本文選題：椎體成形術(shù)　切入點(diǎn)：高粘度骨水泥　出處：《中國人民解放軍醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：了解在椎體成形術(shù)中高粘度骨水泥的使用是否能夠降低骨水泥滲漏的發(fā)生率。方法：本課題分兩大部分：第一部分回顧性分析解放軍總醫(yī)院脊柱外科過去2年間68例行經(jīng)皮椎體成形術(shù)患者(均使用常規(guī)低粘度骨水泥)的術(shù)后影像學(xué)資料,了解經(jīng)皮椎體成形術(shù)術(shù)中骨水泥滲漏的發(fā)生率及好發(fā)節(jié)段;第二大部分分為兩小部分：1.體外尸體標(biāo)本實(shí)驗(yàn)：選取新鮮老年男性椎體標(biāo)本24個(gè),制作椎體壓縮骨折模型后隨機(jī)分為2組,分別經(jīng)椎弓根注入高、低粘度骨水泥4 ml,使用B.A.Georgy評級方法來評估兩組的骨水泥滲漏發(fā)生情況,同時(shí)測量兩組標(biāo)本壓縮的椎體前緣高度的恢復(fù)情況；2.動(dòng)物實(shí)驗(yàn)：選取平均體重45kg的雌性長白豬16頭并隨機(jī)分為兩組,分別向已制備骨缺損模型的手術(shù)椎體內(nèi)注入高、低粘度骨水泥2.0ml,術(shù)后1個(gè)月時(shí)行X光平片檢查和CT平掃評估并比較兩組骨水泥滲漏情況;并分別于術(shù)前、術(shù)后1個(gè)月、術(shù)后3個(gè)月抽取兩組長白豬下腔靜脈血送檢鈣、磷、鎂離子濃度；待術(shù)后3個(gè)月時(shí)處死動(dòng)物并取標(biāo)本,制備骨缺損椎體不脫鈣硬切片并行Geimsa染色觀察兩組標(biāo)本骨-骨水泥界面,并取心肌、肝臟、腎臟標(biāo)本行HE染色觀察。結(jié)果：第一部分,回顧性病例分析結(jié)果提示：使用常規(guī)低粘度骨水泥的椎體成形術(shù)其骨水泥滲漏的發(fā)生率為52.7%,好發(fā)節(jié)段為胸12和腰1。第二部分體外尸體標(biāo)本實(shí)驗(yàn)中,高粘度骨水泥組骨水泥滲漏的B.A.Georgy評級結(jié)果為：Ⅰ級8個(gè),Ⅱ級3個(gè),Ⅲ級1個(gè)；低粘度骨水泥組：Ⅰ級2個(gè),Ⅱ級6個(gè),Ⅲ級4個(gè)。兩組椎體前緣高度的恢復(fù)情況分別為：高粘度骨水泥組94.3%,低粘度骨水泥組93.5%;動(dòng)物實(shí)驗(yàn)中,高低粘度骨水泥滲漏的B.A.Georgy評級結(jié)果：Ⅰ級6個(gè),Ⅱ級2個(gè),Ⅲ級0個(gè);低粘度骨水泥組：Ⅰ級1個(gè),Ⅱ級4個(gè),Ⅲ級3個(gè)；兩組術(shù)前、術(shù)后1個(gè)月和術(shù)后3個(gè)月3個(gè)時(shí)間點(diǎn)靜脈血清鈣磷鎂離子濃度無統(tǒng)計(jì)學(xué)差別;兩組不脫鈣硬切片染色提示兩組骨水泥的骨-骨水泥界面新骨長入及骨-骨水泥貼合情況均良好。結(jié)論：常規(guī)椎體成形術(shù)的骨水泥滲漏發(fā)生率較高,相關(guān)并發(fā)癥較多：與低粘度骨水泥相比,高粘度骨水泥可減少椎體成形術(shù)中的骨水泥滲漏,具有較高的安全性,從而減少了骨水泥滲漏所引起的相關(guān)并發(fā)癥,具有較高的安全性;其在恢復(fù)椎體前緣高度方面與低粘度骨水泥相比并無優(yōu)勢。另外其在生物相容性方面(對骨代謝的影響和骨-骨水泥界面情況)并無統(tǒng)計(jì)學(xué)差異,提示高粘度骨水泥不失為將來椎體成形術(shù)的一個(gè)很好的選擇。
[Abstract]:Objective: to understand whether the use of high viscosity bone cement in vertebroplasty can reduce the incidence of bone cement leakage. Methods: this subject is divided into two parts: the first part is a retrospective analysis of the past spinal surgery in PLA General Hospital. The imaging data of 68 patients with percutaneous vertebroplasty (all of whom were treated with conventional low viscosity bone cement) during the past two years, To understand the incidence of bone cement leakage during percutaneous vertebroplasty and the predilection segment. The second part was divided into two small parts: 1. In vitro cadavers: 24 fresh old male vertebrae specimens were selected. The model of vertebral compression fracture was randomly divided into two groups. The bone cement with high and low viscosity was injected into the pedicle of vertebrae at 4 ml. The incidence of bone cement leakage was evaluated by B.A. Georgy rating method. Animal experiment: 16 female Landrace pigs with an average weight of 45kg were selected and randomly divided into two groups. Low viscosity bone cement 2.0 ml, X ray plain film and CT scan were used to evaluate and compare the two groups of bone cement leakage at 1 month after operation, and two groups of pig inferior vena cava blood were sampled before, 1 month and 3 months after operation for calcium and phosphorus, respectively. Mg ~ (2 +) concentration, the animals were killed and the specimens were taken at 3 months after operation, the undecalcified vertebrae sections were prepared and Geimsa staining was used to observe the bone-bone cement interface between the two groups, and the myocardium and liver were taken out. The kidney specimens were observed by HE staining. Results: the first part, The results of retrospective case analysis showed that the incidence of bone cement leakage in vertebroplasty with conventional low viscosity bone cement was 52.7%, and the predilection segments were thoracic 12 and lumbar 1.In the second part of the experiment of cadaveric specimens in vitro, the incidence of bone cement leakage was 52.7%. The results of B.A.Georgy rating of bone cement leakage in high viscosity bone cement group were as follows: grade 鈪，

本文編號：1638867