本文選題：小空腔技術(shù) + 椎體成形術(shù)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:經(jīng)皮椎體成形術(shù)(percutaneous vertebroplasty,PVP)自問(wèn)世以來(lái),在臨床得到廣泛應(yīng)用,作為一種微創(chuàng)治療因骨質(zhì)疏松造成的椎體壓縮骨折的技術(shù),它具有住院時(shí)間短、花費(fèi)少等優(yōu)點(diǎn)。但由于椎體骨折嚴(yán)重程度不一,骨水泥推注量多少不一,骨水泥自身具有流動(dòng)性等因素的存在,椎體成形術(shù)的相關(guān)并發(fā)癥也越來(lái)越引起人們重視。骨水泥滲漏與鄰近椎體骨折是椎體成形術(shù)中最主要的并發(fā)癥,而骨水泥滲漏又可引起肺栓塞,嚴(yán)重危及患者生命。因此,在PVP中減少骨水泥滲漏是每一個(gè)臨床醫(yī)師都要面對(duì)的問(wèn)題。我們將離體防腐椎體標(biāo)本作為實(shí)驗(yàn)對(duì)象,研究小空腔技術(shù)是否可應(yīng)用于椎體成形術(shù)以及其預(yù)防骨水泥滲漏的作用。方法:選用同一地區(qū)、種族、平均年齡65歲(62-68歲)的防腐尸體標(biāo)本5具,每具防腐尸體取T8--L5椎體,所有防腐椎體標(biāo)本均行X線掃描,以排除骨折、腫瘤、先天性畸形,將椎旁肌肉等軟組織切除,兩端切除椎間盤(pán),制成完整單個(gè)游離椎體標(biāo)本,用0STEOCOREⅢ型雙能X線數(shù)字閃爍式二維全身骨密度儀(Dual Emission X—ray Absorptiometry DEXA)測(cè)量骨密度,從50個(gè)椎體中選取骨密度相近的48個(gè)進(jìn)行實(shí)驗(yàn)(余2個(gè)行預(yù)實(shí)驗(yàn))。將分好組的單個(gè)椎體放在生物力學(xué)實(shí)驗(yàn)機(jī)(長(zhǎng)春試驗(yàn)機(jī)研究所,CSS44020)上下鋼板之間,先預(yù)載100N壓力,作用時(shí)間5min,以消除防腐標(biāo)本松弛、蠕變的影響,接著以5 mm/min的速度進(jìn)行垂直加載,當(dāng)垂直載荷達(dá)到最高值并開(kāi)始下降后即停止,制成壓縮骨折模型。A組行傳統(tǒng)椎體成形術(shù),B組行小空腔技術(shù)椎體成形術(shù),即在推注骨水泥之前,通過(guò)工作套筒插入鼻異物鉗至椎體中前1/3處,隨后360度旋轉(zhuǎn)鼻異物鉗,通過(guò)操縱手柄壓迫骨質(zhì)周?chē)慕M織,最終在椎體內(nèi)創(chuàng)建一個(gè)不規(guī)則的錐形小空腔,小空腔創(chuàng)建完畢后,置入骨水泥推注器推注骨水泥。所有標(biāo)本行椎體成形術(shù)均采用經(jīng)單側(cè)椎弓根入路緩慢勻速(2ml/min)注入相同廠家、相同量(2.5ml)的骨水泥。術(shù)后行CT掃描評(píng)定A,B兩組椎體骨水泥滲漏的發(fā)生率,同時(shí)采用精密量筒測(cè)量各組骨水泥平均滲漏體積。應(yīng)用SPSS 21.0統(tǒng)計(jì)軟件分析。滲漏率結(jié)果以率(%)表示,采用行×列表χ2檢驗(yàn)比較兩組差異;骨水泥滲漏體積以均數(shù)±標(biāo)準(zhǔn)差(-x±s)表示,采用兩均數(shù)比較的t檢驗(yàn);以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1小空腔技術(shù)椎體成形術(shù)(B組)骨水泥滲漏率為20.8%(5/24)明顯低于傳統(tǒng)椎體成形術(shù)(PVP)(A組)的58.3%(14/24),兩組滲漏率差異有統(tǒng)計(jì)學(xué)意義(χ2=7.056,P0.05)。兩均數(shù)比較的t檢驗(yàn)分析顯示:B組骨水泥滲漏平均體積(0.23±0.02)ml明顯低于A組(0.77±0.06)ml,差異有統(tǒng)計(jì)學(xué)意義(t=18.732,P0.05);2術(shù)后CT掃描顯示,A組椎體內(nèi)骨水泥分布欠佳;B組椎體內(nèi)骨水泥較A組分布均勻、有規(guī)律;3術(shù)后CT掃描示,共19個(gè)椎體發(fā)生骨水泥滲漏,發(fā)生率為39.6%(19/48)。結(jié)論:椎體成形術(shù)中人為創(chuàng)建小空腔,模擬了經(jīng)皮球囊撐開(kāi)椎體成形術(shù),利用小空腔的體積,使推注的骨水泥首先在小空腔內(nèi)聚集,小空腔容納了部分骨水泥,不會(huì)使椎體在推注骨水泥時(shí)產(chǎn)生瞬間高壓。鼻異物鉗在椎體中旋轉(zhuǎn)一圈,掉落的骨松質(zhì)人為的對(duì)骨水泥滲漏通道進(jìn)行封閉,同時(shí)對(duì)小空腔周?chē)墓墙M織進(jìn)行壓實(shí),骨水泥滲漏相應(yīng)減少,滲漏體積也隨之減少。本實(shí)驗(yàn)證實(shí)小空腔技術(shù)是一種簡(jiǎn)單、易于操作的手術(shù)方法,利用椎體成形術(shù)前創(chuàng)建的小空腔,使骨水泥在椎體內(nèi)分布更加均勻,明顯降低椎體成形術(shù)中骨水泥的滲漏率和滲漏量。然而,由于樣本數(shù)較少且采用的是離體標(biāo)本,我們目前的結(jié)論是有限的,需要進(jìn)一步的實(shí)驗(yàn)室和臨床研究來(lái)證實(shí)我們當(dāng)前的結(jié)果。
[Abstract]:Objective: percutaneous vertebroplasty (PVP) has been widely used in clinical practice since it was asked. As a minimally invasive technique for the treatment of vertebral compression fracture caused by osteoporosis, it has the advantages of short hospitalization time and less cost, but the amount of bone cement is different because of the different severity of vertebral body fracture. Cement has its own fluidity and other factors, and the complications related to vertebroplasty are becoming more and more important. Bone cement leakage and adjacent vertebral fractures are the most important complications in vertebroplasty, and bone cement leakage can cause pulmonary embolism, which seriously endangers the patient's life. Therefore, reducing the leakage of bone cement in PVP is every one. One of the problems to be faced by a clinician. We use the isolated anticorrosive vertebral specimen as an experimental object to study whether the small cavity technique can be applied to vertebroplasty and the effect of its prevention of bone cement leakage. Method: select 5 antiseptic corpses of the same area, race, average age 65 (62-68 years old), each antiseptic corpse to take T8--L5 Vertebral body, all specimens of the anticorrosive vertebral body were scanned by X-ray to remove the fracture, tumor, congenital malformation, excise the soft tissues such as the paravertebral muscles, excise