经皮椎体成形中的骨水泥分期注射

背景：对于椎体骨皮质不完整的骨质疏松性椎体压缩骨折患者,经皮椎体成形治疗可能会发生骨水泥外漏压迫、损伤周围脆弱的神经、脊髓、血管组织而被视为临床禁忌。 目的：观察骨水泥分期注射在经皮椎体成形治疗中应用的方法和疗效。 方法：选择椎体骨皮质不完整的骨质疏松性椎体压缩性骨折患者26例,全部行经皮椎体成形治疗,随机选择12椎体采用骨水泥单侧椎弓根注射,14椎体采用骨水泥双侧椎弓根注射。治疗前后了解骨折椎体复位情况、椎体的容量变化、骨水泥分布及外漏情况及疼痛目测类比评分变化。 结果与结论：26个椎体无骨水泥外漏及神经根及脊髓受损情况,无肺栓塞及心脑血管系统急性反应,无手术中死亡。治疗后6个月时,两组椎体体积、疼痛目测类比评分均较治疗前明显改善(P < 0.01)。两组间比较差异无显著性意义(P > 0.05)。表明采用骨水泥分期注射经扩大了皮椎体成形手术适应证,能有效防止骨水泥外漏,获得满意临床疗效。     

椎体成形中病椎内骨水泥弥散与骨折时间的关系

背景：椎体成形骨水泥注射治疗骨质疏松椎体压缩性骨折具有肯定的临床疗效,但在手术最佳时机方面还存在着较大的争议。 目的：分析骨折时间对椎体成形病椎内骨水泥弥散的影响。 方法：纳入骨质疏松椎体压缩性骨折老年患者160例,均采用高黏度骨水泥进行椎体成形治疗,按骨折至手术时间分为新鲜组(<3周)、亚急性组(3-6周)和陈旧组(>6周)3组,术后即刻采用CT三维立体图像及X射线分析病椎内骨水泥的分布特点、弥散及渗漏情况。 结果与结论：骨水泥弥散体积比较为新鲜组>亚急性组>陈旧组,组间两两比较差异有显著性意义(P < 0.05);各组骨水泥弥散特征均以均匀分布为主,骨水泥形状以实习团块状为主,绝大多数骨水泥均能够较大程度地弥散到超过椎体中线、达到上下椎板;各组患者病椎内骨水泥弥散系数为新鲜组>亚急性组>陈旧组,组间两两比较差异有显著性意义(P < 0.05);新鲜组骨水泥渗漏率明显低于亚急性组和陈旧组(P < 0.05)。表明选择骨折3周内进行椎体成形治疗可获得较好的病椎内骨水泥弥散效果。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程      

Femoroplasty--augmentation of the proximal femur with a composite bone cement--feasibility, biomechanical properties and osteosynthesis potential

BACKGROUND: Analogous to vertebroplasty, cement-augmentation of the proximal femur ("femoroplasty") could reinforce osteoporotic bones. This study was to evaluate (i) the feasibility of femoroplasty with a composite cement (Cortoss), (ii) its influence on femoral strength by mechanical testing and (iii) the feasibility of stable osteosynthesis of the augmented fractured bones. METHODS: Nine human cadaveric femora were augmented with a composite bone cement, the surface heat generation monitored, and then tested biomechanically against their native contralateral control to determine fracture strength. Subsequently, thirteen reinforced and fractured femora were osteosynthetized by different implants and tested against their osteosynthetisized, non-augmented contralateral control. FINDINGS: Cement could be injected easily, with a moderate temperature rise. A positive correlation between BMD and fracture load and a significant increase in fracture load (+43%) of the augmented femora compared to their native controls (6324 N and 4430 N, respectively) as well as a significant increase in energy-to-failure (+187%, 86 N m and 30 N m, respectively) was found. Osteosynthesis was possible in cement-augmented femora. Osteosynthetisized femora showed equivalent strength to the intact controls. INTERPRETATION: Augmentation of the proximal femur with composite bone cement could be of use in prophylaxis of fractures in osteoporotic femurs. Osteosynthesis of the fractured augmented bones is a challenging procedure but has a good chance to restore strength.     

