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骨水泥灌注时机和灌注量对囊袋成形术效果的影响

Impact of time phase and volume of bone cement infusion on the effect of vesselplasty

  • 摘要:
    目的 探讨骨水泥的灌注时机和灌注量对囊袋成形术效果的影响。
    方法 取新鲜尸体胸、腰椎椎体,置入骨填充囊袋(bone-filling mesh container, BFMC;额定容积2 mL),分别按骨水泥混合后4 min灌注3、4、5、6 mL,骨水泥混合后4、5、6、8 min灌注4 mL分组,每组随机分配3个椎体。通过椎体的X线片、CT和骨水泥重建图像等影像学表现对结果进行评估。测量调整后CT图像上囊袋外的骨水泥渗出深度,分析骨水泥的渗出与灌注时机和灌注量之间的关系。
    结果 23个胸、腰椎椎体均呈骨质疏松状态(T值为-5.7±1.4)。各灌注量组椎体内囊袋的填充效果较好,囊袋外的骨水泥突起与松质骨之间形成较好的铰锁。灌注3~5 mL量时,囊袋外骨水泥渗出深度随灌注量增多而增加,Pearson相关系数为0.840(P<0.001);灌注5 mL量时有1个椎体发生破裂,6 mL量时有1个椎体发生骨水泥渗漏。各灌注时机组椎体内囊袋的填充均较好,骨水泥突起与松质骨之间铰锁满意,且均未发生明显的骨水泥渗漏。4 min组骨水泥的渗出深度较其他组稍大,但各组间差异无统计学意义。骨水泥渗出深度与灌注时机的相关性不强(Pearson相关系数为-0.429,P=0.052)。在4 min时进行灌注可能更易导致阻力增大(P=0.179)。
    结论 囊袋成形术效果与骨水泥灌注量有较强相关性,与灌注时机的相关性不强。在骨水泥混合后5~6 min进行灌注,灌注量较囊袋的额定容积增加1~2 mL,有利于改善囊袋成形术效果。

     

    Abstract:
    Objective To study the impact of volume and time phase of bone cement infusion on the effect of vesselplasty.
    Method Cadaveric thoracolumbar vertebral bodies were collected and divided into different groups according to the volume (3, 4, 5, 6 mL at 4 min after bone cement mixed) or time phase (4, 5, 6, 8 min as 4 mL) of bone cement injected into the bone-filling mesh container (BFMC) with 2 mL of capacity. The infusion effect was evaluated by X-ray and CT images of vertebrae and reconstructed images of cement mass. The cement permeation depth was measured on the adjusted CT image. The correlations of permeation depth with the volume and time phase of cement infused as well as interdigitation between bone and cement were analyzed.
    Result All 23 specimens were osteoporotic with the average T value of -5.7±1.4. BFMCs in each volume group expanded well, with good interdigitation between cement and cancellous bone outside the BFMC. The permeation depth outside BFMC grew obviously with addition of cement volume when injecting 3-5 mL, with 0.840 of correlation coefficient (P < 0.001). Cement leakage occurred in a vertebra when injecting 6 mL cement, while rupture of a specimen occurred in 5 mL group. There were also good filling and interdigitation when injecting cement at different time phase without obvious leakage. There was no strong correlation between permeation depth and volume of cement. Deeper permeation depth and higher injecting resistance were observed at the time phase of 4 min, but the differences were not statistically significant.
    Conclusion The effect of vesselplasty is related to the cement volume rather than time phase of cement infused. It recommends injecting bone cement of 1-2 mL more than capacity of BFMC at the time phase of 5-6 min.

     

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