经皮椎体成形术中应用明胶海绵封堵骨水泥渗漏的疗效

黄震; 赵春; 杨志勇; 许刚; 王开明

doi:10.16766/j.cnki.issn.1674-4152.002811

经皮椎体成形术中应用明胶海绵封堵骨水泥渗漏的疗效

doi: 10.16766/j.cnki.issn.1674-4152.002811

黄震¹,
赵春¹,
杨志勇¹,
许刚²,
王开明^1, ,

1.
蚌埠市第三人民医院骨科, 安徽蚌埠 233000
2.
蚌埠医学院第一附属医院骨科, 安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究项目 KJ2021A0802

详细信息

通讯作者:
王开明，E-mail：57079971@qq.com

中图分类号: R683.2 R687.42
计量
- 文章访问数: 218
- HTML全文浏览量: 40
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-19
- 网络出版日期: 2023-04-07

Therapeutic efficacy of gelatin sponge to block bone cement leakage during percutaneous vertebroplasty

1.
Department of Orthopedics, Third People' s Hospital of Bengbu City, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨在骨质疏松性胸腰椎压缩性骨折中使用经皮椎体成形术方式中，应用明胶海绵封堵后骨水泥渗漏的治疗疗效。方法选取2020年2月—2022年2月蚌埠市第三人民医院骨科收治的46例胸腰椎体骨质疏松导致的骨折患者，采用随机数字表法将其分为明胶海绵组与常规对照组，每组各23例。患者术后随访1个月。记录3个时间点(术前、术后1 d、术后1个月)患者手术时间及骨水泥注入量、Cobb角、Beck指数、Oswestry功能障碍指数(ODI)、骨水泥弥散系数行统计分析，评估经皮椎体成形术中明胶海绵应用对骨水泥渗漏的疗效，并采用视觉模拟评分法评估术后患者疼痛缓解的情况。结果明胶海绵组患者发生骨水泥渗漏1例，渗漏率为4.35%，常规对照组骨水泥渗漏8例，骨水泥渗漏率为34.78%，2组差异有统计学意义(χ²=4.973, P=0.026)。明胶海绵组患者骨水泥弥散系数为(77.57±0.72)%，常规对照组为(58.20±0.85)%，2组差异有统计学意义(t=83.392, P＜0.001)。组间术前、术后1 d、术后1个月比较ODI、VAS评分、Cobb角、Beck指数差异均无统计学意义(均P＞0.05), 但各指标组内术后1 d、术后1个月与术前比较，差异均有统计学意义(均P＜0.05)。结论经皮椎体成形术中，采用预先置入明胶海绵封堵，能明显降低手术过程中由于骨水泥弥散过程中发生的渗漏率，有效改善骨水泥在责任椎体中的弥散效果。明胶海绵具有取材容易、价格低廉、便于操作等一系列优点，在临床工作中具有一定的推广价值。
- 经皮椎体成形术 /
- 明胶海绵 /
- 胸腰椎体骨质疏松性压缩骨折 /
- 骨水泥渗漏
Abstract: Objective To investigate the therapeutic efficacy of bone cement leakage after gelatin sponge plugging in percutaneous vertebroplasty in osteoporotic vertebral compression fracture. Methods The study retrospectively enrolled 46 patients with osteoporotic vertebral compression fracture, who were admitted to the Department of Orthopedics of Third People ' s Hospital of Bengbu City from February 2020 to February 2022. All patients were randomly divided into gelatin sponge group and control group, with 23 patients in each group. Patients were followed up for 1 months after surgery. The operation time, bone cement injection volume, Cobb angle, Beck index, Oswestry disability index (ODI), and bone cement diffusion coefficient were recorded and analyzed before operation, 1 day after operation, and 1 month after operation. The therapeutic efficacy of gelatin sponge application on bone cement leakage during percutaneous vertebroplasty was evaluated, and the pain relief effect of postoperative patients was evaluated by visual analog scale. Results The gelatin sponge group had one case of cement leakage (4.35%), while 8 patients (34.78%) had cement penetration in the control group, the difference between the two groups was statistically significant (χ²=4.973, P=0.026). The cement diffusion coefficient of gelatin sponge group and control group were (77.57±0.72)% and (58.20±0.85)%, respectively, with a statistically significant difference (t=83.392, P < 0.001). Before operation, 1 day after operation, and 1 month after operation, there were no significant differences in ODI, VAS score, Cobb angle, and Beck index between groups (all P>0.05). However, there were statistically significant differences in each index group 1 day after operation, 1 month after operation and before operation (all P < 0.05). Conclusion Gelatin sponge plugging can significantly reduce the incidence of leakage caused by cement diffusion during percutaneous vertebroplasty, and improve the diffusion effect of bone cement in diseased vertebrae. Gelatin sponge has a series of advantages such as easy material acquisition, low price, and easy operation, and has certain promotion value in clinical work.
- Percutaneous vertebroplasty /
- Gelatin sponge /
- Osteoporotic vertebral compression fractures /
- Cement leakage