骨折线内骨水泥弥散状况对经皮椎体成形治疗的影响

背景：研究证实经皮椎体成形治疗过程中,骨水泥固化后可明显提高骨折椎体的稳定性、强度及力学支撑等效能,但目前关于骨水泥骨折线内弥散状况对经皮椎体成形治疗影响的研究很少。 目的：分析胸腰椎体骨质疏松性压缩骨折骨折线内骨水泥弥散状况对经皮椎体成形治疗的影响。 方法：纳入胸腰椎体骨折疏松性压缩骨折患者90例,其中男42例,女48例,年龄53-80岁,均进行经皮椎体成形骨水泥注射治疗,根据骨水泥在椎体内的弥散情况分2组,研究组(n=60)骨水泥弥散良好,对照组(n=30)骨水泥弥散不佳。记录患者治疗前后的目测类比评分、Oswestry功能障碍指数、伤椎后凸角及与骨水泥材料相关的不良反应情况。 结果与结论：两组治疗前的目测类比评分、Oswestry功能障碍指数比较差异均无显著性意义;研究组治疗后3 d及末次随访的目测类比评分低于对照组(P < 0.05),治疗后3 d的Oswestry功能障碍指数、伤椎后凸角低于对照组(P < 0.05),两组末次随访的Oswestry功能障碍指数、伤椎后凸角及骨水泥渗漏情况比较差异无显著性意义。表明在经皮椎体成形治疗中,骨水泥弥散良好者疼痛缓解更明显,椎体稳定性更好,近期疗效更明显。     

侧开与前开式骨水泥注入器椎体成形治疗骨质疏松性椎体压缩性骨折的比较

文题释义：经皮椎体成形：自Galibert等于1987年首次描述以来,经皮椎体成形已被广泛用于骨质疏松性椎体骨折的治疗,可迅速缓解腰背痛,改善患者活动,是治疗骨质疏松性椎体骨折安全有效的一种微创手术。 侧开口骨水泥注入器：在传统前开口注入器的基础上,通过密封前开口并在远端末端侧向开口来修改套管,侧开口的尺寸对应于套管的横截面。与传统的前开口注入器相比,侧开口骨水泥注入器可改善经皮椎体成形术中的骨水泥充盈模式,引导水泥流向内侧,降低渗漏风险,同时增加骨水泥注入量。 背景：有研究显示与传统的前开口注入器相比,侧开口注入器可改善椎体成形治疗中的骨水泥充盈模式,引导水泥流向内侧,降低渗漏风险,同时增加骨水泥注入量。 目的：探讨采用侧开式注入器进行椎体成形骨水泥注射治疗骨质疏松性椎体压缩性骨折及防止术中骨水泥渗漏的临床疗效。 方法：选择2014年1月至2018年12月衡水市哈励逊国际和平医院收治的220例骨质疏松性椎体压缩性骨折患者,其中114例采用侧开式注入器进行双侧椎弓根椎体成形骨水泥注射治疗,106例采用标准前开式注入器进行双侧椎弓根椎体成形骨水泥注射治疗,术后拍摄X射线和CT扫描评估骨水泥渗漏情况。术前和术后3 d及6个月进行目测类比评分与椎体压缩率评估。研究获得衡水市哈励逊国际和平医院伦理委员会批准(20131214841X)。 结果与结论：①220例患者均顺利完成手术,无任何早期并发症,疼痛均有所缓解,生活质量得到明显改善;②侧开式注入器组骨水泥注射量大于前开式注入器组(P < 0.05);③两组术后3 d、6个月的目测类比评分均明显低于术前(P < 0.05),但两组组间比较差异无显著性意义(P > 0.05);④侧开式注入器组130个椎体中21个椎体发生骨水泥渗漏(渗漏率为16.15%),前开式注入器组120个椎体中36个椎体发生骨水泥渗漏(渗漏率为30%),侧开式注入器组骨水泥渗漏率低于前开式注入器组(P < 0.05);⑤两组术后3 d、6个月的椎体压缩率较术前显著降低(P < 0.05),两组组间椎体压缩率比较差异无显著性意义(P > 0.05);⑥结果表明,采用侧开式或前开式注入器进行椎体成形骨水泥注射治疗骨质疏松性椎体骨折均可获得令人满意的临床疗效,但侧开式注入器可优化骨水泥注入模式,降低渗漏及渗入椎体周围血管的潜在风险,同时可通过调整骨水泥注入方向达到较为满意的骨水泥弥漫效果。 ORCID: 0000-0001-5328-9440(庞巨涛) 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

