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目的 探讨经皮椎体成形术 (percutaneousvertebroplasty,PVP)的几个关键技术和其作用机制。方法 将骨水泥 (聚甲基丙烯酸甲酯 ,polymethylmethacrylate ,PMMA)的粉、液比例分别按 1∶1、3∶2、2∶1共 3种方式调配 ,每组 10份 ,在体外测试其聚合过程。将 4具正常成人尸体胸腰段 ,分成2组 ,1组取T12～L4共 10个椎体 ,在CT +X线透视下行经皮椎体穿刺 ,注入骨水泥 ,另 1组取T12～L4共 10个椎体 ,作抗压强度测试的对照组。将注射组和对照组分别游离成各 10个单个椎体 ,双盲法测量其纵向最大抗压强度。结果 3种比例骨水泥的稀、稠阶段持续时间及聚合时温度的升高值具有显著性差异 (P <0 0 5 ) ;合适的PMMA粉、液比例为 3∶2 ;均未发生椎弓根及椎体前缘骨皮质损伤 ,平均每个注入骨水泥 4.5ml,有 4个椎体出现椎旁静脉渗漏 ;注入PMMA的椎体的最大抗压强度比对照组提高约 38% (P <0 .0 5 )。结论 掌握适宜的PMMA粉、液比例和注射时机是PVP成功的关键因素 ;采用经椎弓根穿刺行PVP是可行的途径 ;椎体内注入PMMA可显著增强其抗压强度。
Objective To investigate several key techniques and their mechanisms of percutaneous vertebroplasty (PVP). Methods The powder and liquid ratio of bone cement (PMMA) were prepared by 3 ways, 1: 1, 3: 2, 2: 1 respectively. process. Thoracic and lumbar segments of 4 normal adult cadaver were divided into 2 groups. One group consisted of 10 vertebrae from T12 to L4. Percutaneous vertebral puncture was performed on CT + X-ray, and bone cement was injected into the other group. T12 ~ L4 A total of 10 vertebral body, for the compressive strength test control group. The injection group and the control group were dissociated into 10 single vertebra respectively, and the maximum longitudinal compressive strength was measured by double-blind method. Results The duration of lean and thick phase and the increase of temperature during polymerization were significantly different (P <0 05). The suitable PMMA powder and liquid ratio was 3: 2. No pedicle Root and vertebral anterior cortical bone injury, an average of 4.5ml each injected into the bone cement, 4 vertebral paravertebral venous leakage; vertebral injected PMMA maximum compressive strength than the control group increased by about 38% (P <0 .0 5). Conclusion Appropriate PMMA powder and liquid ratio and timing of injection are the key factors for the success of PVP. Pedicle perforation of PVP is a viable approach. Injecting PMMA into the vertebral body significantly enhances its compressive strength.