明胶海绵在经皮椎体成形术中预防骨水泥渗漏的作用研究

目的 观察明胶海绵在经皮椎体成形术(percutaneous vertebroplasty,PVP)中预防骨水泥渗漏的作用效果.方法 回顾性分析2014年6月至2015年12月于我院行PVP治疗伴椎体前壁破损的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)病人72例,术中应用明胶海绵预先填塞椎体破损处的36例病人纳入明胶海绵组,未使用明胶海绵填塞的36例病人纳入常规组.收集并比较两组病人的疼痛视觉模拟量表(visual analogue scale,VAS)评分改善、椎体高度改善、Cobb角改善以及骨水泥渗漏率.结果 明胶海绵组未发生骨水泥渗漏,常规组发生6例(16.67%)骨水泥渗漏,两组间渗漏率的差异有统计学意义(χ2=4.546,P=0.033);明胶海绵组的VAS评分改善、椎体高度改善和Cobb角改善分别为(5.14±1.08)分、(8.70±3.64)mm、17.15°±6.81°,常规组的各项指标分别为(5.11±1.34)分、(8.69±4.31)mm、15.80° ±6.61°,两组间以上三项指标比较,差异均无统计学意义(P均>0.05).结论PVP治疗伴有椎体前壁破损的OVCF术中应用明胶海绵可以有效降低骨水泥的渗漏率,对骨水泥渗漏具有一定的预防作用.     

高黏度骨水泥经皮椎体成形术对骨质疏松性椎体压缩性骨折患者术后VAS及ODI评分的影响

目的探讨高黏度骨水泥经皮椎体成形术对骨质疏松性椎体压缩性骨折(OVCF)患者术后VAS及ODI评分的影响。方法选取2017-02—2019-03间遂平县仁安医院行经皮椎体成形术的64例OVCF患者,随机将其分为2组,每组32例。对照组术中应用低黏度骨水泥,观察组术中注入高黏度骨水泥。比较分析不同黏度骨水泥的临床效果。结果(1)观察组术后第1天的骨水泥渗漏率及术后3个月的VAS、ODI评分均低于对照组,差异均有统计学意义(P<0.05)。结论应用高黏度骨水泥行经皮椎体成形术治疗OVCF,骨水泥渗漏率低,有利于缓解患者术后疼痛和改善脊柱功能。     

明胶海绵预填充在经皮椎体成形术中预防骨水泥渗漏

[目的]探讨明胶海绵预填充在经皮椎体成形术(PVP)中预防骨水泥渗漏的可行性和有效性。[方法]回顾性分析2017年01月～2018年01月于本院行PVP治疗的伴椎体前壁破损的病理性椎体压缩骨折患者68例。明胶海绵组34例,术中应用明胶海绵预填充;常规组34例,术中未使用明胶海绵。分别记录并比较两组患者手术时间、骨水泥注入量、VAS和JOA评分、椎体高度变化、骨水泥渗漏例数等指标。[结果] 68例患者均顺利完成手术,两组患者术中均无明显出血,无明显骨水泥渗漏临床相关症状。两组在手术时间和骨水泥注入量的差异无统计学意义(P0.05)。与术前相比较,术后3 d两组患者VAS评分均显著减少,差异有统计学意义(P0.05),而术后3 d的JOA评分均较术前显著增加,差异有统计学意义(P0.05)。各相应时间点,两组间VAS和JOA评分的差异均无统计学意义(P0.05)。明胶海绵组无骨水泥渗漏病例,常规组有7例发生骨水泥渗漏,两组间渗漏率的差异有统计学意义(P0.05)。术后患椎椎体高度增量两组差异无统计学意义(P0.05)。[结论] PVP治疗伴有椎体前壁破损的病理性椎体压缩骨折术中应用明胶海绵预填充的方法可在缓解疼痛、改善椎体高度的基础上,有效预防骨水泥渗漏。     