经皮椎体成形中椎旁血管渗漏与骨水泥性肺栓塞

背景：通过经皮穿刺向椎体内注射骨水泥可增强椎体强度及稳定椎体,达到止痛目的,但骨水泥可能在注入过程中渗漏入椎旁血管,并通过腔静脉系统回流至右心室进而进入肺动脉造成肺栓塞。 目的：探讨经皮椎体成形中骨水泥椎旁血管渗漏与骨水泥性肺栓塞的关系。 方法：回顾性分析骨质疏松性椎体压缩骨折行椎体成形患者134例,其中出现骨水泥椎旁血管渗漏患者共23例设为实验组,取未出现骨水泥椎旁血管渗漏且有完整影像学资料43例患者设为对照组。通过椎体成形前后行脊柱和胸部X射线检查确定两组患者是否存在骨水泥椎旁血管渗漏及骨水泥性肺栓塞。 结果与结论：134例患者中共有23例出现骨水泥椎旁血管渗漏,占17.2%。出现椎旁血管渗漏的23例中有3例出现骨水泥性肺栓塞,占出现椎旁血管渗漏患者的13%,但均无胸部症状。对照组43例患者中未出现椎旁血管渗漏的患者也未出现骨水泥性肺栓塞,两组比较差异有显著性意义(P=0.039)。提示骨质疏松性椎体压缩骨折患者行椎体成形过程中一旦出现骨水泥椎旁血管渗漏,尽管并无胸部症状仍应警惕骨水泥性肺栓塞可能。     

骨水泥注射体积与骨质疏松压缩性骨折椎体及邻近椎体应力的关系

背景：椎体成形及椎体后凸成形可有效修复骨质疏松性椎体压缩性骨折,但术后可引起骨折椎体及邻近椎体应力改变易导致新发骨折。 目的：应用三维有限元法分析椎体成形不同体积骨水泥注射后骨折椎体及邻近椎体的应力变化。 方法：选取1例有代表性的健康成年男性志愿者行腰椎CT扫描,将图像处理后导出应用Mimics进行三维重建,应用Geomagic对三维模型进行光滑、打磨、去噪,Ansys Workbench下装配实体模型,赋值后建立L2-L4段骨质疏松椎体压缩性骨折模型。设定在L3椎体注入分别1 mL、2 mL、4 mL、6 mL骨水泥,骨水泥在椎体中央呈球形分布。在L2上表面施加500 N预载荷,附加弯矩为50 N•m,约束L4下表面自由度。模拟L2-L4前屈、后伸、右屈及右侧轴向旋转4种运动状态,比较不同体积骨水泥注射前后骨折椎体及上下邻近椎体的应力变化。 结果与结论：骨折椎体及邻近椎体应力骨水泥注射后均较注射前明显增加,并随骨水泥注入量的增加骨折椎体及邻近椎体承受的应力也随之增大,其可能是导致邻近椎体骨折的因素之一。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程      

Dispersion degree of a small-dose bone cement北大核心

BACKGROUND: During the percutaneous vertebroplasty, the optimal dose of bone cement that can bring favorable cement dispersion and remodel the biomechanical balance of the fractured vertebrae remains controversial. OBJECTIVE: To investigate the dispersion degree of small dose of bone cement in vertebroplasty. METHODS: In this experiment, 18 sheep selected with the same condition were randomly divided into three groups (group A, group B, group C), 6 in each group. A model of thoracolumbar vertebral compression fracture (T12, L1, L2) was made in each sheep. The injected volume of bone cement in groups A, B, C was 15%, 20%, 25% of the average volume of adjacent vertebral bodies, respectively. Postoperative CT images were used to evaluate the bone cement dispersion. Dispersion degree of bone cement among the three groups was compared by the Kruskal-Wallis test. RESULTS AND CONCLUSION: There was no statistical difference in the dispersion degree of bone cement among the three groups, and the excellent and good rate of dispersion was over 80%. To conclude, the optimal dose of bone cement injected into the fractured vertebra is 15% of the average volume of adjacent vertebral bodies, which can achieve good dispersion degree and restore the biomechanical stability of the vertebral body. © 2018, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

