明胶海绵在经皮椎体成形术中预防骨水泥渗漏的作用研究

摘要

目的 观察明胶海绵在经皮椎体成形术(percutaneous vertebroplasty,PVP)中预防骨水泥渗漏的作用效果.方法 回顾性分析2014年6月至2015年12月于我院行PVP治疗伴椎体前壁破损的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)病人72例,术中应用明胶海绵预先填塞椎体破损处的36例病人纳入明胶海绵组,未使用明胶海绵填塞的36例病人纳入常规组.收集并比较两组病人的疼痛视觉模拟量表(visual analogue scale,VAS)评分改善、椎体高度改善、Cobb角改善以及骨水泥渗漏率.结果 明胶海绵组未发生骨水泥渗漏,常规组发生6例(16.67%)骨水泥渗漏,两组间渗漏率的差异有统计学意义(χ2=4.546,P=0.033);明胶海绵组的VAS评分改善、椎体高度改善和Cobb角改善分别为(5.14±1.08)分、(8.70±3.64)mm、17.15°±6.81°,常规组的各项指标分别为(5.11±1.34)分、(8.69±4.31)mm、15.80° ±6.61°,两组间以上三项指标比较,差异均无统计学意义(P均>0.05).结论PVP治疗伴有椎体前壁破损的OVCF术中应用明胶海绵可以有效降低骨水泥的渗漏率,对骨水泥渗漏具有一定的预防作用.%Objective To study the preventive effect of gelfoam on cement leakage in percutaneous vertebroplasty (PVP). Methods A retrospective analysis was conducted in 72 OVCF patients with vertebral body anterior wall broken treated by PVP in our hospital from June 2014 to December 2015. Thirty-six patients who were treated by gelfoam for the vertebral bodies damaged served as the gelfoam group, and the other 36 cases without using gelfoam as the routine group. The visual analogue scale (VAS) scores, vertebral height, and kyphosis Cobb angel in the two groups were recorded and compared. Results The gelfoam group had no leakage of cement. Cement leakage occurred in 6 cases in routine group with a leakage rate of 16.67%, and the difference in the leakage rate between the two groups was statistically significant (χ2=4.546, P=0.033). The improvements in VAS score, vertebral height and Cobb angle in the gelfoam group were 5.14±1.08, (8.70±3.64) mm and 17.15° ± 6.81° , and those in the routine group were 5.11 ± 1.34, (8.69 ± 4.31) mm and 15.80° ± 6.61° respectively. There was no statistically significant difference between the two groups (P>0.05 for all). Conclusion Usage of gelfoam could effectively decrease the incidence of bone cement leakage in PVP for OVCF patients with vertebral body anterior wall broken, and also could have a certain preventive effect on bone cement leakage.