Effectiveness comparison of low-temperature bone cement perfusion before and after improvement in percutaneous vertebroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yang ,  LONG Hao , XIAO Jie , ZOU Wei , ZHOU Changjun , LIU Jie , WANG Guoxian

Department of Spine Surgery, the Fourth People’s Hospital of Guiyang City, Guiyang Guizhou, 550002, P.R.China;

Corresponding?author：

LONG Hao, Email: gylonghao@126.com

Keywords：

Percutaneous vertebroplasty; osteoporotic vertebral compression fracture; low-temperature cement perfusion; bone cement leakage

DOI：

10.7507/1002-1892.201905013

Video：

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Objective To discuss the safety and effectiveness of the improved technique by comparing the effects of low temperature bone cement infusion before and after the improvement in the percutaneous vertebroplasty (PVP).Methods The clinical data of 170 patients (184 vertebrae) with osteoporotic vertebral compression fracture who met the selection criteria between January 2016 and January 2018 were retrospectively analyzed. All patients were treated with PVP by low-temperature bone cement perfusion technology. According to the technical improvement or not, the patients were divided into two groups: the group before the technical improvement (group A, 95 cases) and the group after the technical improvement (group B, 75 cases). In group A, the patients were treated by keeping the temperature of bone cement at 0℃ and parallel puncture; in group B, the patients were treated by increasing the temperature of bone cement or reducing the time of bone cement in ice salt water and cross puncture. There was no significant difference in gender, age, disease duration, T value of bone mineral density, operative segment, and preoperative vertebral compression rate, visual analogue scale (VAS) score between the two groups (P>0.05). CT examination was performed immediately after operation, and the leakage rate of bone cement was calculated. The amount of bone cement perfusion and the proportion of bone cement in contact with the upper and lower endplates at the same time were compared between the two groups. The vertebral compression rate was calculated and the VAS score was used to evaluate the pain before operation, at immediate after operation, and last follow-up.Results There was no complication such as incision infection, spinal nerve injury, or pulmonary embolism in both groups. There was no significant difference in the amount of bone cement perfusion between groups A and B (t=0.175, P=0.861). There were 38 vertebral bodies (36.89%) in group A and 49 vertebral bodies (60.49%) in group B exposed to bone cement contacting with the upper and lower endplates at the same time, showing significant difference (χ²=10.132, P=0.001). Bone cement leakage occurred in 19 vertebral bodies (18.45%) in group A and 6 vertebral bodies (7.41%) in group B, also showing significant difference (χ²=4.706, P=0.030). The patients in group A and group B were followed up (13.3±1.2) months and (11.5±1.1) months, respectively. The vertebral compression rates of the two groups at immediate after operation were significantly lower than those before operation (P<0.05), but the vertebral compression rate of group A at last follow-up was significantly higher than that at immediate after operation (P<0.05), and there was no significant difference in group B between at immediate after operation and at last follow-up (P>0.05). The VAS scores of the two groups at immediate after operation were significantly lower than those before operation (P<0.05); but the VAS scores of group A at last follow-up were significantly higher than those at immediate after operation (P<0.05) and there was no siginificant difference in group B (P>0.05). There was no significant difference in VAS scores between the two groups at immediate after operation (t=0.380, P=0.705); but at last follow-up, VAS score in group B was significantly lower than that in group A (t=3.627, P=0.000).Conclusion The improved advanced low-temperature bone cement perfusion technology during PVP by increasing the viscosity of bone cement combined with cross-puncture technology, can reduce bone cement leakage, improve the distribution of bone cement in the vertebral body, and reduce the risk of vertebral collapse, and achieve better effectiveness.