骨水泥充填治疗多节段骨质疏松性压缩性骨折的病例分析

背景：椎体骨质疏松性压缩骨折多发生于骨质钙丢失严重的老年人群,轻微的外力就可以引起椎体骨折,近年来发展起来的经皮椎体成形治疗骨质疏松性压缩性骨折效果较好。 目的：探讨骨水泥充填治疗多节段骨质疏松性压缩性骨折的疗效及材料的特性。 方法：采用骨水泥充填材料经皮椎体成形治疗多椎体骨质疏松性压缩骨折患者32例,共158个椎体。治疗后复查X 射线、CT等辅助检查,了解骨折椎体复位情况、椎体的容量变化、骨水泥分布及外漏情况,用CT容量分析法检测治疗前后椎体的容积变化,观察疼痛强度评价的目测类比评分变化,分析发生骨水泥渗漏的原因。 结果与结论：纳入结果分析32例,158个椎体。注射骨水泥后无神经根及脊髓损伤,无肺栓塞及心脑血管系统急性反应。①治疗后随访6-16个月,平均随访10个月,无严重并发症和椎体塌陷。②治疗前椎体体积为(22.2±8.6) cm³,治疗后增至(24.8±6.9) cm³,体积变化差异有统计学意义(P < 0.05)。③6个椎体发生骨水泥渗漏,分别为椎管内硬膜外2个、椎旁静脉4个,可能与椎体后缘爆裂、骨水泥黏度过低以及注射速度过快有关。④治疗后48 h目测类比评分为(2.2±3.7)分,较治疗前(8.3±1.6)分显著下降(t=25.2,P < 0.05)。作者认为,对于多节段骨质疏松性压缩性骨折,采用充分的治疗前准备和恰当的方法,选择合适的骨水泥充填材料,一期行经皮椎体成形治疗是安全可行的,可明显缓解患者的疼痛症状,治疗中操作要注意防止骨水泥渗漏。     

Influence of oscillatory mixing on the injectability of three acrylic and two calcium-phosphate bone cements for vertebroplasty

Injecting acrylic and, increasingly, calcium-phosphate cements into the porous bone structure is an emerging procedure, referred to as vertebroplasty, for the augmentation of osteoporotic vertebrae. Despite the benefits of vertebroplasty, it has limitations. The limitations of interest in this study are the injectability of bone cements and their mixing variability (i.e., low reproducibility of resulting viscosity). The objective of this study is to investigate the effect of oscillatory versus manual mixing on cement viscosity and mixing variability. Five cements are tested: (a) Vertebroplastic, (b) DP-Pour, (c) Antibiotic Simplex, (d) chronOS Inject, and (e) Biopex. Compared to manual mixing, oscillatory mixing significantly decreased the mean viscosity and the mixing variability, which was inferred from the coefficient of variation. For example, under oscillatory mixing, the viscosity and the variability for Vertebroplastic decreased to one-third of the corresponding values for manual mixing. Similar results were obtained for the other cements. The decrease in viscosity is attributed to the pseudo-plastic behavior of bone cements. The decrease in the variability of cement viscosity was attributed to greater dispersive mixing of the cement components under oscillatory mixing. The decrease in viscosity eases the injection by reducing the pressure required. The decrease in the variability of cement viscosity increases reproducibility of the cement injection. Oscillatory mixing appears to have the potential to contribute to improving vertebroplasty.     

经皮椎体成形高黏度骨水泥注入修复老年椎体压缩骨折：椎体高度恢复评价

背景：在应用高黏度骨水泥以及椎体成形修复骨质疏松性椎体压缩骨折的过程中,骨水泥的推注量-压缩椎体高度的恢复-临床疗效”之间是否存在必然联系以及内在的规律,目前缺乏此方面的循证医学证据,且存在一定争议。 目的：观察经皮椎体成形高黏度骨水泥注入修复老年骨质疏松椎体压缩性骨折的椎体高度恢复情况。 方法：选取2011年1月至2012年12月新疆维吾尔自治区中医医院脊柱外科收治的骨质疏松压缩性骨折老年患者110例,共139椎,均由同一组外科医生采用经皮椎体成形治疗,在骨水泥拉丝期时在“G”形臂监视下将高黏度骨水泥注入骨折椎体内。治疗后随访12个月,以目测类比评分、Barthel指数、椎体高度恢复为观察评价指标。 结果与结论：110例患者共139椎,修复过程顺利,单个椎体骨水泥平均注入量为3-6 mL,平均3.5 mL。患者的目测类比评分由治疗前平均7.9分降到了治疗后12个月的平均1.8分;Barthel指数治疗前平均为40.25,治疗后12个月时为82.21,治疗后与治疗前比较目测类比评分和Barthel指数均有明显改善(P < 0.05)。治疗后139个椎体前、中部的高度增加到了原椎体高度的(81.25±9.26)%和(78.22±10.65)%,治疗后24 h、3个月、12个月与治疗前相比椎体前部、中部高度均有显著恢复(P < 0.05)。治疗后通过随访观察发现,发生高黏度骨水泥渗漏的椎体有5个,以上患者未出现临床症状,未发生神经损伤或肺栓塞等严重并发症。提示经皮椎体成形高黏度骨水泥注入修复骨质疏松性椎体压缩性骨折的过程中,不仅可以有效缓解患者疼痛,在不同程度上恢复压缩椎体的高度,而且并发症发生率低,患者恢复时间短。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

