骨水泥混合与注射一体化装置行经皮椎体成形术治疗椎体压缩性骨折

目的探讨骨水泥混合与注射一体化装置行经皮椎体成形术治疗椎体压缩性骨折的操作技术、临床疗效。方法2002～2004年间共计治疗了108例诉有严重疼痛的椎体压缩性骨折患者,其中骨质疏松性压缩性骨折85例,椎体恶性肿瘤31例。穿刺入路采用双侧椎弓根穿刺法,所有患者均在透视监视下双侧注射聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA),注射设备为骨水泥混合与注射一体化装置。术后随访患者6个月。结果共计注射116个椎体(腰椎69个,胸椎47个),双侧穿刺和骨水泥注射成功率100％,99例患者(91．7％)术后疼痛明显缓解,6个月内疼痛无复发95例(95．6％),9例患者(8．3％)术后疼痛无缓解。发生骨水泥外漏12例(11％),有临床症状5例(4．6％)。结论骨水泥混合与注射一体化装置行经皮椎体成形术创伤小、并发症少,而且止痛疗效显著,是一种非常有前景的治疗椎体压缩性骨折的介入手术方法。     

椎体成形术的实验研究

目的　通过对骨质疏松的山羊椎体成形探讨椎体成形术的安全性和临床应用依据。材料与方法　将 5只复制成功的骨质疏松的山羊每只取 3个椎体 (L1～L5)共 15个椎体作为手术组 ,2个椎体 (L1～L5)共 10个椎体作对照组。手术解剖出椎弓根直视下椎体穿刺 ,注入聚甲基丙烯酸甲酯 (PMMA ,骨水泥 )。测量椎体中心、椎体前缘和椎体后缘的温度变化。CT检查椎体骨水泥充填情况。 3天后处死动物每只取 1个注射椎体共 5个椎体行病理检查。将另 10个注射椎体和 10个未手术对照组椎体游离成单个椎体 ,去掉椎间盘和椎体附件 ,双盲法测量其纵向最大负载、极限强度、弹性模量。结果　注射后椎体的最大负载、极限强度、弹性模量比对照组明显提高 (P <0 .0 5 )。注射骨水泥后椎体内中心温度为 5 1.12℃ ,椎体前缘 37.31℃ ,后缘 37.6 1℃。大体病理和显微病理显示骨水泥弥散在椎体内骨小梁间呈不均匀分布 ,同CT检查结果一致。结论　掌握适宜的粉液比例和注射时机是椎体成形术的关键因素 ,椎体内注入骨水泥可显著增强其纵向最大负载、极限强度、弹性模量     

椎体成形术中是否有必要行骨静脉造影

目的 探讨在椎体成形术中是否有必要行椎体骨静脉造影.资料与方法回顾性分析533例患者共779节椎体成形,分为两组:组1为先行椎体骨静脉造影后再注入骨水泥(PMMA)共247例362节椎体,包括骨质疏松性椎体压缩骨折135例177节椎体、椎体转移性肿瘤112例185节椎体;组2为直接注入PMMA共286例417节椎体,包括骨质疏松性椎体压缩骨折194例288节椎体、椎体转移性肿瘤92例129节椎体.PVP后1天均作CT复查观察PMMA分布及有无椎体周围渗漏.比较两组近期疗效、PMMA渗漏情况、注入量、手术成本及术中X线辐射时间.结果两组病例在性别、年龄、疼痛程度、病变部位、疾病种类及穿刺操作等方面无显著性差异.组1有效为214例(86.6%),组2为258例(90.2%)(P=0.995);组1椎体周围PMMA渗漏为41节,组2为53节(P=0.995);组1平均注入PMMA量为3.74 ml,组2为4.06 ml(P＜0.01);组1平均手术费用为6.77千元/节,组2为5.72千元/节(P＜0.01),组2比组1节省约1.05千元/节;组1平均X线照射时间为12.93 min,组2为8.81 min(P＜0.05),组2比组1减少约4.1 min.结论椎体骨静脉造影不能提高PVP疗效和安全性,相反增加了手术成本和X线照射时间.     

