数字骨科分析PVP术后骨水泥弥散程度及其与临床疗效的关联性

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摘要目的探讨应用数字骨科技术计算评价骨水泥弥散程度方法的可能性，评价骨水泥弥散体积、骨水泥弥散比与临床效果的相关性。方法回顾性研究2015年8月至2016年3月确诊为骨质疏松性椎体压缩性骨折并行经皮椎体成形术的55例患者，记录骨水泥注射量、有无骨水泥渗漏及并发症发生情况。术前、术后3 d，术后3、6个月对患者进行Oswestry功能障碍指数(The Oswestry disability index，ODI)及视觉模拟评分(visual analogue scale，VAS)，评价患者术后脊柱功能及疼痛恢复情况。患者均在术前、术后3 d行CT扫描，并将CT数据在数字骨科软件中建模，计算骨水泥弥散体积、椎体体积、骨水泥弥散比。对比骨水泥注入量与骨水泥弥散比之间差异，评价骨水泥注入量、弥散体积、骨水泥弥散比与术后ODI、VAS评分改善间的关联性。结果所有患者手术均顺利完成。术中骨水泥注射量为2.5～6.1 mL，平均(4.26±0.86)mL。无神经损伤、脑脊液漏及感染等严重并发症，其中5例骨水泥少量渗漏。骨水泥弥散体积平均值为(5.36±0.92)mL，术中实际骨水泥注入量与弥散体积间差异有统计学意义(P＜0.05)，骨水泥注入量与术后3 d、术后3个月VAS、ODI评分间存在关联性，骨水泥弥散体积、弥散比与术后3 d、术后3个月VAS、ODI评分间存在关联性，骨水泥注入量的关联性弱于后两者的关联性。结论应用数字骨科技术计算PVP术后骨水泥弥散体积、骨水泥弥散比的方法准确性及可重复性均较高。本研究证实骨水泥弥散体积、骨水泥弥散比与术后疼痛及改善功能障碍改善情况关联密切，该方法相比于骨水泥注入量来说更为客观、准确。

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	王拴池
	王芳芳
	陶晓冰

关键词 ：数字骨科, 骨质疏松性椎体压缩骨折, 经皮椎体成形术, 骨水泥, 弥散体积, 弥散比

Abstract：Objective To explore the possibility of using digital orthopedic techniques to evaluate the dispersion of bone cement，and to evaluate the correlation between the diffusion volume and the diffusion coefficient of bone cement and clinical effect.Methods Fifty-five patients with osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty from August 2015 to March，2006 were retrospectively studied.The injection volume of bone cement，the leakage of bone cement and complications were recorded.ODI score and VAS score were used to assess the postoperative spinal function and pain recovery at the timebeforeoperation，3 days，3 months and 6 months after the operation.CT scan was performed before and 3 days after operation.CT data were modeled in digital orthopedic software.The volume of bone cement，the volume of vertebral body and the diffusion ratio of bone cement were calculated.The difference between bone cement injection and bone cement diffusion ratio were compared.The relationship between the bone cement injection volume，dispersion volume，bone cement diffusion ratio and postoperative ODI，VAS score improvement were evaluated.Results All the operations were successfully completed.(4.26±0.86) mlbone cement were injected(range 2.5 to 6.1 mL).No nerve injury，cerebrospinal fluid leakage and infection and other serious complicationshappened. Buttherewere 5 cases of small amountbone cement leakage.The mean volume of bone cement was (5.36±0.92)mL.There was significant difference between the injection volume of cement and the volume of diffusion (P＜0.05).There was a correlation between the volume of bone cement，the volume of diffusion of cementandthe VAS and ODI score at 3 days and 3 months after operation，and the correlation between bone cement injection volume and VAS and ODI were weaker.Conclusion The application of digital orthopedic technique in the calculation of the volume of bone cement and the dispersion of bone cement has a high accuracy and reproducibility.The volume of bone cement，bone cement diffusion ratio and postoperative pain and functionimprovementare closely related. Compared to the amount of bone cement injection，this method is more objective and accurate.

Key words： digital orthopedic technique osteoporosis vertebral compression fracture percutaneous bertebroplasty bone cement diffuse volume diffuse ratio

作者简介: 王拴池(1983－ )，男，主治医师，河北省沧州市中西医结合医院脊柱脊髓外科，061001。

引用本文:

王拴池，王芳芳，陶晓冰. 数字骨科分析PVP术后骨水泥弥散程度及其与临床疗效的关联性[J]. 实用骨科杂志, 2018, 24(2): 104-107.
Wang Shuanchi，Wang Fangfang，Tao Xiaobing. Analysis of the Correlation between the Bone Cement Diffusion and the Clinical Effect after PVP Base on the Digtal Quantification. sygkzz, 2018, 24(2): 104-107.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I2/104

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