PKP与高粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折的疗效比较

目的比较经皮椎体后凸成形术(PKP)与高粘度骨水泥经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的临床效果。方法纳入自2012-02—2016-04诊治的100例骨质疏松性椎体压缩骨折,行PKP治疗者50例(PKP组),行高粘度骨水泥PVP治疗者50例(PVP组)。比较2组术后VAS评分、ODI指数、伤椎前缘高度压缩比值、伤椎前缘高度恢复比值,以及骨水泥渗漏率。结果 2组术后VAS评分、ODI指数、伤椎前缘高度压缩比值较术前明显降低,差异有统计学意义(P0.05)。但2组术后各时间点VAS评分、ODI指数差异无统计学意义(P0.05)。PKP组术后3 d、12个月伤椎前缘高度压缩比值低于PVP组,伤椎前缘高度恢复比值高于PVP组,差异有统计学意义(P0.05)。PVP组骨水泥渗漏发生率低于PKP组,差异有统计学意义(P0.05)。结论 PKP、高粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折可明显减轻患者疼痛,改善患者功能障碍程度,PKP术后椎体高度恢复效果更优,而高粘度PVP骨水泥渗漏率较低。     

经皮椎体成形术中椎体内骨水泥分布范围对疗效的影响

[目的]探讨经皮椎体成形术中骨水泥在椎体内分布范围对临床疗效的影响。[方法]对2013年6月~2014年6月确诊为骨质疏松性压缩性骨折并行经皮椎体成形术治疗的60例患者进行回顾性研究,参照术后X线片或CT重建判断骨水泥在椎体内的分布情况,将患者分为3组,A组:骨水泥没有弥散于骨折线区域;B组:骨水泥仅弥散于骨折线区域;C组:骨水泥弥散于整个椎体。记录术前、术后第3 d、术后3、6个月时的疼痛视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数(ODI)评分,对3组患者不同时间点的疼痛程度及个人生活情况进行比较分析。[结果]所有患者均顺利完成手术,无严重并发症发生。术中骨水泥注射量为3.5~6.0 ml,平均(4.7±0.8)ml。3组患者术后疼痛及生活质量明显改善,术后第3 d,第3、6个月VAS评分及ODI与术前相比,差异有统计学意义(P0.05)。A组和B、C组患者术后3 d VAS评分及ODI分别对比差异均有统计学差异(P0.05),B、C组患者术后第3 d VAS评分及ODI对比,差异无统计学意义(P0.05),3组患者术后3、6个月VAS评分及ODI分别比较,差异均无统计学意义(P0.05)。B、C两组患者术后即时疗效较A组明显,随访3个月后3组患者疗效差异不明显。[结论]骨质疏松性压缩性骨折患者行经皮椎体成形术后,在疼痛及生活质量上均有明显改善,椎体内骨水泥是否弥散于骨折线区域可能是影响椎体成形术疗效的因素之一。     

骨质疏松性胸椎压缩骨折PVP术后骨水泥弥散效果对疗效的影响

目的探讨骨质疏松性胸椎压缩骨折经皮椎体成形术(Percutaneous vertebroplasty,PVP)术后骨水泥弥散效果对临床疗效的影响。方法回顾性分析自2018-01—2020-12采用PVP治疗的82例骨质疏松性胸椎压缩骨折。41例术后骨水泥弥散良好(弥散良好组),41例术后骨水泥弥散不佳(弥散不佳组)。比较两组伤椎后凸角改善率、椎体前缘高度恢复率、并发症情况,比较两组术后3 d及术后3个月ODI指数、疼痛VAS评分。结果两组均顺利完成手术并获得至少3个月的随访。弥散良好组术后并发症数较弥散不佳少,伤椎后凸角改善率、椎体前缘高度恢复率较弥散不佳组大,差异有统计学意义(P<0.05)。术后3 d及术后3个月弥散良好组ODI指数、疼痛VAS评分较弥散不佳组低,差异有统计学意义(P<0.05)。结论骨水泥弥散类型与骨质疏松性胸椎压缩骨折PVP术后疗效密切相关,骨水泥弥散情况良好的患者伤椎后凸角及椎体前缘高度恢复情况满意,脊柱功能恢复及疼痛缓解的效果较好,并发症发生率较低。     

