Gravius S, Kraska N, Maus U, Mumme T, Berdel P, Weisskopf M
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn.
Z Orthop Unfall. 2009 Jan-Feb;147(1):43-7. doi: 10.1055/s-2008-1039114. Epub 2009 Mar 4.
Extravasation of bone cement into the vertebral venous system during cement injection has been reported to be a major complication of percutaneous vertebroplasty. Therefore, high injection pressures during cement application into the fractured vertebral body are considered as one possible cause of cement leakage or extravasation. The aim of the current study was to measure the increase in intravertebral pressure caused by cement injection during vertebroplasty compared to the baseline venous pressure for the ascending lumbar vene.
In context of a cadaver study of 19 unfixed lumbar cadaver spines (L2-L5) [9 female, 10 male, 72 +/- 4.1 years] 19 vertebroplasties have been performed under operative conditions through a transpedicular approach. A manometer was placed in the lateral corticalis of each vertebral body for dynamic pressure measurement during 4 cement application cycles. Average and maximal intravertebral pressures as well as the average intravertebral pressure over the time of cement application ["area under the curve" (AUC)] were calculated.
Average intravertebral pressure (10.9 +/- 12.6 kPa [min.: - 15.2 +/- 24.7 kPa; max.: 56.1 +/- 70.1 kPa]) showed a 13.6-fold increase compared to the baseline venous pressure for the ascending lumbar vein and a 70-fold increase compared to maximal pressure. During the 4 cement application cycles a continuous increase of the average intravertebral pressure over the application cycle (AUC) occurred.
The 13.6-fold increase in intravertebral body pressure caused by cement injection during percutaneous vertebroplasty in comparison to the baseline venous pressure for the ascending lumbar vein might be one possible cause of the high rate of extravasation of bone cement reported in the current literature.
据报道，在骨水泥注射过程中骨水泥渗漏至椎静脉系统是经皮椎体成形术的主要并发症。因此，在向骨折椎体注入骨水泥时的高注射压力被认为是骨水泥渗漏或外渗的一个可能原因。本研究的目的是测量椎体成形术期间骨水泥注射引起的椎体内压力升高，并与腰升静脉的基线静脉压力进行比较。
在对19个未固定的腰椎尸体脊柱（L2-L5）[9例女性，10例男性，72±4.1岁]进行的尸体研究中，通过经椎弓根入路在手术条件下进行了19例椎体成形术。在每个椎体的外侧皮质放置一个压力计，在4个骨水泥注入周期内进行动态压力测量。计算平均和最大椎体内压力以及骨水泥注入期间的平均椎体内压力["曲线下面积"（AUC）]。
平均椎体内压力（10.9±12.6 kPa[最小值：-15.2±24.7 kPa；最大值：56.1±70.1 kPa]）与腰升静脉的基线静脉压力相比增加了13.6倍，与最大压力相比增加了70倍。在4个骨水泥注入周期内，平均椎体内压力在注入周期（AUC）内持续增加。
与腰升静脉的基线静脉压力相比，经皮椎体成形术期间骨水泥注射引起的椎体内压力增加13.6倍，可能是当前文献报道的骨水泥高渗漏率的一个可能原因。