不同程度椎体压缩骨折行经皮穿刺椎体成形术后骨水泥的弥散分布规律

目的探讨不同程度椎体压缩骨折行经皮穿刺椎体成形术(PVP)术后骨水泥的弥散分布规律。方法回顾性分析青岛大学医学院骨外科2016年7月—2017年3月因骨质疏松椎体压缩骨折(OVCF)行PVP100例患者的临床资料。根据术前MRI检查骨折水肿信号的面积及椎体压缩程度,对所选病例分为4组(Ⅰ型1组24例,Ⅱ型2组26例,Ⅲ型3组27例,Ⅳ型4组23例),并将骨水泥弥散等级分为3级。记录术前、术后1周、术后3个月的VAS评分、ODI评分、骨水泥弥散等级情况,并对术后1周ODI评分、骨水泥沿骨折线弥散等级与骨折类型3个变量进行Spearman相关性分析。结果患者均顺利完成手术,无神经损伤、脑脊液漏及感染等严重手术并发症发生,其中4例(Ⅲ组1例,Ⅳ组3例)骨水泥少量渗漏至椎旁静脉丛,无椎管内及椎间隙骨水泥渗漏。各组患者术后VAS评分、ODI评分较术前显著下降,差异有统计学意义(P<0.05),其中术后1周ODI评分Ⅰ组(37.92±8.43)、Ⅱ组(39.67±9.26)与Ⅲ组(30.53±8.65)、Ⅳ组(32.48±9.24)分别比较,差异有统计学意义(P<0.05)。余各组间比较差异无统计学意义(P>0.05)。骨水泥弥散等级情况:对4组患者行独立样本非参数检验,差异有统计学意义(P<0.05)。其中Ⅰ组、Ⅱ组与Ⅲ组、Ⅳ组分别比较,差异有统计学意义(P<0.05)。余各组间比较差异无统计学意义(P>0.05)。术后1周评分与骨折类型、骨水泥弥散等级呈负相关,骨折类型与骨水泥弥散等级呈显著正相关。结论术前水肿信号的面积大小将影响骨水泥沿骨折线的弥散等级从而导致早期临床效果的差异,其面积越大,术后早期效果越好,临床上要尽量使骨水泥均匀且充分地弥散。     

经皮弯角椎体成形术与单侧经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效比较

目的:比较经皮弯角椎体成形术（PCVP）与单侧经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCF）的临床效果。方法:采用回顾性队列研究分析2019年9月至2020年9月天津医院收治的104例单发椎体OVCF患者的临床资料,其中男21例,女83例;年龄50~91岁［（70.3±7.7）岁］。骨折AO分型：A...     

经皮椎体成形术后相邻椎体的新发骨折

经皮椎体成形术为治疗椎体溶骨性骨肿瘤及骨质疏松性椎体压缩性骨折等脊柱疾患的重要方法之一,它能迅速缓解疼痛,提高患者的生活质量,但也存在并发症。越来越多的文献报道椎体成形术后其相邻椎体发生了新发骨折,但两者之间究竟是否存在因果关系,目前尚无定论。因为接受椎体成形术的患者本身即患有转移性骨肿瘤、骨质疏松等基础疾病,新发骨折可能并不是椎体成形术引起的并发症,而可能仅仅是原有基础疾病的进展。本文结合相关文献,重点讨论椎体成形术后是否容易导致新发骨折,新发骨折的发生率是否高于无椎体成形术者,从支持及反对椎体成形术与新发骨折之间存在因果关系两个方面作一综述。     