PVP术中椎体骨折线内骨水泥弥散情况对疗效的影响

目的探讨经皮椎体成形(PVP)术中骨水泥在椎体骨折线内弥散情况对疗效的影响。方法回顾性分析自2014-01—2016-11行PVP治疗的20例骨质疏松性胸腰椎压缩骨折,根据椎体骨折线内骨水泥弥散情况分为2组(各10例),A组骨水泥在椎体骨折线内充分弥散,B组骨水泥在椎体骨折线内弥散不均匀。比较2组术后4 d、3个月ODI指数、VAS评分、局部后凸Cobb角,以及并发症情况。结果20例均获得3~6(3.82±0.26)个月随访。术后3个月时,A组未出现并发症,B组出现1例椎体再骨折、2例椎体塌陷;B组并发症发生率高于A组,差异有统计学意义(P0.05)。2组术后4 d、3个月的ODI指数、VAS评分、局部后凸Cobb角均较术前明显改善,而且A组术后4 d的ODI指数、VAS评分、局部后凸Cobb角明显低于B组,差异有统计学意义(P0.05)。结论 PVP治疗骨质疏松性胸腰椎压缩骨折可明显改善功能障碍与缓解疼痛程度,但骨水泥在椎体骨折线内弥散不佳会对早期疗效造成影响,甚至可能导致后凸畸形。     

经皮椎体成形术中骨水泥弥散容积比与疗效相关性的临床研究

目的 评价椎体成形术中骨水泥弥散容积比与疗效的关系。方法 2016年1月至2018年5月,43例骨质疏松性椎体压缩骨折患者在我科施行经皮椎体成形术,术后Mimics软件上计算出伤体内骨水泥弥散容积。骨水泥弥散容积比=骨水泥弥散容积/伤锥体积,将骨水泥弥散容积比分为3级,1级<25%,25%<2级<50%,3级>50%,对比术前与术后随访（12个月）的模拟VAS评分与腰疼ODI评分。结果 37例患者实施PVP,术后获12~27个月随访（平均16.8个月）,患者背部疼痛均有不同程度缓解或者消失。骨水泥弥散容积比分为1级、2级、3级各组之间的疼痛缓解疗效的差异无统计学意义（P>0.05）。结论 经皮椎体成形术中骨水泥弥散容积比<25%即可获得满意疗效,增加骨水泥弥散容积比不能获得更好的疗效。     

高黏度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的效果

目的探讨高黏度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的效果。方法随机将80例接受椎体成形手术的骨质疏松性椎体压缩性骨折患者分为2组,各40例。观察组应用高黏度骨水泥,对照组应用普通骨水泥。比较2组术后第1天、1个月及6个月的椎体前缘高度、Cobb角和疼痛评分(VAS)、脊柱评分(ODI);统计2组骨水泥渗透率。结果 (1)治疗前2组的椎体前缘高度、Cobb角和VAS评分、ODI脊柱评分差异无统计学意义(P0.05)。2组术后第1天、1个月及6个月的椎体前缘高度、Cobb角、ODI脊柱评分均优于术前,差异有统计学意义(P0.05);但组间差异无统计学意义(P0.05)。(2)术后第1天观察组的VAS评分优于对照组,差异有统计学意义(P0.05);但术后1个月及6个月2组的VAS评分差异无统计学意义(P0.05)。(3)观察组骨水泥渗透率低于对照组,差异有统计学意义(P0.05)。随访期间2组邻近椎体压缩性骨折等并发症发生率比较,差异无统计学意义(P0.05)。结论高黏度骨水泥和普通水泥应用于椎体成形术治疗骨质疏松性椎体压缩性骨折,均有可靠效果,但前者能快速缓解患者的疼痛程度,且骨水泥渗漏率较低。     