Citation： ZHANG Yang, LONG Hao, XIAO Jie, ZOU Wei, ZHOU Changjun, LIU Jie, WANG Guoxian. Effectiveness comparison of low-temperature bone cement perfusion before and after improvement in percutaneous vertebroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 428-434. doi: 10.7507/1002-1892.201905013 Copy

1.	Muijs SP, Nieuwenhuijse MJ, Van Erkel AR, et al. Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures: evaluation after 36 months. J Bone Joint Surg (Br), 2009, 91(3): 379-384.
2.	Lador R, Dreiangel N, Ben-Galim PJ, et al. A pictorial classification atlas of cement extravasation with vertebral augmentation. Spine J, 2010, 10(12): 1118-1127.
3.	Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J, 2011, 11(9): 839-848.
4.	Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore), 2016, 95(24): e3850.
5.	劉滔, 張志明, 史金輝, 等. 骨水泥溫度梯度灌注技術在經皮椎體后凸成形術中的應用. 中國脊柱脊髓雜志, 2015, 25(12): 1073-1078.
6.	趙勝軍, 趙麗, 金寶城, 等. 低溫分階段注射經皮椎體后凸成形術治療多節段骨質疏松性椎體骨折的療效觀察. 河北醫學, 2018, 24(7): 1091-1096.
7.	陳陽, 李非, 梁杰. PKP 術中應用骨水泥溫度梯度灌注技術的可行性分析. 頸腰痛雜志, 2019, 40(1): 79-81.
8.	Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg (Br), 2003, 85(1): 83-89.
9.	Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fracture. Spine (Phila Pa 1976), 2001, 26(14): 1631-1638.
10.	趙磊, 王黎明, 王剛銳, 等. 經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折中骨水泥滲漏的防治. 中國修復重建外科雜志, 2009, 23(4): 404-407.
11.	姚珍松, 陳康, 江曉兵, 等. 網袋成形術治療骨壁破損型復雜椎體骨折的經驗. 中國矯形外科雜志, 2016, 24(16): 1466-1470.
12.	文豪, 劉元, 張柯, 等. 椎體強化術骨水泥滲漏并發癥及預防的研究進展. 中國矯形外科雜志, 2019, 27(12): 1111-1115.
13.	王朝南, 蘇忠良, 周佩敏, 等. 骨填充囊袋椎體成形術治療老年骨質疏松性椎體壓縮性骨折的臨床療效. 浙江醫學, 2019, 41(13): 1395-1398.
14.	王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2018, 32(2): 203-209.
15.	張凡, 楊惠林, 管華清. 經皮椎體后凸成形分次和溫度梯度灌注骨水泥治療胸腰椎轉移性腫瘤. 中國組織工程研究, 2014, (26): 4206-4211.
16.	Nieuwenhuijse MJ, Muijs SP, van Erkel AR, et al. A clinical comparative study on low versus medium viscosity polymethylmetacrylate bone cement in percutaneous vertebroplasty: viscosity associated with cement leakage. Spine (Phila Pa 1976), 2010, 35(20): E1037-E1044.