椎体后凸成形骨水泥注射治疗的有限元模型数字化评价

背景:由于经皮椎体后凸成形的治疗原理、远期疗效、并发症均与其生物力学密切相关,其生物力学引起了广泛关注。目的:建立椎体后凸成形骨水泥注射治疗后的生物力学变化及骨水泥泄漏虚拟数字化评价系统。方法:在前期实验已建立的L3-L5三维模型的基础上进行椎体后凸成形骨水泥注射操作,并导入Abaqus2016软件将模型立体化,进行有限元分析,分析骨水泥注射方式、注射压力及注射量对L4骨折椎体终板应力的影响。结果与结论:①模拟经皮椎体后凸成形手术操作填充骨水泥后,L4骨折椎体终板在骨水泥的承载分压作用下应力明显降低。不同注射方式对L4骨折椎体终板所受应力影响不显著(P> 0.05),但双侧注射使骨水泥分布更加均匀,效果最好;②不同注射压力对L4骨折椎体终板所受应力影响不显著(P> 0.05),但随着注射压力的增加,骨水泥分布更加分散,更容易出现渗漏;③随着骨水泥注射剂量逐渐增加,L4骨折椎体终板应力逐渐降低(P<0.05),注射2 mL时不能恢复椎体的生理刚度,4 mL时骨水泥分布更加集中,8 mL时达到屈服点;④骨水泥注射后,下位椎体上终板比上位椎体下终板更容易出现再骨折的情况:⑤结果表明,模拟手术前后L4椎体终板应力发生明显转移,即L4上终板应力增加,L4下终板应力减少;不同注射方式对手术结果影响不大,但双侧注入的骨水泥分布更加均匀,降低了术后再次骨折和塌陷的概率;选用低注射压力可降低术后骨水泥泄露风险;4 mL注射量既能使病椎恢复较好的刚度及生理曲度又未达到屈服点而引起再次骨折。     

Cardiovascular changes after pulmonary embolism from injecting calcium phosphate cement

Concerns have been raised that the use of calcium phosphate (CaP) cements for the augmentation of fractured, osteoporotic bones may aggravate cardiovascular deterioration in the event of pulmonary cement embolism by stimulating coagulation. The aim of the present study was therefore to investigate the cardiovascular changes after pulmonary embolism of CaP cement using an animal model. In 14 sheep, 2.0 mL CaP or polymethylmethacrylate cement were injected intravenously. Cardiovascular parameters and antithrombin levels were monitored until 60 min postinjection. Postmortem, lungs were subjected to CT scanning, and 3D reconstruction of the cement was performed. Intravenous injection of CaP cement resulted in a more severe increase in pulmonary arterial pressure and decrease in arterial blood pressure. Disintegration of the CaP cement seemed to be the reason for the more severe reaction. There was no evidence of thromboembolism. Disintegration of CaP cement in circulating blood does not only compromise the mechanical properties, but also represents a risk of cardiovascular complications. Reliable cohesion of CaP cements in an aqueous environment is essential for clinical applications such as osteoporotic bone augmentation.     

应用弯角椎体成形装置修复胸腰段骨质疏松性椎体压缩骨折

BACKGROUND: Currently, the cement delivery device used in vertebral augmentation vertebral augmentation (vertebroplasty and kyphoplasty) has flat tips that cannot be bent. During surgery, we always choose injection cement by symmetric way to keep the balance of power on the biomechanics of the vertebral body, while the traditional cement delivery tube can only be used in ipsilateral vertebral body.     