骨水泥弥散类型对治疗骨质疏松性椎体压缩骨折的影响

目的:观察PVP、PKP及手法复位PVP术后不同骨水泥弥散类型构成及其对老年骨质疏松性椎体压缩骨折治疗效果和骨水泥渗漏率的影响。方法:对2012年1月至2015年1月采用单侧经皮椎体成形术治疗的老年骨质疏松性椎体压缩骨折病例进行回顾性分析,其中PVP术式56例,男22例,女34例,年龄60~78岁;PKP术式48例,男17例,女31例,年龄61~79岁;手法复位PVP术式43例,男15例,女28例,年龄60~76岁。术后摄正侧位DR片,以Auto CAD图形处理软件计算椎体内骨水泥弥散区面积和团块区面积,然后计算正侧位DR片平均弥散区与平均团块区面积的比值(K),定义K50%为团块型,50%≤K≤100%为混合型,K100%为弥散型。分析不同椎体成形术式骨水泥弥散类型构成,然后按骨水泥弥散类型分为弥散型、混合型和团块型3组,观察各类型组的视觉模拟评分(VAS)、椎体压缩率、JOA评分以及骨水泥渗漏率等并进行统计学分析。结果:所有患者获得随访,时间为12~24个月,平均17.2个月。PVP及PKP和手法复位PVP 3种术式的骨水泥弥散类型构成不同(P0.05),PVP术式弥散型、混合型、团块型构成比分别为46.43%、35.71%和17.86%,PKP术式为16.67%、37.50%和45.83%,手法复位PVP术式为37.21%、44.19%和18.60%。PVP术式以及手法复位PVP术式以弥散型和混合型构成为主,而PKP术式以团块型和混合型构成为主。VAS评分及JOA评分以及骨水泥渗漏率3种弥散类型术后组间比较差异均无统计学意义。椎体压缩率:3种弥散类型术后比较差异有统计学意义(P0.05),弥散型组术后24 h和末次随访时分别为(17.31±5.06)%和(18.58±4.91)%,混合型组为(14.21±5.15)%和(14.59±5.07)%,团块型组为(13.89±5.02)%和(14.28±4.94)%。结论 :PVP及PKP和手法复位PVP 3种不同术式骨水泥弥散类型构成不同,且团块型与混合型弥散方式较弥散型能更好地恢复压缩椎体的高度,而不同骨水泥弥散方式的中早期疗效差异不明显。     

PVP与PKP治疗骨质疏松性胸腰椎压缩骨折的疗效比较

目的比较经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗骨质疏松性胸腰椎压缩骨折的临床疗效。方法回顾性分析自2015-09—2017-08诊治的75例骨质疏松性胸腰椎压缩骨折,39例(63椎)采用PVP手术治疗(PVP组),36例(55椎)PKP手术治疗(PKP组)。比较2组手术时间、术中透视时间、骨水泥注入量、骨水泥渗漏发生率、非手术椎体再骨折发生率,术后疼痛VAS评分、ODI指数、伤椎前缘高度比值与后凸Cobb角。结果 75例均获得至少12个月随访。PKP组手术时间、术中透视时间较PVP组长,骨水泥注入量较PVP组多,骨水泥渗漏发生率较PVP组低,差异有统计学意义(P <0.05)。PVP组与PKP组术后疼痛VAS评分、非手术椎体再骨折发生率比较差异无统计学意义(P>0.05)。PKP组术后1周、3个月ODI指数、伤椎前缘高度比值、后凸Cobb角均优于PVP组,差异有统计学意义(P <0.05)。结论PVP与PKP手术均可以有效缓解骨质疏松性胸腰椎压缩骨折患者的临床症状,但PKP手术对伤椎前缘相对高度恢复、后凸畸形改善的效果更好,进而更能够减轻患者脊柱功能障碍。     