HTML全文

图 1 明胶海绵组胸腰椎椎体压缩性骨折患者术前、术后影像学资料

注：A为术前T₂ MRI；B为术前脊椎X线正位片；C为术前脊柱X线侧位片；D为术后脊柱X线正位片；E为术后脊柱X线侧位片。

Figure 1. Preoperative and postoperative imaging data of patients with thoracolumbar vertebral compression fracture in gelatin sponge group

下载: 全尺寸图片幻灯片

图 2 常规对照组胸腰椎椎体压缩性骨折患者术前、术后影像学资料

注：A为术前T₂ MRI；B为术前脊椎X线正位片；C为术前脊柱X线侧位片；D为术后脊柱X线正位片；E为术后脊柱X线侧位片。

Figure 2. Preoperative and postoperative imaging data of patients with thoracolumbar vertebral compression fracture in conventional control group

下载: 全尺寸图片幻灯片

表 1 2组胸腰椎椎体压缩性骨折老年患者手术时间、骨水泥注入剂量比较(x ±s)

Table 1. Comparison of operative time and bone cement injection dose between two groups (x ±s)

组别	例数	手术时间(min)	骨水泥注入剂量(mL)
明胶海绵组	23	34.29±0.53	4.10±0.05
常规对照组	23	34.58±0.57	4.09±0.07
t值		1.787	0.558
P值		0.081	0.580

下载: 导出CSV

表 2 2组胸腰椎椎体压缩性骨折老年患者手术前后ODI、VAS评分、Cobb角、Beck指数比较(x ±s)

Table 2. Comparison of ODI, VAS score, Cobb angle, and Beck index before and after surgery between two groups (x ±s)

组别	例数	ODI(%)			F值	P值	VAS评分(分)			F值	P值
组别	例数	术前	术后1 d	术后1个月	F值	P值	术前	术后1 d	术后1个月	F值	P值
明胶海绵组	23	77.22±0.78	48.46±0.75^a	29.67±0.64^a	86.765	0.032	7.04±0.79	2.65±0.31^a	2.58±0.36^a	101.482	0.013
常规对照组	23	77.61±0.91	48.40±0.73^a	29.44±0.54^a	69.598	0.047	7.18±0.60	2.64±0.37^a	2.60±0.38^a	251.972	0.022
t值		1.521	0.275	1.317			0.677	0.099	0.183
P值		0.136	0.785	0.195			0.502	0.921	0.856

组别	例数	Cobb角(°)			F值	P值	Beck指数(%)			F值	P值
组别	例数	术前	术后1 d	术后1个月	F值	P值	术前	术后1 d	术后1个月	F值	P值
明胶海绵组	23	19.62±3.27	11.18±1.84^a	11.65±1.85^a	43.869	0.003	0.47±0.06	0.67±0.04^a	0.60±0.05^a	11.372	0.037
常规对照组	23	20.14±2.99	10.95±1.83^a	11.55±2.06^a	53.793	0.005	0.48±0.05	0.69±0.06^a	0.59±0.06^a	14.472	0.021
t值		0.563	0.425	0.173			0.614	1.330	0.614
P值		0.576	0.673	0.863			0.542	0.190	0.542
注：与同组术前比较，^aP＜0.05。

下载: 导出CSV

参考文献(20)

