CAJ | 학술논문

目的评价一种新型可注射磷酸钙骨水泥(CPC)在椎体后凸成形术中的体外生物力学性能,以探讨该材料能否有效替代聚甲基丙烯酸甲酯骨水泥(PMMA)应用于经皮椎体后凸成形术.方法取老年尸体共20个胸腰椎新鲜标本(T11～L3),经双能X线吸收骨密度仪测试骨密度后完全随机分为CPC组和PMMA组.在材料试验机上制成椎体压缩骨折模型并测量两组椎体初始的强度和刚度,然后分别用CPC和PMMA两种材料行椎体后凸成形术,再次测量术后两组椎体的强度和刚度.结果两种骨水泥都具有良好的可注射性,CPC固化后不放热,PMMA固化有明显放热反应,体外工作时间CPC长于PMMA,X线显影效果CPC优于PMMA.椎体后凸成形术后PMMA组椎体最大载荷(4.80±1.957)kN、抗压强度(4.794±1.683)kPa,均较术前明显增加,差异有统计学意义(P＜0.05).刚度高于骨折前,但差异无统计学意义(P＞0.05).CPC组椎体后凸成形术后最大载荷(3.412±1.078)kN、抗压强度(3.477±0.689)kPa,稍高于骨折前,差异无统计学意义(P＞0.05).而刚度(918±201)N/mm,低于骨折前,差异有统计学意义(P＜0.05).结论新型CPC在椎体后凸成形术中能有效恢复椎体的生物力学性能,可望在椎体后凸成形术中作为PMMA的理想替代材料.
목적 평개일충신형가주사린산개골수니(CPC)재추체후철성형술중적체외생물역학성능,이탐토해재료능부유효체대취갑기병희산갑지골수니(PMMA)응용우경피추체후철성형술.방법 취노년시체공20개흉요추신선표본(T11～L3),경쌍능X선흡수골밀도의측시골밀도후완전수궤분위CPC조화PMMA조.재재료시험궤상제성추체압축골절모형병측량량조추체초시적강도화강도,연후분별용CPC화PMMA량충재료행추체후철성형술,재차측량술후량조추체적강도화강도.결과 량충골수니도구유량호적가주사성,CPC고화후불방열,PMMA고화유명현방열반응,체외공작시간CPC장우PMMA,X선현영효과CPC우우PMMA.추체후철성형술후PMMA조추체최대재하(4.80±1.957)kN、항압강도(4.794±1.683)kPa,균교술전명현증가,차이유통계학의의(P＜0.05).강도고우골절전,단차이무통계학의의(P＞0.05).CPC조추체후철성형술후최대재하(3.412±1.078)kN、항압강도(3.477±0.689)kPa,초고우골절전,차이무통계학의의(P＞0.05).이강도(918±201)N/mm,저우골절전,차이유통계학의의(P＜0.05).결론 신형CPC재추체후철성형술중능유효회복추체적생물역학성능,가망재추체후철성형술중작위PMMA적이상체대재료.
Objective To evaluate the biomechanical properties of a novel injectable calcium phosphate cement (CPC) in kyphoplasty model and to explore the feasibility for its use as an alternative to polymethylmethacrylate(PMMA)in percutaneous kyphoplasty. Methods A total of 20 fresh specimens of thoracolumbar vertebrae (T11-L3) were collected from four elderly cadavers. The specimens were randomized into CPC group and PMMA group after bone mineral density test by dual - energy X-ray absorptiometry. Models of vertebral compression fracture were established using these specimens, and were measured for initial level of strength and stiffness on MTS material testing device. Vertebral kyphoplasty was performed on these models using CPC or PMMA. Thereafter, the models were re-evaluated for strength and stiffness. Results The both types of cements showed good injectablility.Obvious exothermicity during solidification was seen with PMMA but not with CPC. Moreover, CPC showed longer working time ex-vivo and better X-ray visibility, as compared with PMMA. Compared with before kyphoplasty,the PMMC group showed higher levels in postoperative maximum load [(4.80±1.957)kN, P＜0.05] , compression strength [(4.794±1.683) kPa, P＜0.05] and stiffness [(2046±762)N/mm, not statistically significant] , while the CPC group showed higher levels in postoperative maximum load [(3.412?1.078)kN] and compression strength[(3.477?.689)kPa] (both P＞0.05) , and lower stiffness[(918?01) N/mm,P＜0.05)]. The maximum load, compression strength and stiffness of PMMA were obviously higher than those of CPC group after kyphoplasty (f＜0.05).Conclusions The novel injectable CPC appears effective for restoring the biomechanical properties of vertebrae, and can be an ideal replacement for PMMA in percutaneous kyphoplasty.