不同黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折

目的 比较采用高黏度骨水泥和低黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效差异.方法 回顾性分析2013年9月至2014年11月我科治疗的83例骨质疏松性椎体压缩性骨折病人的病例资料.根据手术所用不同黏度骨水泥分组:采用低黏度骨水泥椎体成形术治疗的病人43例(低黏度组);采用高黏度骨水泥椎体成形术治疗的病人40例(高黏度组).记录单个椎体手术时间、骨水泥渗漏发生率,术后并发症发生率.采用疼痛视觉模拟量表(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)对两组进行术前及术后1 d、术后3个月疼痛及功能进行评价.通过X线检查对术前、术后椎体各部进行测量,统计椎体高度变化.结果 83例病人术后均得到3个月随访.两组术前VAS评分和骨折压缩率上无差异.高黏度组的手术时间较低黏度组明显缩短(t=22.32,P=0.000).术后1 d、术后3个月,两组组内VAS评分、ODI较术前明显降低(均P=0.000),但术后组间比较无明显差异(均P>0.05).高黏度组骨水泥渗漏率较低黏度组低,差异有统计学意义(P=0.0494).椎体成形术后高黏度组椎体高度恢复优于低黏度组,差异有统计学意义(P=0.000).结论 椎体成形术中使用不同类型的骨水泥均能有效地缓解病人疼痛,改善生活质量.与低黏度骨水泥相比,高黏度骨水泥有着较低的骨水泥渗漏率,同时缩短了手术时间和降低了术中放射性的暴露.     

两种骨水泥治疗老年骨质疏松性椎体压缩骨折的比较

目的比较应用高黏度骨水泥的经皮椎体成形术(percutaneous vertebroplasty,PVP)与应用普通(低黏度)骨水泥的经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)在治疗老年骨质疏松性椎体压缩骨折的临床效果及并发症。方法 2014年6月至2015年6月青岛大学医学院附属烟台毓璜顶医院脊柱骨科收治的老年骨质疏松性椎体压缩骨折患者,采用完全随机化方法将实验对象按入院先后顺序分为高黏度组和低黏度组,分别行PVP手术及PKP手术。各组均于术前及术后3 d、1个月、6个月摄腰椎正侧位片。观察并比较两组患者的手术时间、骨水泥注入量、骨水泥渗漏数、骨水泥渗漏率,计算并比较各观察时间点的视觉模拟评分(visual analogue scale,VAS)和功能障碍指数(oswestry disability index,ODI)评分。结果高黏度组手术时间为18.3~30.6 min,平均为(25.3±3.8)min;低黏度组手术时间为27.9~44.3 min,平均为(36.8±4.2)min,两组手术时间对比差异有统计学意义(P0.05)。高黏度组骨水泥注入量3.8~5.5 m L,平均(4.2±0.3)m L;低黏度组骨水泥注入量3.7~5.9 m L,平均(4.3±0.5)m L,两组手术骨水泥注入量比较差异无统计学意义(P0.05)。高黏度组发生骨水泥渗漏2例,均为椎旁软组织内渗漏,渗漏率7.14%;低黏度组发生骨水泥渗漏3例,1例为椎旁软组织内渗漏,2例为椎间盘内渗漏,渗漏率为10.71%,两组手术骨水泥的渗漏率比较差异有统计学意义(P0.05)。两组患者术前及术后各观察时间点的VAS评分及ODI指数评分比较差异无统计学意义(P0.05)。结论应用高黏度骨水泥的PVP与应用低黏度骨水泥的PKP在治疗老年骨质疏松性椎体压缩骨折方面具有相似的临床治疗效果,但应用高黏度骨水泥的PVP能显著缩短手术时间。在骨水泥的渗漏方面,高黏度骨水泥能显著降低骨水泥的渗漏率,具有更好的临床安全性。     

The effect of cement gun and cement syringe use on the tibial cement mantle in total knee arthroplasty

Evidence suggests that a thicker cement mantle improves fixation strength and resistance to tensile and shear forces in the tibial component of total knee arthroplasty. A low proportion of orthopaedic surgeons currently use techniques to improve cement penetration in the tibial plateau. We demonstrate that the use of a pressurized cement gun or cement syringe provides a highly statistically significant difference (P < .001) to the depth of the tibial cement mantle and reduction in radiolucent lines when compared to cement applied by hand. This ensures a thicker cement mantle and may reduce the possibility of early failure by improving the strength of fixation and the resistance to tensile and shear forces. There is no statistical difference in the cement mantle produced by the cement syringe and the cement gun.     

