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目的 探讨经皮椎体强化的方法及聚甲基丙烯酸甲酯 (PMMA)骨水泥在椎体内的影像学分布 ,为临床开展应用提供技术指导。方法 15个新鲜的人体腰椎椎体分成 3组 ,经椎弓根分别注入 3种浓度为 1∶1(6个 )、2∶3(6个 )、1∶2 (3个 ) (水粉比 ,ml/g)的PMMA各 8ml,观察PMMA的渗漏情况。 5具新鲜胸腰段脊柱标本取 18个椎体节段 ,在CT引导下经皮后路椎弓根途径穿刺 ,注入混有对比剂的PMMA ,观察PMMA在椎体内分布并记录注入的浓度和量。将标本游离成单个椎体 ,观察PMMA在椎体外渗漏情况 ;并取 8个椎体强化后测量PMMA分布中心区温度。结果 1∶1浓度组 6个椎体均有渗漏 ,1∶2浓度组 3个椎体均无渗漏 ,但骨水泥不易注入 ,2∶3浓度组强化较理想 ,6个椎体仅有 1个渗漏。 18个胸腰段脊柱标本的椎体节段均穿刺顺利 ,没有副损伤 ;PMMA在椎体内沿骨小梁分布至整个椎体 ,有 2个出现椎体后静脉窦渗漏 ,没有出现其他部位渗漏。PMMA分布中心区温度变化最高为 48℃。结论 2∶3浓度的PMMA最适于经皮椎体强化 ;PMMA在椎体内发热时 ,对周围正常骨细胞的诱导活性无影响 ;CT引导下经皮椎体强化安全、可靠
Objective To investigate the method of percutaneous vertebroplasty and the imaging distribution of polymethylmethacrylate (PMMA) cements in the vertebral body to provide technical guidance for the clinical application. Methods Fifteen fresh human lumbar vertebrae were divided into three groups, and the three vertebral bodies were injected with three concentrations of 1: 1 (6), 2: 3 (6), 1: 2 ml / g) PMMA each 8ml, PMMA leakage observed. Five fresh thoracolumbar spine specimens were taken from 18 vertebral body segments. CT-guided percutaneous post-pedicular approach was used to inject PMMA mixed with contrast agent. PMMA was distributed in the vertebral body and the injected concentration And amount. The specimens were dissociated into single vertebral bodies and the leakage of PMMA in the vertebral body was observed. The temperature of central zone of PMMA distribution was measured after the eight vertebral bodies were strengthened. Results All the 6 vertebral bodies in the 1: 1 concentration group had leakage. There was no leakage in 3 vertebrae in the 1: 2 concentration group, but the cement in the 1: 2 group was not easy to be infused. The enhancement in the 2: 3 concentration group was more satisfactory. 1 leak. Vertebral segments of 18 thoracolumbar spine specimens were well punctured without side effects. PMMA was distributed in the vertebral body along the trabeculae to the entire vertebral body, and 2 posterior sinus venous leakage did not occur. Leakage site. The temperature change in the central zone of PMMA is up to 48 ℃. Conclusions 2: 3 PMMA is most suitable for percutaneous vertebral body strengthening. PMMA has no effect on the inducing activity of surrounding normal osteocytes when it is heated in the vertebral body. Percutaneous vertebral body strengthening under CT guidance is safe and reliable