压力引导式经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的探讨压力引导式经皮椎体后凸成形术(PKP)治疗合并周壁破损的骨质疏松性椎体压缩性骨折(OVCF)的临床疗效及骨水泥渗漏情况。方法回顾性分析2015年9月-2018年9月采用压力引导式PKP治疗的89例合并周壁破损的OVCF患者临床资料,依据术前CT显示的椎体周壁破损部位进行分组,前壁并侧壁破损46例(A组),前壁并终板破损20例(B组),前壁、侧壁并后壁破损23例(C组)。记录所有患者术前骨密度、术中骨水泥用量、手术时间及住院时间。测量手术前后X线片上病变节段椎体前缘高度、中央高度及伤椎后凸Cobb角等参数,评估伤椎恢复情况;在术后CT上观察骨水泥渗漏情况。采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估临床疗效。结果所有手术顺利完成,患者随访3~20(11.60±5.58)个月。手术时间30~90(60.30±10.62)min,住院时间4~8(6.10±1.01)d。3组患者术后1 d和术后3个月的椎体前缘高度、椎体中央高度、伤椎后凸Cobb角、VAS评分、ODI较术前明显改善,差异均有统计学意义(P<0.05)。3组骨水泥注入量和骨水泥渗漏率组间比较差异无统计学意义(P>0.05)。A组发生骨水泥渗漏6例,4例沿椎前渗漏,2例沿椎体侧方渗漏;B组发生2例,均沿上终板渗漏至椎间隙;C组发生3例,2例沿椎前渗漏,1例沿椎体侧方渗漏。所有患者切口均一期愈合,无骨水泥致脏器栓塞、神经根受压等并发症发生。结论压力引导式PKP治疗合并周壁破损的OVCF,临床疗效及影像学指标恢复满意,骨水泥渗漏率低,值得临床推广。     

经皮椎体后凸成形术填塞明胶海绵后二次行球囊扩张预防骨水泥渗漏的临床意义

目的探讨经皮椎体后凸成形术填塞明胶海绵后二次行球囊扩张预防骨水泥渗漏的效果。方法回顾性分析自2018-01—2020-12采用经皮椎体后凸成形术治疗的350例骨质疏松性椎体压缩骨折,172例填塞明胶海绵后二次行球囊扩张(观察组),178例填塞明胶海绵后未再行球囊扩张(对照组)。比较2组术后1 d骨水泥渗漏数以及末次随访时的疼痛VAS评分、JOA评分、伤椎Cobb角。结果 2组均顺利完成手术,未出现脑梗塞、肺栓塞、椎体感染、骨水泥椎管内渗漏以及神经功能障碍等严重并发症。术后1 d观察组出现7例骨水泥渗漏,对照组出现20例骨水泥渗漏,观察组骨水泥渗漏数较对照组少,差异有统计学意义(P0.05)。末次随访时2组疼痛VAS评分、JOA评分、伤椎Cobb角比较差异无统计学意义(P0.05)。结论骨质疏松性椎体压缩骨折经皮椎体后凸成形术填塞明胶海绵后二次行球囊扩张可以有效减少术后骨水泥渗漏的发生率,并且同样可以取得满意的缓解疼痛、恢复椎体高度以及改善功能等方面的疗效,在临床有一定的推广价值。     

网袋加压成形与后凸成形治疗后壁破损型骨质疏松性椎体压缩性骨折的近期疗效对比

目的探讨网袋加压椎体成形术(vesselplasty)与经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗后壁破损型骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的近期疗效。方法纳入2014年1月～2017年8月因后壁破损型OVCF于我院行vesselplasty或PKP的42例,其中前者15例,后者27例,观察骨水泥渗漏情况,记录术前及术后第1天疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、伤椎Cobb角、椎体前中后缘高度。结果 vesselplasty组骨水泥渗漏率57. 1%(8/14),其中6例非椎体后壁渗漏,2例后壁渗漏; PKP组骨水泥渗漏率65. 4%(17/26),其中12例非后壁渗漏,5例后壁渗漏。2组骨水泥渗漏率差异无显著性(χ~2=0. 264,P=0. 608)。2组术后第1天VAS评分、ODI较术前均明显改善,Cobb角较术前均明显减小,伤椎前、中、后缘高度比较术前均明显增加,组内手术前后差异有显著性(P 0. 05); 2组间以上指标差异均无显著性(P 0. 05)。结论对存在后壁破损的OVCF,以vesselplasty或PKP治疗,在缓解胸腰椎疼痛、提高生活质量、恢复伤椎Cobb角及伤椎高度上均较术前有明显改善,但两者间并无明显差异。两者在骨水泥渗漏率上亦无明显差异,临床安全性相似。     