the intervertebral discs at both ends, and make a complete single free vertebra specimen, and measure the bone with the Dual Emission X ray Absorptiometry DEXA of the two energy X-ray digital scintillator (Emission X - ray Absorptiometry DEXA). The density, 48 specimens of similar bone density were selected from 50 vertebrae (2 pre experiments). The single vertebral body of the divided group was placed between the upper and lower plates of the biomechanics experiment machine (Changchun test institute, CSS44020), and the 100N pressure was preloaded and the action time was 5min to eliminate the effect of the relaxation and creep of the anticorrosive specimen, then the speed of 5 mm/min. When the vertical load is loaded vertically, when the vertical load reaches the highest value and begins to fall, the compression fracture model.A group is made by traditional vertebroplasty, and the small cavity technique vertebroplasty is performed in group B, that is, before inserting the bone cement, inserting the nose foreign body forceps to the anterior 1/3 through the work sleeve, and then using the 360 degree rotating nose foreign body forceps, through exercises. The longitudinal handle oppressed the tissue around the bone and finally created an irregular conical cavity in the vertebral body. After the small cavity was established, the bone cement was inserted into the bone cement. All the specimens were treated with the same manufacturer, the same amount (2.5ml) of the bone cement after the single lateral pedicle approach (2ml/min). The incidence of bone cement leakage in A and B two groups was evaluated by CT scan, and the average leakage volume of bone cement in each group was measured by precision cylinder. The results were analyzed with SPSS 21 statistical software. The results of leakage rate were indicated by rate (%), and two groups were compared by line x list 2 test. The leakage volume of bone cement was represented by mean number + standard deviation (-x + s), and two T test compared with P0.05; results: 1 small cavity technique vertebroplasty (group B) bone cement leakage rate was 20.8% (5/24) significantly lower than that of traditional vertebroplasty (PVP) (group A) 58.3% (14/24), two groups of leakage rates were statistically significant (x 2=7.056, P0.05). Two average comparison of t test analysis showed: B group bone The average volume of cement leakage (0.23 + 0.02) ml was significantly lower than that of group A (0.77 + 0.06) ml, and the difference was statistically significant (t=18.732, P0.05). After 2, CT scan showed that the distribution of bone cement in group A was not good, and the bone cement in group B was distributed evenly compared with the A group, and the cement leakage in 19 vertebrae was 39.6% (19/48) in 19 vertebrae. Conclusion: in vertebroplasty, the small cavity is created artificially, and the percutaneous balloon valvuloplasty is simulated, and the volume of the small cavity is used to make the injected bone cement first gather in the small cavity, and the small cavity holds the part of the cement, which will not cause the transient high pressure when the vertebral body is pushed into the bone cement. The nose foreign body forceps rotates one circle and falls in the vertebral body. It is verified that the small cavity technique is a simple and easy operation method to use the small cavity created before the vertebral body forming to make the bone cement in the vertebral body. The internal distribution is more uniform, obviously reducing the leakage and leakage of bone cement in vertebroplasty. However, our current conclusion is limited due to the small number of samples and the use of isolated specimens. Further laboratory and clinical studies are needed to confirm our current results.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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