[1]	LI K P, FENG H Y, LUO D W, et al. Efficacy and safety of high-viscosity cement in percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures: a retrospective cohort study[J]. Medicine, 2020, 99(23): e20515. DOI: 10.1097/MD.0000000000020515.
[2]	RENIER H, GÉRARD L, LAMBORELLE P, et al. Efficacy of the tract em-bolization technique with gelatin sponge slurry to reduce pneumo- thorax and chest tube placement after percutaneous CT-guided lung biopsy[J]. Cardiovasc Inter Rad, 2020, 43(4): 597-603. doi: 10.1007/s00270-019-02387-3
[3]	BUCHBINDER R, JOHNSTON R V, RISCHIN K J, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J]. Cochrane Database Syst Rev, 2018, 4(4): CD006349. DOI: 10.1002/14651858.CD006349.pub4.
[4]	PEDERSEN P H, VERGARI C, ALZAKRI A, et al. A reduced microdose protocol for 3D reconstruction of the spine in children with scoliosis: results of a phantom-based and clinically validated study using stereo-radiography[J]. Eur Rad, 2019, 29(4): 1874-1881. doi: 10.1007/s00330-018-5749-8
[5]	YANG J S, LIU J J, CHU L, et al. Causes of residual back pain at early stage after percutaneous vertebroplasty: a retrospective analysis of 1, 316 cases[J]. Pain Physician, 2019, 22(5): E495-E503.
[6]	BAYRAM S, AKGVL T, AdIyaman A E, et al. Effect of sarcopenia on mortality after percutaneous vertebral augmentation treatment for os-teoporotic vertebral compression fractures in elderly patients: a ret-rospective cohort study[J]. World Neurosurg, 2020, 138: e354-e360. doi: 10.1016/j.wneu.2020.02.121
[7]	YANG E Z, XU J G, HUANG G Z, et al. Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures: a prospective randomized controlled clinical study[J]. Spine (Phila Pa 1976), 2016, 41(8): 653-660. doi: 10.1097/BRS.0000000000001298
[8]	LOU S, SHI X, ZHANG X, et al. Percutaneous vertebroplasty versus non-operative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials[J]. Osteoporosis Int, 2019, 30(12): 2369-2380. doi: 10.1007/s00198-019-05101-8
[9]	孙力. 探讨经皮椎体成形术治疗老年骨质疏松性胸腰椎压缩性骨折的疗效[J]. 中国现代药物应用, 2020, 14(2): 65-67. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202002033.htm SUN L. To investigate the effect of percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in the elderly[J]. Chinese Journal of Modern Drug Application, 2020, 14(2): 65-67. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202002033.htm
[10]	张顺利, 顾运涛, 陈荣, 等. 无脊髓压迫症状的迟发性创伤后脊柱塌陷患者行经皮椎体后凸成形术的疗效优势[J]. 中华全科医学, 2020, 18(10): 1667-1670, 1792. doi: 10.16766/j.cnki.issn.1674-4152.001588 ZHANG S L, GU Y T, CHEN R, et al. The advantage of percutaneous kyphoplasty in patients with Kummell' s disease without symptoms of spinal cord compression[J]. Chinese Journal of General Practice, 2020, 18(10): 1667-1670, 1792. doi: 10.16766/j.cnki.issn.1674-4152.001588
[11]	SAPER R B, LEMASTER C, DELITTO A, et al. Yoga, physical therapy, or education for chronic low back pain: a randomized noninferiority trial[J]. Ann Intern Med, 2017, 167(2): 85-94. doi: 10.7326/M16-2579
[12]	ÇOLAK T K, AKGÜL T, ÇOLAK I, et al. Health related quality of life and perception of deformity in patients with adolescent idiopathic scoliosis[J]. J Back Musculoskelet Rehabil, 2017, 30(3): 597-602. doi: 10.3233/BMR-160564
[13]	BEALL D P, CHAMBERS M R, THOMAS S, et al. Prospective and multicenter evaluationof outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures: the evolve trial[J]. Neurosurgery, 2019, 84(1): 169-178. doi: 10.1093/neuros/nyy017
[14]	王谦, 董军峰. 骨质疏松性椎体骨折椎体成形术后新发骨折的影响因素和注意事项[J]. 中国组织工程研究, 2022, 26(27): 4401-4405. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF202227023.htm WANG Q, DONG J F. Influencing factors and precautions of new vertebral fractures after vertebroplasty for osteoporotic vertebral fractures[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(27): 4401-4405. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF202227023.htm
[15]	李庆达, 贺园, 贺宝荣. 骨质疏松性胸腰椎骨折椎体强化术后并发骨水泥渗漏的若干问题[J]. 中华创伤杂志, 2022, 38(3): 193-197. LI Q D, HE Y, HE B R. Some issues in cement leakage after vertebral augmentation for osteoporotic thoracolumbar fracture[J]. Chinese Journal of Trauma, 2022, 38(3): 193-197.
[16]	YANG S F, LIU Y N, YANG H L, et al. Risk factors and correlation of secondary adjacentvertebral compression fracture in percutaneous kyphoplasty[J]. Int J Surg, 2016, 36(PtA): 138-142.
[17]	刘志强, 周云龙, 雷飞, 等. 不同时相骨水泥推注对经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折疗效的影响[J]. 中国修复重建外科杂志, 2020, 34(4): 435-441. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202004005.htm LIU Z Q, ZHOU Y L, LEI F, et al. Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 435-441. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202004005.htm
[18]	李友文, 郑兴平, 曾建洪, 等. 经皮椎体后凸成形与椎体成形治疗骨质疏松性椎体压缩骨折: 骨水泥渗漏与术后疼痛、伤椎Cobb角、步态恢复的关系[J]. 中国组织工程研究, 2022, 26(28): 4494-4499. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF202228015.htm LI Y W, ZHENG X P, ZENG J H, et al. Percutaneous kyphoplasty and percutaneous vertebroplasty for osteoporotic vertebral compression fractures: relationship of bone cement leakage with postoperative pain, Cobb angle of injured vertebrae, and gait recovery[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(28): 4494-4499. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF202228015.htm
[19]	田保磊, 姚啸生, 戚晓楠, 等. 椎体强化术后邻椎再发骨折影响因素及预防研究进展[J]. 中国中医骨伤科杂志, 2019, 27(1): 82-85. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG201901023.htm TIAN B L, YAO X S, QI X N, et al. Research progress on influencing factors and prevention of adjacent vertebral recurrent fracture after vertebral augmentation[J]. Chinese Journal of Traditional Medical Traumatology & Orthopedics, 2019, 27(1): 82-85. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG201901023.htm
[20]	刘刚, 石展英, 彭小忠, 等. 经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床效果分析[J]. 中国临床新医学, 2020, 13(1): 75-78. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLN202001018.htm LIU G, SHI Z Y, PENG X Z, et al. Clinical effect of percutaneous vertebroplasty on osteoporotic vertebral compression fractures[J]. Chinese Journal of New Clinical Medicine, 2020, 13(1): 75-78. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLN202001018.htm