经皮椎体成形术中椎体内压力的测定与分析
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Measurement and Analysis of Vertebral Pressure in Percutaneous Vertebroplasty
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    摘要:

    目的 从生物力学的角度来分析椎体成形术(PVP)中并发症发生的可能性缘由,并提出科学的预防性建议。方法 对16例具有脊柱椎体骨质疏松症临床诊断的老年尸体腰椎(14具)有椎体压缩性骨折的椎体(其椎体骨密度值T<-2.5)予以C-arm透视机的动态监测下达到临床评价要求的椎体成形术,采用unisensor AG公司生产的直径为2.0mm的微型压力传感器(5mv/bar)和Peekel Instruments GmbH生产的载频放大器及其附属配套软件-SignaSoft6000 (PICAS & SIGNALOG 6000)测定每个椎体的椎体成形术术中椎体内压力的动态变化,采用描述性的统计和非参数统计方法进行统计学上的描述和分析,并就并发症发生的可能性进行临床意义上的分析。结果 每个椎体的椎体成形术均达到临床评价要求,每次推杆(美国Kypho公司提供标准椎体成形术中Yamshi-Nadel套系中推注骨水泥入椎体的器具,每具推杆可容纳骨水泥约1.5mL)推注骨水泥入椎体时所产生的椎体内的压力P(下标 max)不是很高,多数在0.50 bar以下,其所导致的效应具有显著的统计学差异(P<0.01),而每次推杆推注骨水泥入椎体时的椎体内压力面积值P(下标 ares)也不是很高,多数在10.00 Unit以下,其所导致的效应具有显著的统计学差异(P<0.01),两者均呈偏态分布;而且,对每例椎体的第一、二、三、四杆之间两两予以统计学上的分析,在总体存在差异有统计学意义的基础上还发现除第一和二杆、第三和四杆之间外,其他各杆之间存在着差异(a<0.0083)。结论 对骨质疏松性腰椎椎体压缩性骨折行椎体成形术(PVP)时,其在推注骨水泥入病椎时一般3推杆(约4.5ml骨水泥)即可达到推注骨水泥的临床评价要求,已无必要予第四杆等再次将骨水泥推注入病椎,既不作无意义的行为,又减少发生手术并发症的风险。

    Abstract:

    Objective To analyze the possible causes of complication in vertebroplasty (PVP) operation from the view of biomechanics and provide some preventive suggestions accordingly. Method The 16 lunbar spinal vertebrae with osteoprotic compression fracture from the 14 elderly corpses (the vertebral bone mineral density T<-2.5) were selected and monitored to meet the demands of clinical assessment of PVP under C-arm. With the adoption of micro pressure unisensor (5mv/bar) and carrier frequency amplifier as well as its Signai-Soft6000 (PICAS & SIGNALOG 6000) produced by AG company and Peekel Instrument GmbH respectively, the dynamic changes with pressure in each vertebrae vertebroplasty were assessed by using statistical description and analysis through descriptive statistics and nonparametric statistical approach; the possibility of complication was also clinically examined. Result Each vertebra of vertebroplasty met the clinical evaluation requirements. Each time after putting to (the instrument with the set of Yamshidi-Nadel provided by Kypho of America for injection of bone cement into the vertebrae; each putting could contain about 1.5 mL bone cement) inject bone cement into the vertebrae, the pressure P(subscript max) was not very high, with 500 kPa bar below for majority and the effect caused showed a significant statistical difference (P<0.01). Whereas, the pressure within the area of the vertebral P(subscript area) value was not high either, the majority was 10.00 Unit lower, which also led to the effects of significant difference (P<0.01). Both two states showed partial distribution. After making the statistical analysis to the casual two puttings between the first, second, third and fourth putting of each vertebrae, there existed the general differences. The differences were also found between other puttings (a<0.0083) on the statistics basis apart from between the first and second and between the third and fourth. Conclusions For osteoporosis of lumbar vertebral compression fractures vertebroplasty (PVP), its bone cement injected into the vertebrae could achieve clinical evaluation requirements with three putts enough (about 4.5 ml of bone cement), and no need to have fourth-bone cement injection, which not only could avoid frivolous behavior, but also reduce the risk of surgical complications.

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胡晓晖,Fritz-Uwe Niethard,张扬,吴春根,张明.经皮椎体成形术中椎体内压力的测定与分析[J].医用生物力学,2009,24(1):44-49

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  • 收稿日期:2008-08-26
  • 最后修改日期:2008-11-03
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