PKP术中应用低温间断灌注技术治疗周壁破裂型OVCF

目的通过与温度梯度灌注技术进行比较,探讨低温间断灌注技术在经皮椎体后凸成形术治疗椎体周壁破裂型骨质疏松性骨折中的临床价值。方法回顾性分析我院2015年1月至2018年12月期间共60例周壁破损型骨质疏松性椎体骨折患者,均为单椎体骨折,根据骨水泥灌注方法的不同分为温度梯度灌注组30例和低温间断灌注组30例。温度梯度灌注组男6例,女24例;平均年龄为(71.9±6.9)岁;低温间断灌注组男8例,女22例;平均年龄(69.7±7.2)岁。比较两组术前、术后2 d及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI),椎体后凸角,伤椎椎体前缘相对高度,手术时间,骨水泥注射量,骨水泥分布面积比,骨水泥可推注时间(从开始推注到所有骨水泥至团块期晚期不可推注的时间),骨水泥渗漏率。结果温度梯度灌注组术后随访时间平均(15.3±8.4)个月;低温间断灌注组术后随访时间平均(18.6±8.2)个月,两组间比较差异无统计学意义(P>0.05)。两组内术后2 d和末次随访时VAS评分、ODI评分较术前差异均有统计学意义(P<0.05),两组内末次随访时与术后2d相比差异无统计学意义(P>0.05)。术后2 d和末次随访时,两组组间的VAS评分比较差异有统计学意义(P<0.05),其余时间点VAS评分和ODI比较差异无统计学意义(P>0.05)。手术前后及末次随访时,两组组间的伤椎前缘相对高度和伤椎椎体后凸角比较差异均无统计学意义(P>0.05)。两组间手术时间差异无统计学意义(P>0.05),其中低温间断灌注组的骨水泥可推注时间(12.1±1.0)min,显著长于温度梯度灌注组(5.3±1.1)min(P<0.05)。低温间断灌注组的骨水泥灌注量(3.9±0.79)mL,骨水泥分布面积比(0.46±0.10),均优于温度梯度灌注组(3.20±0.67)mL和(0.31±0.07),差异有统计学意义(P<0.05)。低温间断灌注组有2例患者发生骨水泥渗漏,渗漏率6.7%,显著低于温度梯度灌注组的骨水泥渗漏率26.7%(P<0.05)。结论低温间断灌注技术可以有效延长骨水泥可推注时间,有利于提高骨水泥在椎体内的注射量和分布面积,降低骨水泥渗漏率的同时可获得更好的临床疗效。     

Factors affecting flexural strength in cement within cement revisions

Cement within cement revisions provide substantial benefits for conventional revision yet remains uncommon possibly because of the perceived weakness of the cement-cement interface. This study investigated the flexural strength of beams composed of 2 different cements, exploring the factors of pore size, fracture location, viscosity, and the surface roughness of the interface. We found no significant difference when comparing combinations of different cements (P = .30), varying pore sizes (P = .13), or surface roughness (P = .39). Differences in fracture locations and viscosity combinations approached statistical significance (P = .08 and .05, respectively). Our findings suggest strong bonding between cements at the interface, with other factors being more important causes of weakness. Thus, we recommend that the strength of the cement-cement interface should not be a factor when considering such revisions.     

Characterization of Bone Cements

Thirty-seven patients with fractures of the thoracic and lumbar spine treated with Harrington instrumentation were reviewed. Twenty-seven patients with a follow-up time of more than 2 years were summoned for a clinical and radiographic examination. This report presents the results related to reduction, stabilization, return of neural function, spinal posture and mobility, and residual disability. It is concluded that Harrington instrumentation can be performed without a substantial number of complications. Its major advantages are early mobilization and ambulation. The operative technique is discussed with special reference to the preservation of the normal configuration of the back. The value of computerized tomography in the preoperative assessment is stressed.     

