showed that there was no significant difference in the leakage of bone cement between the different BMD groups (P 0.05. 05%, P < 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). The diffusive distribution of contrast agents in the injured vertebrae of osteoporotic thoracolumbar fractures was more fully distributed in the patients with lower QCT value than in the patients with higher QCT value. However, the occurrence of bone cement leakage was not significantly related to the QCT value, which indicated that according to the QCT value combined with contrast agent distribution, different puncture injury vertebrae injection can reduce the leakage of bone cement. To improve the safety of vertebroplasty.
【作者單位】： 廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院骨科;廣西中醫(yī)藥大學(xué);廣西醫(yī)科大學(xué)第一附屬醫(yī)院康復(fù)醫(yī)學(xué)科;
【基金】：廣西科學(xué)研究與技術(shù)開(kāi)發(fā)計(jì)劃課題(桂科攻10124001B-38) 廣西壯族自治區(qū)衛(wèi)生和計(jì)劃生育委員會(huì)課題(合同號(hào):Z2014119) 廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院青年科學(xué)基金項(xiàng)目(GZYQJ2014016,GZYQJ2014015)~~
【分類號(hào)】：R580;R683
【正文快照】： 0引言Introduction隨著老齡化社會(huì)的到來(lái),骨質(zhì)疏松性椎體壓縮性骨折(osteoporosis vertebral compression fracture,OCVR)的發(fā)病率隨之迅速增高。嚴(yán)重的骨質(zhì)疏松癥患者在較輕的外力作用下即可出現(xiàn)椎體壓縮性骨折,甚至出現(xiàn)脊髓神經(jīng)損傷,傳統(tǒng)的保守治療需臥床較長(zhǎng)時(shí)間,限制了自

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