犬急性骨水泥肺栓塞的实验研究

目的通过股静脉注入骨水泥建立犬急性肺栓塞模型,探讨一定剂量范围内不同量骨水泥肺栓塞引起的生理病理变化间的差异。方法 18只成年家犬随机分成A、B、C 3组,每组6只,麻醉后行胸部CT平扫,穿刺右股静脉、左股动脉并置入血管鞘,经静脉鞘注入聚甲基丙烯酸甲酯(PMMA)A组0.5 ml,B组1 ml,C组2 ml。于注入PMMA前和注入后即刻、30 min及1 h分别检测血气分析、平均肺动脉压;于注入PMMA前、后5 min行肺动脉造影。术后1h行胸部CT平扫+增强。术后2 h将犬处死,开胸解剖观察大体形态后,沿肺动脉分支方向随机取肺组织3块进行病理学检查。结果 18只实验犬经股静脉注入PMMA操作均成功,经CT及病理证实均成功建立急性骨水泥肺栓塞模型。各组实验犬动脉血氧分压、二氧化碳分压在骨水泥注入前后差异均无统计学意义(P>0.05)。仅C组骨水泥注入后即刻平均肺动脉压为(24.12±1.74)mmHg,注入后30 min为(23.84±1.25)mmHg,注入后1 h为(24.17±1.63)mmHg,均较注射前的(16.47±0.55)mmHg差异有统计学意义(P<0.05)。A组、B组平均肺动脉压在骨水泥注入前后差异均无统计学意义(P>0.05)。各组实验犬术后胸部CT平扫均可见两肺高密度影,下肺多见,C组尤为明显。部分实验犬平扫见条索状阴影及肺不张征象。C组部分实验犬胸部增强CT可见肺动脉小分支内部分充盈缺损。肺动脉造影仅C组部分实验犬出现肺内部分细小血管减少,血管纹理稀疏,未见肺动脉主干及分支的充盈缺损。病理学检查均发现肺动脉分支存在骨水泥栓子,未见继发血栓形成。结论≤2 ml的骨水泥致急性肺栓塞的严重程度与注入骨水泥剂量没有相关性。在心肺功能正常情况下,≤2 ml的急性骨水泥肺栓塞不会引起明显的呼吸功能障碍。     

1253个椎体经皮成形术的治疗结果及远期疗效的单中心研究

多位研究者报道经皮椎体成形术（PVT）是一项成熟的技术，但其远期疗效仍存在争议。本研究的目的在于评价经皮椎体成形术治疗有症状而经保守治疗无效的椎体骨折病人的疗效。共624例病人的1253个压缩性骨折纳入本研究。     

椎体成形术中非骨水泥渗漏引起心血管系统的变化

椎体成形术中较严重并发症主要由骨水泥渗漏引起。近年来的研究表明即使在椎体成形术中不发生骨水泥渗漏,患者亦可能出现心血管系统的变化,从而导致严重后果。其原因可能与骨水泥的毒性、神经反射、脂肪栓塞以及椎体内压力变化有关。     

Effects of barium concentration on the radiopacity and biomechanics of bone cement: experimental study

Purpose  This study was undertaken to evaluate the changes in the radiopacity and mechanics of polymethylmethacrylate (PMMA) bone cement with the addition of barium. Materials and methods  Barium sulfate powder was added to a PMMA bone cement with an initial 10% barium concentration. The changes in radiopacity and strength were evaluated by testing cement blocks containing four barium concentrations (10%, 20%, 30%, 40%). Radiopacity was evaluated by measuring the computed tomography (CT) values of the bone cement, and strength was evaluated by compressive, three-point bending, and impact load tests. Results  CT values increased in proportion to the barium concentration. The compressive load test showed that cement with a 40% barium concentration was significantly more fragile than cement with lower barium concentrations. The three-point bending load test showed that the cement became more fragile in proportion to the barium concentration. The impact load test showed that cement with 30% and 40% barium concentrations was significantly more fragile than cement with 10% and 20% barium concentrations. Conclusion  Radiopacity is increased and strength is reduced by adding increasing concentrations of barium powder to bone cement. The results of the present study suggest that adding barium permits the radiopacity and strength of bone cement to be adjusted in clinical practice.     

骨密度随增龄变化及其测定影响因素的初步探讨

目的分析正常人骨密度随增龄变化的规律和检测中遇到的实际问题，以求提高对骨质疏松症诊断的可靠性。方法选取313例正常人，男性162例，女性151例，年龄范围20~84岁。采用法国SophosL-XRA骨密度仅测量前臂、股骨上端及腰椎正、侧位。每10岁为一个年龄组进行统计分析。结果男、女前臂和腰椎峰值骨量均为30~39岁，股骨颈、Ward区峰值骨量均为20~29岁。除男性60~69岁年龄组腰椎正位和股骨上端外，骨密度值随年龄增长而下降。结论腰椎侧位检测可避开某些因素对腰椎正位检测的影响。     

Continuous-infusion contrast-enhanced US: in vitro studies of infusion techniques with different contrast agents

