定向弧形骨钻用于椎体成形术的实验研究

摘要

Objective To evaluate the effect of elastic curved bone drill unit upon percutaneous vertebroplasty,in order to explore the application value of intraoperative in vertebroplasty.Methods EDTA-Na2 immersion prepared calf osteoporosis vertebral in vitro,40 osteoporotic vertebral bodies were randomly divided into A and B two groups,each group had 20 vertebral bodies for vertebroplasty.Group A underwent routine straight bone drill puncture,Group B using self made elastic curved bone drill unit puncture,puncture arc direction toward the other side,depth to thefirst 1/3 termination of vertebral body,statistical analysis the two groups of puncture bone drill and bone cement which achieved or over the sagittal midline.Results 7 vertebral bodies of Group A that drill bit reach or over vertebral sagittal midline,11 vertebral bodies showed bone cement distribution beyond the vertebral sagittal midline.18 vertebral bodies of Group B that drill bit reach or over vertebral sagittal midline,19 vertebral bodies showed bone cement distribution beyond the vertebral sagittal midline.The effect of drilling and distribution of bone cement on the two groups had statistical significance(P<0.05).9 vertebral bodies of Group A happened intraspinal bone cement leakage,but 4 happened in group B,the leakage of bone cement showed no significant difference between Group A and B(P>0.05).Conclusion The self made elastic curved bone drill unit can build an osseous channel that reach or beyond the vertebral sagittal midline only through one side transpedicular puncture,then guided bone cement distributed to the other lateral of puncture,will avoid the disadvantages of bilateral pedicle puncture.The result show that the self made elastic curved bone drill unit has adventage in vertebroplasty than that of traditional straight bone drill.%目的：观察自制定向弧形骨钻在体外骨质疏松椎体成形术中的手术效果，从而探讨其在椎体成形术中的应用价值。方法：采用乙二胺四乙酸二钠盐（EDTA-Na2）浸泡法制备小牛体外骨质疏松椎体，将40个骨质疏松椎体随机分为A组、B组，每组20个椎体行椎体成形术，A组行常规直钻穿刺，B组采用自制定向弧形骨钻穿刺，弧形方向朝向穿刺对侧，深度达到椎体中前三分之一终止，对两组穿刺骨钻及骨水泥是否达到或越过椎体矢状中线进行统计分析。结果：直钻穿刺组钻头达到或越过椎体矢状中线有7个椎体，骨水泥分布达到或越过椎体矢状中线11个；定向弧形骨钻组穿刺钻头达到或越过椎体矢状中线有18个椎体，骨水泥分布达到或越过椎体矢状中线19个，两组骨钻穿刺效果及骨水泥分布上差异有统计学意义（P＜0.05）。A组9个椎体发生骨水泥椎管内渗漏，B组4个椎体发生骨水泥椎管内渗漏，两组间在骨水泥渗漏上差异无统计学意义（P＞0.05）。结论：自制定向弧形骨钻通过一侧椎弓根穿刺，可以建立一个达到或越过椎体矢状中线的骨性通道，引导骨水泥向穿刺对侧分布，避免了双侧椎弓根穿刺的弊端，其实验效果优于直骨钻。