经皮椎体强化术中骨水泥渗漏与否对患者凝血功能变化的影响

目的 利用前瞻性研究探讨骨质疏松性椎体压缩骨折（OVCF）患者行经皮椎体强化术时是否发生骨水泥渗漏对凝血功能变化的影响.方法 本研究选取2009年10月至2010年4月在我科确诊为OVCF并行椎体强化术的45例患者（59个椎体）进行前瞻性研究.测定其注入骨水泥前后不同时间点凝血四项和纤溶组合的值,术中透视及术后行X线和（或）CT检查,将患者分为骨水泥渗漏组与非骨水泥渗漏组,分析两组患者骨水泥注入后凝血功能变化的异同.结果 在所有时间点,渗漏组及非渗漏组患者的APTF、PT、PT-INR、FIB数值、3P值均在参考值范围内,各时间点的数值间无统计学差异（P＞0.05）,两组间亦无统计学差异（P＞0.05）.在注入骨水泥后,两组的D-Dmier值均有逐渐升高的趋势,其中渗漏组在骨水泥注入后不同时间点的D-Dmier值均要比注入前的D-Dmier值显著增高（P＜0.05）,与非渗漏组同一时间点的D-Dmier值相比也有统计学差异（P＜0.05）,在非渗漏组中,骨水泥注入后3 min的D-Dmier值与注入前无统计学差异（P＞0.05）,但在骨水泥注入后1h及3h均显著增高（P＜0.05）.结论 椎体强化术注入骨水泥可引起D-Dmier值升高,骨水泥渗漏可能会加速D-Dmier的升高,并可能加大其升高的幅度,骨水泥渗漏可能会影响患者的凝血功能.

Effects of the leakage of bone cement on coagulation functions of patients with osteoporotic vertebral compression fractures during percutaneous vertebral augmentation

Objective To prospectively evaluate the effect of the leakage of bone cement （polymethylmethacrylate,PMMA） on coagulation functions of patients with osteoporotic veterbral compression fractures （OVCF） during percutaneous vertebral augmentation.Methods This prospective research included 45patients（59 vertebral bodies）,who were diagnosed OVCF and accepted percutaneous vertebral augmentation in our hospital from October 2009 to April 2010.We measured the APTr,PT,PT-INR,FIB,D-Dmier and 3 P test at different time-point before and after the injection of bone cement （IBC）.We determine the bone cement leakage based on radiographies and（or） computed tomography scan （CT） of operated segment after operation.The influence of bone cement leakage on coagulation fuctions was analyzed,the differences between group of leakage （G1） and group of non-leakage （Gnl） was assessed.Results In G1 and Gnl,the value of APTT,PT,PT-INR,FIB,D-Dmier and 3P test at different time-point before and after the injection of bone cement （IBC） were in the reference range and had no significant difference between each other （P ＞ 0.05）.There was an ascending trend for the value of D-Dmier after injection of bone cement in both Gl and Gnl.Especially,the values of D-Dmier at the different time-points after IBC were significantly higher than the value before IBC （P ＜ 0.05）,which were higher than the reference range,furthermore,the values of D-Dmier at the different time-points after IBC were also significantly higher than the value at the same time-point in Gnl（P ＜0.05）.In Gnl,there was no difference between the value of D-Dmier at 3 minutes after IBC and 3 minutes before IBC,however,the value at 1 hour and 3 hours after IBC were significantly higher than 3 minutes before IBC （P ＜ 0.05）.Conclusions Injection bone cement may heighten the values of D-Dmier during vertebral augmentation,which might become higher when the bone cement leakage happens.Bone cement leakage may influence patients＇ coagulation function during vertebral augmentation.