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.	刘滔, 张志明, 史金辉, 等. 骨水泥温度梯度灌注技术在经皮椎体后凸成形术中的应用. 中国脊柱脊髓杂志, 2015, 25(12): 1073-1078.
6.	赵胜军, 赵丽, 金宝城, 等. 低温分阶段注射经皮椎体后凸成形术治疗多节段骨质疏松性椎体骨折的疗效观察. 河北医学, 2018, 24(7): 1091-1096.
7.	陈阳, 李非, 梁杰. PKP 术中应用骨水泥温度梯度灌注技术的可行性分析. 颈腰痛杂志, 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.	赵磊, 王黎明, 王刚锐, 等. 经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折中骨水泥渗漏的防治. 中国修复重建外科杂志, 2009, 23(4): 404-407.
11.	姚珍松, 陈康, 江晓兵, 等. 网袋成形术治疗骨壁破损型复杂椎体骨折的经验. 中国矫形外科杂志, 2016, 24(16): 1466-1470.
12.	文豪, 刘元, 张柯, 等. 椎体强化术骨水泥渗漏并发症及预防的研究进展. 中国矫形外科杂志, 2019, 27(12): 1111-1115.
13.	王朝南, 苏忠良, 周佩敏, 等. 骨填充囊袋椎体成形术治疗老年骨质疏松性椎体压缩性骨折的临床疗效. 浙江医学, 2019, 41(13): 1395-1398.
14.	王翔宇, 谭伦, 林旭, 等. 光电导航引导单侧穿刺椎体后凸成形术治疗胸腰椎骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 2018, 32(2): 203-209.
15.	张凡, 杨惠林, 管华清. 经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤. 中国组织工程研究, 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, 张英泽, 等. 经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折骨水泥渗漏的相关因素分析. 中国修复重建外科杂志, 2010, 24(1): 27-31.
20.	郭瑞, 文豪, 杨利学, 等. 椎体强化术后骨水泥渗漏并发症与危险因素的研究进展. 中华创伤杂志, 2019, 35(1): 50-56.
21.	许正伟, 贺宝荣, 郝定均, 等. 胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展. 中华骨科杂志, 2016, 36(17): 1142-1148.
22.	王华锋, 叶小伟, 周福山, 等. PVP 术后有症状椎管内骨水泥渗漏的诊治并文献回顾. 中国骨与关节损伤杂志, 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.	贺宝荣, 许正伟, 郝定均, 等. 骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系. 中华骨科杂志, 2012, 32(8): 768-773.
27.	谢华, 李继春, 何劲, 等. 骨水泥分布对椎体成形手术后疗效影响的研究. 中华骨科杂志, 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.	李玉伟, 王海蛟, 崔巍, 等. 极外侧穿刺法行经皮椎体成形术治疗骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 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.	贺双军, 吕南宁, 刘昊, 等. 经皮椎体后凸成形术骨水泥分布形态对术后早期疗效的影响. 中华骨科杂志, 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.	田伟, 韩骁, 刘波, 等. 经皮椎体后凸成形术后骨水泥分布与手术椎体再骨折的关系. 中华创伤骨科杂志, 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. 刘滔, 张志明, 史金辉, 等. 骨水泥温度梯度灌注技术在经皮椎体后凸成形术中的应用. 中国脊柱脊髓杂志, 2015, 25(12): 1073-1078.
6. 赵胜军, 赵丽, 金宝城, 等. 低温分阶段注射经皮椎体后凸成形术治疗多节段骨质疏松性椎体骨折的疗效观察. 河北医学, 2018, 24(7): 1091-1096.
7. 陈阳, 李非, 梁杰. PKP 术中应用骨水泥温度梯度灌注技术的可行性分析. 颈腰痛杂志, 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. 赵磊, 王黎明, 王刚锐, 等. 经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折中骨水泥渗漏的防治. 中国修复重建外科杂志, 2009, 23(4): 404-407.
11. 姚珍松, 陈康, 江晓兵, 等. 网袋成形术治疗骨壁破损型复杂椎体骨折的经验. 中国矫形外科杂志, 2016, 24(16): 1466-1470.
12. 文豪, 刘元, 张柯, 等. 椎体强化术骨水泥渗漏并发症及预防的研究进展. 中国矫形外科杂志, 2019, 27(12): 1111-1115.
13. 王朝南, 苏忠良, 周佩敏, 等. 骨填充囊袋椎体成形术治疗老年骨质疏松性椎体压缩性骨折的临床疗效. 浙江医学, 2019, 41(13): 1395-1398.
14. 王翔宇, 谭伦, 林旭, 等. 光电导航引导单侧穿刺椎体后凸成形术治疗胸腰椎骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 2018, 32(2): 203-209.
15. 张凡, 杨惠林, 管华清. 经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤. 中国组织工程研究, 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, 张英泽, 等. 经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折骨水泥渗漏的相关因素分析. 中国修复重建外科杂志, 2010, 24(1): 27-31.
20. 郭瑞, 文豪, 杨利学, 等. 椎体强化术后骨水泥渗漏并发症与危险因素的研究进展. 中华创伤杂志, 2019, 35(1): 50-56.
21. 许正伟, 贺宝荣, 郝定均, 等. 胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展. 中华骨科杂志, 2016, 36(17): 1142-1148.
22. 王华锋, 叶小伟, 周福山, 等. PVP 术后有症状椎管内骨水泥渗漏的诊治并文献回顾. 中国骨与关节损伤杂志, 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. 贺宝荣, 许正伟, 郝定均, 等. 骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系. 中华骨科杂志, 2012, 32(8): 768-773.
27. 谢华, 李继春, 何劲, 等. 骨水泥分布对椎体成形手术后疗效影响的研究. 中华骨科杂志, 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. 李玉伟, 王海蛟, 崔巍, 等. 极外侧穿刺法行经皮椎体成形术治疗骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 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. 贺双军, 吕南宁, 刘昊, 等. 经皮椎体后凸成形术骨水泥分布形态对术后早期疗效的影响. 中华骨科杂志, 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. 田伟, 韩骁, 刘波, 等. 经皮椎体后凸成形术后骨水泥分布与手术椎体再骨折的关系. 中华创伤骨科杂志, 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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