PURPOSE: To evaluate the infusion properties of three ultrasonographic (US) contrast agents and to compare different infusion techniques for achieving constant signals during harmonic power Doppler US. MATERIALS AND METHODS: In vitro studies were performed in a flow phantom. SH U 508A, NC100100, or FS069 was continuously infused at clinically usable doses and infusion rates. To assess agent-specific physical properties, these agents were administered by using a vertically fixed infusion pump and varying infusion start times. The contrast agents were administered by also using a horizontally oriented infusion pump that was either fixed or continuously rotated to homogenize the agent in the syringe. RESULTS: With SH U 508A and NC100100, constant signals were achieved, regardless of the infusion modality used. Compared with conventional infusion, the continuous homogenization of SH U 508A, although not necessary for signal constancy, increased the agent's usefulness (P <.05). With FS069, only continuous homogenization yielded constant signals (P <.001). CONCLUSION: Continuous infusion of SH U 508A or NC100100 provided constant harmonic power Doppler US signals, regardless of the infusion modality used. Because of the special physical properties of FS069, only homogenization produced constant harmonic power Doppler US signals during continuous infusion of this agent.     

不同型号卡波母凝胶剂对体外组织的粘附性

目的:测定、比较不同型号卡波姆凝胶剂对离体大鼠结肠组织的粘附性.方法:利用自制粘附力测定装置进行测定比较.结果:3种型号的卡波母凝胶剂对离体大鼠结肠组织的粘附力无显著性差异(P＜0.05),与非粘附材料乙基纤维素相比差异显著(P＜0.01).结论:3种型号的卡波姆对于离体大鼠结肠组织均有较好的粘附性.卡波姆934P凝胶剂更适合于腔道给药.     

In vitro evaluation of alternative oral contrast agents for MRI of the gastrointestinal tract

PURPOSE: In vitro evaluation of different materials as potential alternative oral contrast agents for small bowel MRI. MATERIALS AND METHODS: The T1 and T2 relaxation times of rose hip syrup, black currant extract, cocoa, iron-deferoxamine solution and a commonly used oral contrast material (1 mM Gd-DTPA) were determined in vitro at different concentrations on a 1.0 T clinical MR scanner. T1 values were obtained with an inversion prepared spoiled gradient echo sequence. T2 values were obtained using multiple echo sequences. Finally the materials were visualized on T1-, T2- and T2*-weighted MR images. RESULTS: The relaxation times of the undiluted rose hip syrup (T1=110+/-5 ms, T2=86+/-3 ms), black currant extract (T1=55+/-3 ms, T2=39+/-2 ms) and 5 mM iron-deferoxamine solution (T1=104+/-4 ms, T2=87+/-2 ms) were much shorter than for a 1mM Gd-DTPA solution (T1=180+/-8 ms, T2=168+/-5 ms). Dilution of black currant extract to 30% or a 3 mM iron-deferoxamine solution conducted to T1 relaxation times which are quite comparable to a 1 mM Gd-DTPA solution. Despite its much lower metal content an aqueous cocoa suspension (100 g/L) produced T2 relaxation times (T1=360+/-21 ms, T2=81+/-3 ms) more or less in the same range like the 5 mM iron-deferoxamine solution. Imaging of our in vitro model using clinical sequences allowed to anticipate the T1-, T2- and T2*-depiction of all used substances. Cocoa differed from all other materials with its low to moderate signal intensity on T1- and T2-weighted sequences. While all substances presented a linear 1/T1 and 1/T2 relationship towards concentration, rose hip syrup broke ranks with a disproportionately high increase of relaxation at higher concentrations. CONCLUSIONS: Rose hip syrup, black currant extract and iron-deferoxamine solution due to their positive T1 enhancement characteristics and drinkability appear to be valuable oral contrast agents for T1-weighted small bowel MRI. Cocoa with its differing relaxation and signal enhancement properties is a promising oral contrast agent but needs further clinical evaluation.     

Incompatibility of water-soluble contrast media and intravascular pharmacologic agents. An in vitro study.

In vitro incompatibilities between nine water-soluble contrast media and 21 intravascular pharmacologic agents were investigated using naked-eye observation and a centrifuge. Most of the previously reported incompatibilities were verified, and a few new incompatibilities were discovered: phentolamine mesylate with diatrizoate sodium, diatrizoate meglumine, ioxaglate, and iothalamate; diatrizoate meglumine with diazepam and meperidine hydrochloride; and diatrizoate sodium with meperidine hydrochloride. There were no incompatibilities when the pharmacologic agents investigated were mixed with ioxithalamate, iopromide, iopamidol, and iohexol.     

