【摘要】 [目的]探讨明胶海绵预填充在经皮椎体成形术(PVP)中预防骨水泥渗漏的可行性和有效性。[方法]回顾性分析2017年01月～2018年01月于本院行PVP治疗的伴椎体前壁破损的病理性椎体压缩骨折患者68例。明胶海绵组34例,术中应用明胶海绵预填充;常规组34例,术中未使用明胶海绵。分别记录并比较两组患者手术时间、骨水泥注入量、VAS和JOA评分、椎体高度变化、骨水泥渗漏例数等指标。[结果] 68例患者均顺利完成手术,两组患者术中均无明显出血,无明显骨水泥渗漏临床相关症状。两组在手术时间和骨水泥注入量的差异无统计学意义(P>0.05)。与术前相比较,术后3 d两组患者VAS评分均显著减少,差异有统计学意义(P<0.05),而术后3 d的JOA评分均较术前显著增加,差异有统计学意义(P<0.05)。各相应时间点,两组间VAS和JOA评分的差异均无统计学意义(P>0.05)。明胶海绵组无骨水泥渗漏病例,常规组有7例发生骨水泥渗漏,两组间渗漏率的差异有统计学意义(P<0.05)。术后患椎椎体高度增量两组差异无统计学意义(P>0.05)。[结论] PVP治疗伴有椎体前壁破损的病理性椎体压缩骨折术中应用明胶海绵预填充的方法可在缓解疼痛、改善椎体高度的基础上,有效预防骨水泥渗漏。更多还原

【Abstract】 [Objective] To explore the feasibility and effectiveness of gelfoam prefilling in percutaneous vertebroplasty(PVP) on preventing leakage of bone cement. [Methods] A retrospective analysis was performed on 68 patients who underwent PVP for pathological vertebral compression fractures accompanied with anterior vertebral wall broken in our hospital from January 2017 to January 2018. Of them, 34 patients had gelfoam prefilled before injection of bone cement, while the remaining 34 patients received conventional PVP without gelfoam prefilling. The operative time, volume of bone cement injected, visual analogue scale(VAS) for pain, Japanese Orthopaedic Association(JOA) score, vertebral height increment after PVP and bone cement leakage occurred were recorded and compared between the two groups. [Results] All the 68 patients had the surgical procedures performed smoothly without obvious bleeding and symptoms related the bone cement leakage in anyone of them. There were no significant differences in operation time and volume of bone cement injected between the gelfoam group and the conventional group(P>0.05). Compared with those before operation, the VAS scores significantly decreased, while the JOA scores significantly increased postoperatively in both groups(P<0.05), although no significant differences were proved in aforesaid parameters between the two groups at any matched time point(P>0.05). The bone cement leakage did not happen in anyone of the gelfoam group, whereas was found in 7 patients in the conventional group, which was statistically significant(P<0.05). However,there was no a statistically significant difference in vertebral height increment after PVP between the two groups(P>0.05).[Conclusion] This gelfoam prefilling does effectively prevent bone cement leakage in PVP on the basis of relieving pain and improving vertebral height for pathological vertebral compression fractures with anterior vertebral wall broken.更多还原