椎体成形术中高黏度骨水泥渗漏分析

目的了解高黏度骨水泥在椎体成形术中的渗漏率、渗漏部位及其临床疗效等相关问题。方法回顾性分析本院自2013-06—2014-09行高黏度骨水泥经皮椎体成形术42例的影像资料及临床病例,分析研究手术前后腰背部疼痛VAS评分,骨水泥渗漏部位及相关并发症等。结果患者术后24 h疼痛均明显缓解,视觉疼痛模拟评分(VAS)明显改善(P0.05),10例13个椎体(22.81%)出现骨水泥渗漏,椎体周围渗漏发生率(46.15%)最高,均未出现明显临床症状及体征。结论高黏度骨水泥能确切改善患者疼痛症状,渗漏率相对较低,且多无明显临床症状,适合临床应用。     

Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements: A state-of-the-art review

Prosthetic joint infection (PJI) is the most serious complication following total joint arthroplasty, this being because it is associated with, among other things, high morbidity and low quality of life, is difficult to prevent, and is very challenging to treat/manage. The many shortcomings of antibiotic-loaded poly (methyl methacrylate) (PMMA) bone cement (ALBC) as an agent for preventing and treating/ managing PJI are well-known. One is that microorganisms responsible for most PJI cases, such as methicillin-resistant S. aureus, have developed or are developing resistance to gentamicin sulfate, which is the antibiotic in the vast majority of approved ALBC brands. This has led to many research efforts to develop cements that do not contain gentamicin (or, for that matter, any antibiotic) but demonstrate excellent antimicrobial efficacy. There is a sizeable body of literature on these so-called “antibiotic-free antimicrobial” PMMA bone cements (AFAMBCs). The present work is a comprehensive and critical review of this body. In addition to summaries of key trends in results of characterization studies of AFAMBCs, the attractive features and shortcomings of the literature are highlighted. Shortcomings provide motivation for future work, with some ideas being formulation of a new generation of AFAMBCs by, example, adding a nanostructured material and/or an extract from a natural product to the powder and/or liquid of the basis cement, respectively.     

Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements

Percutaneous vertebroplasty, comprising an injection of polymethylmethacrylate (PMMA) into vertebral bodies, is a practical procedure for the stabilization of osteoporotic compression fractures as well as other weakening lesions. Cement leakage is considered to be one of the major and most severe complications during percutaneous vertebroplasty. The viscosity of the material plays a key role in this context. In order to enhance the safety for the patient, a rheometer system was developed to measure the cement viscosity intraoperatively. For this development, it is of great importance to know the proper viscosity to start the procedure determined by experienced surgeons and the relation between the time period when different injection devices are used and the cement viscosity. The purpose of the study was to investigate the viscosity ranges for different injection systems during conventional vertebroplasty. Clinically observed viscosity values and related time periods showed high scattering. In order to get a better understanding of the clinical observations, cement viscosity during hardening at different ambient temperatures and by simulation of the body temperature was investigated in vitro. It could be concluded, that the direct viscosity assessment with a rheometer during vertebroplasty can help clinicians to define a lower threshold viscosity and thereby decrease the risk of leakage and make adjustments to their injection technique in real time. Secondly, the acceleration in hardening of PMMA-based cements at body temperature can be useful in minimizing leakages by addressing them with a short injection break.     

A reduced-modulus acrylic bone cement: preliminary results

Excessive local contact stress is implicated as an important factor in the initiation of the loosening process after total joint arthroplasties. A reduced-modulus acrylic bone cement, which decreases the bone-cement interface stresses, was developed to test this hypothesis. The formulation consists of butylmethacrylate beads, having a glass transition temperature of 27 degrees C, in a methylmethacrylate matrix. This cement, polybutylmethylmethacrylate (PBMMA), has an elastic modulus one-eighth that of standard PMMA bone cement, 0.27 vs. 2.1 GPa, at body temperature. In vivo use in a pilot study using the sheep total hip arthroplasty model shows a reduction in the rate of loosening of femoral components when compared both radiographically and mechanically with PMMA controls.