A biomechanical model for real-time simulation of PMMA injection with haptics

We have developed a computationally efficient rheological model to simulate polymethylmethacrylate (PMMA) injection into cancellous bone during percutaneous vertebroplasty. The model employs the Hagen-Poiseuille law to predict pressure drop across a delivery cannula with viscoelastic changes of curing PMMA modeled via a time and shear-rate-dependent power law. The power law was derived based on dynamic rheological testing of curing PMMA samples. In conjunction with a branching-pipe geometrical model that is reconstructed from micro-computed tomography scans of cancellous bone for estimating pressure changes during PMMA flow in bone, the method provides a fast estimation of overall injection pressure, and, hence, the reaction force during manual PMMA injection.     

骨水泥植入经皮椎体成形治疗胸腰椎体骨折

背景：近年来,经皮椎体成形作为一种安全有效的微创手术广泛应用于治疗骨质疏松性压缩骨折和椎体肿瘤引起的溶骨性骨破坏,获得了满意的效果。 目的：从骨水泥角度,探讨骨水泥与椎体成形治疗胸腰椎骨折疗效的关系。 方法：以“椎体成形术,腰椎,胸椎,椎体骨折,骨水泥”;“pereutaneous vertebroplasty,PVP,thoracic vertebra,lumbar vertebra,vertebral fracture,bone cement”为关键词检索维普数据库和Pubmed数据库,纳入与经皮椎体成形、骨水泥植入临床研究相关的文章,以22篇文献为重点进行了讨论。临床验证选择新乡医学院第一附属医院骨外科收治的40例(56个椎体)胸腰椎体骨折引起的疼痛患者,在 C形臂X射线机引导下,经皮穿刺完成椎体成形手术,观察术后疼痛改善,并分析并发症发生情况。 结果与结论：目前在经皮椎体成形中常用的骨水泥有聚甲基丙烯酸甲酯骨水泥、磷酸钙骨水泥、硫酸钙骨水泥等。目前仍不清楚为骨折愈合提供足够稳定和预防疼痛所需要的骨水泥量及成分比,但应尽量使用小剂量的骨水泥,且使骨水泥分布均匀,同时应根据病变椎体的不同情况,选择合适的注射方式,防止骨水泥渗漏与新椎体骨折。临床验证结果说明经皮椎体成形可以有效止痛,术后随访显示止痛效果与注入骨水泥的量无正相关,且不随着时间的推移而减弱。     

Evaluation of the biphasic calcium composite (BCC), a novel bone cement,in a minipig model of pulmonary embolism

Polymethylmethacrylate (PMMA) bone cement, which is used as a filler material in vertebroplasty, is one of the major sources of pulmonary embolism in patients who have undergone vertebroplasty. In the present study, we established and evaluated two animal models of pulmonary embolism by injecting PMMA or biphasic calcium composite (BCC) bone cement with a negative surface charge. A total of 12 adults and healthy Wuzhishan minipigs were randomly divided into two groups, the PMMA and BBC groups, which received injection of PMMA bone cement and BBC bone cement with a negative surface charge in the circulation system through the pulmonary trunk, respectively, to construct animal models of pulmonary embolism. The hemodynamics, arterial blood gas, and plasma coagulation were compared between these two groups. In addition, morphological changes of the lung were examined using three-dimensional computed tomography. The results showed that both PMMA and BCC injections induced pulmonary embolisms in minipigs. Compared to the PMMA group, the BCC group exhibited significantly lower levels of arterial pressure, pulmonary artery pressure, blood oxygen pressure, blood carbon dioxide pressure, blood bicarbonate, base excess, antithrombin III and D-dimer. In conclusion, BCC bone cement with a negative surface charge is a promising filler material for vertebroplasty.     

Evolution of Vertebroplasty: A Biomechanical Perspective

This paper is a collection of computational, finite element studies on vertebroplasty performed in our laboratory, which attempts to provide new biomechanical evidence and a fresh perspective into how the procedure can be implemented more effectively toward the goal of preventing osteoporosis-related fractures. The percutaneous application of a bone cement to vertebral defects associated with osteoporotic vertebral compression fracture has proven clinical successful in alleviating back pain. When the biomechanical efficacy of the procedure was examined, however, vertebroplasty was found to be limited in its ability to provide sufficient augmentation to prevent further fractures without risking complications arising from cement extravasations. The procedure may instead be more efficient biomechanically as a prophylactic treatment, to mechanically reinforce osteoporotic vertebrae at risk for fracture. Patient selection for such intervention may be reliably achieved with the more accurate fracture risk assessments based on vertebral strength, predicted using geometrically detailed, specimen-specific finite element models, rather than on bone density alone. Optimal cement volume, placement, and material properties were also recommended. The future of vertebroplasty involving biodegradable augmentation material laced with osteogenic agents that upon release will stimulate new bone growth and increase bone mass was proposed.     

