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 

Relationship between bone cement dispersion within pathologic vertebrae and fracture time in vertebroplasty

BACKGROUND: Vertebroplasty with bone cement injection in treatment of osteoporotic vertebral compression fractures has a positive clinical outcome, but there is a big controversy on the optimal timing of surgery.OBJECTIVE: To analyze the effect of fracture time on bone cement dispersion within pathologic vertebrae in vertebroplasty treatment. METHODS: Totally 160 elderly patients with osteoporotic vertebral compression fracture were included, and all were treated with vertebroplasty with high viscosity bone cement injection. According to the duration from fracture to surgery, patients were divided into three groups: fresh fracture group (< 3 weeks), subacute group (3-6 weeks) and old group (> 6 weeks). The bone cement distribution features, diffusion and leakage within the pathologic vertebrae were analyzed by three-dimensional CT image and X-rays. RESULTS AND CONCLUSION: The bone cement dispersion volume was ranked as fresh group > subacute group > old group, and there was significant difference between groups (P < 0.05). Bone cement dispersion characteristics of each group were uniform distribution with cement-based lumpy shape. The vast majority of bone cement all can disperse to exceed vertebral midline, reaching the upper and lower lamina to a greater degree. Bone cement dispersion coefficient within the pathologic vertebrae of patients in each group was ranked as fresh group > subacute group > old group, and there was significant difference between groups (P < 0.05). The bone cement leakage rate in the fresh fracture group was significantly lower than that in the subacute and old groups (P < 0.05). These results demonstrate that patients undergoing vertebroplasty within 3 weeks can obtain better bone cement dispersion effect.