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目的探讨经皮椎体成形术(percutaneousvertebroplasty,PVP)灌注剂的调配方法与热效应及其临床效果。方法(1)用Palacos骨水泥加入适量造影剂调配灌注剂,将实验组和对照组制成圆柱形标本,测量聚合反应时温度变化,并行生物力学测试。(2)①用灌注剂在20只犬80个椎体上行PVP,术后CT扫描,于第1、2d分别随机取5只犬尸检,其余10只观察4周;②在5只猪10个椎体上取圆柱形骨块,形成空腔并注入灌注剂,测量灌注剂中心、边缘、椎体前缘、椎管前缘的温度变化,2周后取材观察灌注剂周缘骨组织坏死情况。(3)应用PVP治疗有疼痛症状的脊椎血管瘤、脊柱溶骨性转移瘤和骨髓瘤及脊椎骨质疏松性压缩骨折26例共35个椎体,术后行CT检查。结果(1)骨水泥单体、粉末和造影剂按5ml∶6g∶1ml的比例调匀后,可保持易于注射的稀薄糊状5min左右,且透视下显影清晰,灌注剂聚合放热过程和力学特性与对照组差异均无显著性意义。(2)①20只犬行PVP后均未发现肺栓塞表现,CT示椎管内常有渗漏,这与犬椎体的形态有关;②猪椎体内灌注剂平均最高中心温度为70.5℃、边缘为53.5℃、椎体前缘为40.8℃、椎管前缘为40.5℃,术后病理示灌注剂周缘有散在的骨细胞坏死灶。(3)26例PVP术后均未出现肺栓塞、神经损伤等并发症,术后CT示5例7个椎体存在渗漏,其中3例3个椎?
Objective To investigate the deployment and thermal effects of perfusion of percutaneous verteoplasty (PVP) and its clinical effects. Methods (1) Palacosate cement was added with appropriate amount of contrast medium to prepare perfusate. The experimental group and the control group were made into cylindrical specimens, and the temperature changes during the polymerization reaction were measured. Parallel biomechanical tests were performed. (2) (1) PVP was performed in 80 vertebrae of 20 dogs with perfusion agent and postoperative CT scan. Five dogs were autopsied on the 1st and 2nd day respectively and the remaining 10 were observed for 4 weeks. Cylindrical bone was taken from the vertebral body to form a cavity and filled with perfusion agent. The center of the perfusion agent, the edge, the anterior edge of the vertebral body and the temperature of the leading edge of the spinal canal were measured. Two weeks later, the necrosis of periarterial bone tissue was observed. (3) Thirty-five vertebral bodies were obtained from 26 patients with spondylolipoma, spondylolysis, myeloma and vertebral osteoporotic compression fractures treated with PVP. CT was performed postoperatively. Results (1) After the cement, monomer, powder and contrast agent were uniformly mixed in the ratio of 5ml: 6g: 1ml, the thin paste that could be easily injected could be kept for about 5min, and the clear imaging under fluoroscopy, the exothermic process and mechanical properties There was no significant difference with the control group. (2) (1) No pulmonary embolism was observed in 20 dogs after PVP. CT showed frequent leakage in the spinal canal, which was related to the morphology of the vertebral body of dogs. (2) The mean maximum center temperature of porcine in vivo perfusion was 70.5 ℃, The margin was 53.5 ℃, the anterior vertebral body was 40.8 ℃, the anterior margin of the spinal canal was 40.5 ℃. There were scattered necrosis of osteocytes in the periphery of the postoperative pathology perfusion. (3) Complications of pulmonary embolism and nerve injury were not found in 26 PVP cases. Postoperative CT showed leakage of 7 vertebrae in 5 cases, 3 cases of 3 vertebrae?