椎体注射骨水泥强化治疗骨质疏松性胸腰椎体压缩骨折

背景：椎体成形注射骨水泥可在复位骨折的同时,达到矫正后凸畸形、增强椎体强度、消除椎体病变的效果。 目的：分析椎体注射骨水泥强化疗法在骨质疏松性胸腰椎体压缩骨折中的应用效果。 方法：选择84例骨质疏松性胸腰椎体压缩性骨折患者,病变椎体T6-L4,其中男37例,女47例,年龄58-80岁,采用随机数表法均分为2组,研究组进行椎体注射骨水泥强化治疗,对照组进行卧床休息、定期进行腰背肌功能锻炼的保守治疗。对比两组治疗前后的目测类比评分、功能障碍评分和椎体高度。 结果与结论：两组治疗前的椎体高度、目测类比评分和功能障碍评分比较差异均无显著性意义;研究组治疗后3个月的椎体高度为(1.653±0.168) cm,显著高于对照组的(1.521±0.200) cm(P < 0.05);研究组随访3个月及末次随访的目测类比评分和功能障碍评分均低于对照组(P < 0.05)。对照组治疗后,2例发生压疮,3例发生深静脉血栓,1例发生肺炎,2例发生泌尿系统感染;研究组4例发生骨水泥渗漏,但未引发明显的临床症状。对照组中有3例发生再骨折,研究组有4例发生再骨折,两组再骨折发生率比较差异无显著性意义(P > 0.05)。表明椎体注射骨水泥强化治疗骨质疏松性胸腰椎体压缩性骨折能迅速镇痛,短期内改善患者生活质量,且能较好恢复脊椎高度。     

椎体成形与弯角椎体成形治疗骨质疏松性椎体压缩骨折：骨水泥注射后分布与渗漏率的比较

背景:弯角椎体成形为椎体成形的改良术式,其最大的特点是能使骨水泥对称均匀分布,平衡椎体两侧强度,理论上能保证骨水泥在椎体内的均匀分布,解决传统经皮椎体成形单点、单次注射骨水泥分布不均导致骨折区疼痛缓解效果不佳的问题。目的:对比椎体成形与弯角椎体成形行骨水泥注射治疗骨质疏松性椎体压缩骨折的临床疗效,探讨弯角椎体成形在临床应用中的价值。方法:选择2017至2018年安徽医科大学第三附属医院收治的单椎体骨质疏松性椎体压缩骨折患者70例,随机分2组:椎体成形组(n=35)进行椎体成形聚甲基丙烯酸甲酯骨水泥注射治疗,弯角椎体成形组(n=35)进行弯角椎体成形聚甲基丙烯酸甲酯骨水泥注射治疗,观察两组骨水泥分布与渗漏情况;术前、术后1 d进行目测类比评分与Oswestry功能障碍指数评估;术后随访1年,观察伤椎椎体前缘高度恢复情况与邻近椎体骨折发生的情况。试验获得安徽医科大学医科大学第三附属医院伦理委员会批准。结果与结论:①与椎体成形组比较,弯角椎体成形组骨水泥分布较均匀、较满意(P<0.05),骨水泥渗漏率较低(P<0.05);②两组术后1 d的目测类比评分与Oswestry功能障碍指数均较术前明显改善(P<0.05),且弯角椎体成形组术后1 d的Oswestry功能障碍指数改善优于椎体成形组(P<0.05);③两组术后1年的伤椎椎体前缘高度均较术前明显改善(P<0.05),两组间比较差异无显著性意义(P>0.05);④两组邻近椎体骨折发生率比较差异无显著性意义(P>0.05);⑤结果表明与椎体成形治疗比较,弯角椎体成形行骨水泥注射治疗骨质疏松性椎体压缩骨折可降低骨水泥的渗漏率,提高患者生活质量。