单侧与双侧入路经皮椎体成形术治疗骨质疏松压缩性骨折的比较研究

[目的]比较单侧与双侧椎弓根入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效.[方法]2007年9月～2011年7月,46例骨质疏松胸腰椎单节椎体压缩性骨折患者被随机分为两组,其中单侧组22例,双侧组24例.对两组患者的临床资料进行前瞻性分析,比较两组患者的临床疗效.[结果]所有患者均获得1年以上随访,两组患者术前临床资料差异无统计学意义(P＞0.05).两组术后椎体高度及后凸Cobb角均较术前改善(P＜0.01),而两组椎体高度恢复率、椎体后凸Cobb角恢复率差异无统计学意义(P＞0.05).两组患者术后24 h、术后1周、术后1年时,VAS、ODI评分较术前均有改善(P＜0.01),而两组间差异均无统计学意义(P＞0.05).手术时间、X线暴露时间、骨水泥灌注量及骨水泥渗漏发生率,单侧组少于双侧组,两组差异有统计学意义(P＜0.01),但两组间邻近椎体骨折发生率差异无统计学意义(P＞0.05).[结论]单侧与双侧椎弓根入路经皮椎体成形术治疗骨质疏松椎体压缩性骨折均能获得良好的临床疗效,但单侧椎弓根入路具有手术时间短、X线暴露时间短、骨水泥渗漏发生率低的优点.     

高粘度与低粘度骨水泥椎体成形术在治疗骨质疏松椎体压缩性骨折中的价值比较

目的比较高粘度与低粘度骨水泥材料在经皮椎体形成术治疗骨质疏松性椎体压缩性骨折中(OVCF)的应用价值。方法选取我院骨外科2014-01-2015-01收治的骨质疏松性椎体压缩性骨折患者100例为研究对象,随机分为对照组和观察组各50例。观察组给予高粘度骨水泥,对照组给予低粘度水泥,分别进行PVP手术治疗。结果两组患者术后1天、1个月、3个月、半年、末次随访时的后凸Cobb角、VAS评分、ODI评分、SF-36评分均较术前明显降低(P0.05),组间差异无统计学意义(P0.05)。观察组和对照组骨水泥渗漏率分别为18.0%和30.0%,观察组渗漏率明显小于对照组(P0.05)。两组术后椎体高度较术前相比差异显著(P0.05),但两组间无统计学差异(P0.05)。结论两种骨水泥行椎体成形术在治疗OVCF方面具有相似的疗效,高粘度骨水泥材料在骨水泥渗漏等发生率方面有显著改善,有效提高了椎体形成术的安全性和可靠性。     

PKP治疗骨质疏松性椎体压缩性骨折疗效分析

目的分析应用经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的可行性和疗效以及骨水泥渗漏、再骨折原因。方法应用PKP治疗27例骨质疏松性椎体压缩骨折。结果本组获随访6～24个月,术后VAS评分和ODI明显改善,椎体前缘、中部高度明显增加,后凸畸形Cobb角显著变小,术后3 d、1个月与术前比较差异有统计学意义(P<0.05)。结论 PKP能有效缓解疼痛,改善活动功能,能有效控制骨水泥渗漏及再骨折的发生,是治疗OVCF安全有效的方法。     

编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折

目的评估编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折(OVCF)的初步临床效果。方法自2007年12月～2010年4月应用编织囊袋扩张-椎体后凸成形术治疗13例周壁破损的OVCF共15个椎体骨折。随访观察患者的VAS疼痛评分以及影像学改变情况。结果本组获随访3～6个月,平均4.5个月。术后患者疼痛均明显缓解,术后VAS评分、椎体前缘高度和伤椎后凸Cobb角改善显著。未出现骨水泥向椎体外渗漏。结论对于周壁破损的OVCF,编织囊袋扩张-椎体后凸成形术有效避免了骨水泥渗漏、显著缓解疼痛、有效恢复骨折椎体的高度,是一种安全有效的治疗方法。     

