阶段注射法预防椎体成型术中骨水泥渗漏的实验研究

目的通过离体实验评价两阶段注射法在椎体成型术中对骨水泥渗漏的预防作用。方法50个新鲜绵羊腰椎随机分成实验组及对照组。分别采用两阶段注射法及常规椎体成型方法,在X线透视引导下向椎体内注射总量为3mL的PMMA,模拟临床椎体成型术。实验组首先向椎体后部注射0.5mL的PMMA,待其固化后,再次向椎体内注射2.5mL的PMMA。对照组以常规方法向椎体内注射3mL的PMMA。通过X线及肉眼直视,统计两组骨水泥渗漏的发生率。结果对照组有8例出现骨水泥向椎管内渗漏,而实验组中仅2例,显著低于对照组(P=0.032)。尽管实验组骨水泥总体渗漏发生率56%高于对照组44%,但无统计学差别。结论两阶段注射法可显著降低骨水泥向椎管内方向渗漏的发生率。

Staged-injection procedure to prevent cement leakage during vertebroplasty:an in vitro study

Objective To determine the preventable effect of a staged-injection procedure in cement leakage during vertebroplasty.Methods 50 vertebral bodies (L1-L5) were harvested from each of 10 osteoporotic sheep (3±1 years),screened for bone density and disarticulated.PMMA was injected into vertebral bodies by the two-stage injection procedure (group A) and the conventional injection procedure (group B).In group A,0.5 mL cement was injected at first stage.15 minutes later,after the cement solidified,another 2.5 mL cement was injected into the center part of the vertebral bodies through transpedicular approach.In group B,vertehroplasty was performed through the transpedicular approach as usual.When the tip of the needle reached aim area of vertebral bodies,3.0 mL cement was injected one time.Cement leakage rates were recorded.Results The two-stage injection procedure resulted in a significant decrease in the epidural or canal leakage rate.Additionally,the paravertehral leakage rate was higher in two-stage injection procedure (56%) than in conventional injection procedure (44%).However,no significant difference was found for the total cement leakage rate in two groups.Conclusion Compared with conventional procedure,the twostage injection procedure in vertebroplasty decreased incidence of epidural and canal leaks.The first-stage injecting PMMA can be a barrier to the epidural extravasation of cement during vertebroplasty.