17.	Anselmetti GC, Zoarski G, Manca A, et al. Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures. Cardiovasc Intervent Radiol, 2008, 31(5): 937-947.
18.	Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine (Phila Pa 1976), 2006, 31(22): 2562-2568.
19.	申勇, 任虎, 張英澤, 等. 經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折骨水泥滲漏的相關因素分析. 中國修復重建外科雜志, 2010, 24(1): 27-31.
20.	郭瑞, 文豪, 楊利學, 等. 椎體強化術后骨水泥滲漏并發癥與危險因素的研究進展. 中華創傷雜志, 2019, 35(1): 50-56.
21.	許正偉, 賀寶榮, 郝定均, 等. 胸腰椎骨質疏松性骨折經皮椎體成形術后骨水泥滲漏的研究進展. 中華骨科雜志, 2016, 36(17): 1142-1148.
22.	王華鋒, 葉小偉, 周福山, 等. PVP 術后有癥狀椎管內骨水泥滲漏的診治并文獻回顧. 中國骨與關節損傷雜志, 2019, 34(5): 499-501.
23.	Ding J, Zhang Q, Zhu J, et al. Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2016, 25(11): 3411-3417.
24.	Lewis G. Effect of mixing method and storage temperature of cement constituents on the fatigue and porosity of acrylic bone cement. J Biomed Mater Res, 1999, 48(2): 143-149.
25.	Belkoff SM, Molloy S. Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty. Spine, 2003, 28(14): 1555-1559.
26.	賀寶榮, 許正偉, 郝定均, 等. 骨水泥在骨質疏松性骨折椎體內分布狀態與生物力學性能的關系. 中華骨科雜志, 2012, 32(8): 768-773.
27.	謝華, 李繼春, 何勁, 等. 骨水泥分布對椎體成形手術后療效影響的研究. 中華骨科雜志, 2017, 37(22): 1400-1406.
28.	Hadley C, Awan OA, Zoarski GH. Biomechanics of vertebral bone augmentation. Neuroimaging Clin N Am, 2010, 20(2): 159-167.
29.	李玉偉, 王海蛟, 崔巍, 等. 極外側穿刺法行經皮椎體成形術治療骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2019, 33(5): 612-617.
30.	Ha KY, Kim KW, Kim YH, et al. Revision surgery after vertebroplasty or kyphoplasty. Clin Orthop Surg, 2010, 2(4): 203-208.
31.	Niu J, Zhou H, Meng Q, et al. Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis. Acta Radiol, 2015, 56(11): 1380-1387.
32.	賀雙軍, 呂南寧, 劉昊, 等. 經皮椎體后凸成形術骨水泥分布形態對術后早期療效的影響. 中華骨科雜志, 2019, 39(3): 137-143.
33.	Li D, Wu Y, Huang Y, et al. Risk factors of recompression of cemented vertebrae after kyphoplasty for osteoporotic vertebral compression fracture. Int Orthop, 2016, 40(6): 1285-1290.
34.	田偉, 韓驍, 劉波, 等. 經皮椎體后凸成形術后骨水泥分布與手術椎體再骨折的關系. 中華創傷骨科雜志, 2012, 14(3): 211-215.