Lumbar and radial bone mineral density in children and adolescents with X-linked hypophosphatemia: evaluation with dual X-ray absorptiometry

Objective. To evaluate the bone mineral status of children being treated for X-linked hypophosphatemia, including potential differences between cortical bone in the radial diaphysis and combined cortical and trabecular bone in the lumbar spine. Design and patients. Forty-four bone mineral evaluations were performed in 11 children and adolescents with X-linked hypophosphatemia. Bone mineral density (BMD) of the lumbar spine and the radial diaphysis were measured by dual X-ray absorptiometry (DXA), second metacarpal cortical thickness was measured on hand radiographs, and these results were expressed as Z-scores (standard deviations from the mean). Results. For the 11 initial examinations, Z-scores (mean±SD) were: radial BMD, –2.73±1.15, lumbar BMD, +1.28±1.53; and cortical thickness, –2.21±0.95. Lumbar BMD Z-scores were significantly greater than those for radial BMD and cortical thickness. On follow-up examinations there was a mild increase in radial BMD and decrease in lumbar BMD. Although these changes were statistically significant, they were quite small and the discordance between radial and lumbar BMD was not corrected. Conclusions. Children and adolescents who are being treated for X-linked hypophosphatemia manifest a bone mineral disorder characterized by decreased BMD in the appendicular skeleton and increased BMD in the lumbar spine. Although current therapy is successful in its anti-rachitic effects, it does not correct this bone mineral disorder and additional therapeutic trials should be considered. Received: 28 May 1999 Revision requested: 22 July 1999 Revision received: 18 October 1999 Accepted: 26 October 1999     

Positive and negative contrast agents in CT evaluation of the abdomen and pelvis

The oral administration of a dilute positive iodinated contrast agent such as 2% Gastrografin is usually necessary to achieve optimal delineation of abdominal and pelvic organs. The amount of contrast agent administered and the timing of its administration depends on the site of suspected disease within the body. The simultaneous administration of antiperistaltic agents intravenously is generally unnecessary when utilizing the modern fast CT scanners. However, contrast agent-induced artifact may at times be troublesome, and we therefore suggest that lesions in the left lobe of the liver be scanned without positive contrast in the stomach. Negative contrast may also be useful in delineating disease: gas (carbon dioxide) has been shown to be useful in evaluating bladder tumors. We have also used air insufflation to facilitate the evaluation of small rectal tumors. Intravenous administration of contrast agent aids characterization of various disease entities and also facilitates the recognition of vascular structures (such as veins and arteries in the peripancreatic region). In our opinion both the infusion and bolus modes of contrast material administration have their place in the evaluation of abdominal and pelvic lesions by computed tomography. Newer techniques such as dynamic CT scanning will probably prove to be valuable both in delineating and characterizing disease.     

多发性骨髓瘤患者骨密度的改变

目的 探讨多发性骨髓瘤（MM）患者骨密度改变的特点,评价双能X线骨密度仪（DXA）对MM患者骨密度（BMD）测量的价值。方法 采用Hologic QDR-2000型双能X线骨密度仪,测量34例MM患者及24例正常人全身、L2－4椎体正侧位及左股骨近端骨密度,动态监测免疫球蛋白G（IgG)型和未定型MM患者化疗前后的BMD;测定血清免疫蛋白、蛋白电泳、血钙和血磷。结果 （1）MM患者全身、腰椎、左股骨近端BMD明显低于正常人（P＜0．05）;（2）IgG型Ⅲ期患者BMD明显低于Ⅱ期（P＜0．05）;（3）IgG型腰椎BMD与IgG的变化呈负相关,而与全身、左股骨近端BMD无相关性;（4）MM常规化疗有效患者,腰椎BMD明显上升（P＜0．05）,全身及左股骨折近端的BMD反而下降。结论 DXA是定量监测MM患者BMD变化和评价疗效和敏感方法。MM患者BMD降低经有效治疗是可逆转的,但腰椎与股骨近端骨损害及骨修复是不均一的。