Salicylate, mefenamate, meclofenamate, and quinine on cochlear potentials

The perilymphatic spaces of guinea pig cochleae were perfused with artificial perilymph, with and without drug, at a rate of 2.5 microliters/minute for 10 minutes. The compound action potential of the auditory nerve, cochlear microphonics, and the summating potential evoked by 10 kHz tone bursts of varying intensities were recorded from a wire inserted in the basal turn scala vestibuli. The endocochlear potential was recorded from the scala media. Sodium salicylate (1.25 to 10 mmol/L) reduced the magnitude of the compound action potential evoked by low-sound intensities without affecting the compound action potential evoked by high-sound intensities. Sodium salicylate also reduced cochlear microphonics and had no effect on summating potential. Cochlear perfusions of prostaglandin synthesis inhibitors, mefenamate (200 mumol/L), and meclofenamate (200 mumol/L), had no effect on the cochlear potentials. Quinine (10 to 100 mumol/L) reduced the compound action potential input-output function in a parallel fashion rather than selectively affecting the low-intensity compound action potential. Quinine (100 mumol/L) reduced cochlear microphonics and summating potential. Neither quinine (100 mumol/L) nor salicylate (5 mmol/L) affected endocochlear potential. These results suggest that salicylate-induced hearing loss is not caused by either antagonism of the hair cell transmitter or cyclooxygenase inhibition, nor is it caused by the same mechanism that causes quinine-induced hearing loss.     

Effects of vancomycin,daptomycin, fosfomycin,tigecycline, and ceftriaxone on Staphylococcus epidermidis biofilms

Infection of medical implanted material is associated with considerable morbidity and costs. In the following work, we investigated the effects of vancomycin, daptomycin, fosfomycin, tigecycline, and ceftriaxone on biofilms formed by Staphylococcus epidermidis isolates causative for implant infection and catheter‐associated bacteremia. Biofilms were studied using the static microtiter plate model and incubated with the antibiotics increasing the concentration from 1× to 128× the minimal inhibitory concentration (MIC) of the respective isolate tested. To quantify the reduction of the biomass, the optical density ratio (ODr) of stained biofilms and the number of growing bacteria were determined. Incubation of the staphylococcal biofilms with the antibiotics decreased the biofilm ODr (at baseline = 1) for ceftriaxone (0.83 ± 0.48) but minimally only for fosfomycin (0.96 ± 0.64), daptomycin (1.05 ± 0.59), tigecycline (1.18 ± 0.66), and vancomycin (0.98 ± 0.44) at exceedingly high concentrations of 128 × MIC. The significant reduction of the bacterial growth was not achieved for all antibiotics, not even at the highest concentrations tested. Using higher doses of the antibiotics may be of some value in the treatment of biofilm‐associated infections, although effects are seen only at clinically unachievable doses. However, to eradicate the staphylococcal biofilm, additional measures like debridement and/or removal of the implant are needed. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1361–1365, 2009     

The Effect of Alendronate,Risedronate, and Raloxifene on Renal Functions,Based on the Cockcroft and Gault Method,in Postmenopausal Women

Background. Oral alendronate, risedronate, and raloxifene are effective treatment options in the management of postmenopausal osteoporosis. There is little previously reported about the renal safety profiles of these three agents in osteoporosis. We aimed to assess the risk of renal toxicity associated with oral alendronate, risedronate, and raloxifene in the treatment of osteoporosis, prospectively. Methods. One hundred and twenty-seven patients with osteoporosis and osteopenia according to lumbar or femoral-neck bone mineral density t score were enrolled in the study. The patients were randomized to alendronate 70 mg once weekly (n = 47), risedronate 35 mg once weekly (n = 44), or raloxifene 60 mg per day (n = 36) for one year. Preliminary screening included medical history, physical examination, lumbar and femoral bone mineral densitometry measurement, and blood biochemical tests, including renal function tests. The biochemical markers were then assessed at the end of 12 months. Results. There was no significant difference between basal and final renal function parameters of each group. Also these parameters did not differ between the three groups after 12 months of treatment period. Conclusions. These results demonstrate that alendronate, risedronate, and raloxifene are all safe drugs for renal functions in the treatment of osteoporosis.