1. Muijs SP, Nieuwenhuijse MJ, Van Erkel AR, et al. Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures: evaluation after 36 months. J Bone Joint Surg (Br), 2009, 91(3): 379-384.
2. Lador R, Dreiangel N, Ben-Galim PJ, et al. A pictorial classification atlas of cement extravasation with vertebral augmentation. Spine J, 2010, 10(12): 1118-1127.
3. Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J, 2011, 11(9): 839-848.
4. Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore), 2016, 95(24): e3850.
5. 劉滔, 張志明, 史金輝, 等. 骨水泥溫度梯度灌注技術在經皮椎體后凸成形術中的應用. 中國脊柱脊髓雜志, 2015, 25(12): 1073-1078.
6. 趙勝軍, 趙麗, 金寶城, 等. 低溫分階段注射經皮椎體后凸成形術治療多節段骨質疏松性椎體骨折的療效觀察. 河北醫學, 2018, 24(7): 1091-1096.
7. 陳陽, 李非, 梁杰. PKP 術中應用骨水泥溫度梯度灌注技術的可行性分析. 頸腰痛雜志, 2019, 40(1): 79-81.
8. Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg (Br), 2003, 85(1): 83-89.
9. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fracture. Spine (Phila Pa 1976), 2001, 26(14): 1631-1638.
10. 趙磊, 王黎明, 王剛銳, 等. 經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折中骨水泥滲漏的防治. 中國修復重建外科雜志, 2009, 23(4): 404-407.
11. 姚珍松, 陳康, 江曉兵, 等. 網袋成形術治療骨壁破損型復雜椎體骨折的經驗. 中國矯形外科雜志, 2016, 24(16): 1466-1470.
12. 文豪, 劉元, 張柯, 等. 椎體強化術骨水泥滲漏并發癥及預防的研究進展. 中國矯形外科雜志, 2019, 27(12): 1111-1115.
13. 王朝南, 蘇忠良, 周佩敏, 等. 骨填充囊袋椎體成形術治療老年骨質疏松性椎體壓縮性骨折的臨床療效. 浙江醫學, 2019, 41(13): 1395-1398.
14. 王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2018, 32(2): 203-209.
15. 張凡, 楊惠林, 管華清. 經皮椎體后凸成形分次和溫度梯度灌注骨水泥治療胸腰椎轉移性腫瘤. 中國組織工程研究, 2014, (26): 4206-4211.
16. Nieuwenhuijse MJ, Muijs SP, van Erkel AR, et al. A clinical comparative study on low versus medium viscosity polymethylmetacrylate bone cement in percutaneous vertebroplasty: viscosity associated with cement leakage. Spine (Phila Pa 1976), 2010, 35(20): E1037-E1044.
17. Anselmetti GC, Zoarski G, Manca A, et al. Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures. Cardiovasc Intervent Radiol, 2008, 31(5): 937-947.
18. Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine (Phila Pa 1976), 2006, 31(22): 2562-2568.
19. 申勇, 任虎, 張英澤, 等. 經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折骨水泥滲漏的相關因素分析. 中國修復重建外科雜志, 2010, 24(1): 27-31.
20. 郭瑞, 文豪, 楊利學, 等. 椎體強化術后骨水泥滲漏并發癥與危險因素的研究進展. 中華創傷雜志, 2019, 35(1): 50-56.
21. 許正偉, 賀寶榮, 郝定均, 等. 胸腰椎骨質疏松性骨折經皮椎體成形術后骨水泥滲漏的研究進展. 中華骨科雜志, 2016, 36(17): 1142-1148.
22. 王華鋒, 葉小偉, 周福山, 等. PVP 術后有癥狀椎管內骨水泥滲漏的診治并文獻回顧. 中國骨與關節損傷雜志, 2019, 34(5): 499-501.
23. Ding J, Zhang Q, Zhu J, et al. Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2016, 25(11): 3411-3417.
24. Lewis G. Effect of mixing method and storage temperature of cement constituents on the fatigue and porosity of acrylic bone cement. J Biomed Mater Res, 1999, 48(2): 143-149.
25. Belkoff SM, Molloy S. Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty. Spine, 2003, 28(14): 1555-1559.
26. 賀寶榮, 許正偉, 郝定均, 等. 骨水泥在骨質疏松性骨折椎體內分布狀態與生物力學性能的關系. 中華骨科雜志, 2012, 32(8): 768-773.
27. 謝華, 李繼春, 何勁, 等. 骨水泥分布對椎體成形手術后療效影響的研究. 中華骨科雜志, 2017, 37(22): 1400-1406.
28. Hadley C, Awan OA, Zoarski GH. Biomechanics of vertebral bone augmentation. Neuroimaging Clin N Am, 2010, 20(2): 159-167.
29. 李玉偉, 王海蛟, 崔巍, 等. 極外側穿刺法行經皮椎體成形術治療骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2019, 33(5): 612-617.
30. Ha KY, Kim KW, Kim YH, et al. Revision surgery after vertebroplasty or kyphoplasty. Clin Orthop Surg, 2010, 2(4): 203-208.
31. Niu J, Zhou H, Meng Q, et al. Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis. Acta Radiol, 2015, 56(11): 1380-1387.
32. 賀雙軍, 呂南寧, 劉昊, 等. 經皮椎體后凸成形術骨水泥分布形態對術后早期療效的影響. 中華骨科雜志, 2019, 39(3): 137-143.
33. Li D, Wu Y, Huang Y, et al. Risk factors of recompression of cemented vertebrae after kyphoplasty for osteoporotic vertebral compression fracture. Int Orthop, 2016, 40(6): 1285-1290.
34. 田偉, 韓驍, 劉波, 等. 經皮椎體后凸成形術后骨水泥分布與手術椎體再骨折的關系. 中華創傷骨科雜志, 2012, 14(3): 211-215.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of low-temperature bone cement perfusion before and after improvement in percutaneous vertebroplasty

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