Optimal perfusion volume of low-temperature bone cement for treatment of osteoporotic vertebral compression fractures

doi:10.12307/2023.419

Abstract

Abstract: BACKGROUND: Previous studies reported the volume of bone cement needed to restore the strength or stiffness of the fractured vertebral body, and the data varied widely. Considering this difference may be due to the volume difference of vertebral body in different regions and individuals, the volume difference before and after fracture, and the unequal volume and distribution of bone cement.
Objective: To explore the amount of bone cement needed for the treatment of vertebral fractures using biomechanical study.
Methods: Eight adult sheep were selected and 50 vertebrae were finally obtained after screening T8-L2 vertebrae. Osteoporotic compression fractures were created through experiments, and the initial strength and stiffness of the vertebral body and the height of the anterior edge of the vertebral body after the fracture were recorded. The post-fracture volume of each vertebral body was accurately calculated by finite element technique to derive the cement injection volume. According to the finite element analysis results, using Latin square design, the 50 osteoporotic vertebral compression fracture specimens were divided into the first stage and the second stage. In the first stage, 5%, 10%, 15%, and 20% polymethyl methacrylate bone cement was injected by volume of percutaneous kyphoplasty, 5 specimens per volume. In the second stage, 15%, 16%, 17%, 18%, 19%, and 20% of bone cement were injected by volume, 5 specimens per volume. The two-stage specimens were placed on a universal testing machine for compression experiments.
Results and Conclusion: (1) There was no significant difference in preoperative height, width and depth, bone mineral density, strength and stiffness before and after decalcification (P > 0.05). (2) The first stage: Compared with preoperative data, postoperative vertebral strength decreased in 5%, 10%, and 15% groups (P < 0.05), and postoperative vertebral strength increased in 20% group (P < 0.05). Postoperative vertebral stiffness in all four groups decreased (P < 0.05); postoperative vertebral strength and stiffness were greater in 15% and 20% groups than those in 5% and 10% groups. (3) The second stage: Compared with preoperative data, postoperative vertebral strength decreased in 15%, 16%, and 17% groups (P < 0.05), and postoperative vertebral strength increased in 18%, 19%, and 20% groups (P < 0.05). Postoperative vertebral strength was higher in 18%, 19%, and 20% groups than that in the 15% group (P < 0.05). Compared with preoperative data, postoperative vertebral stiffness in each group decreased (P < 0.05). There was no significant difference in postoperative vertebral stiffness among the six groups (P > 0.05). (4) The results show that in a certain range, under the premise of ensuring that there is no leakage of bone cement, the biomechanics and height of the fracture vertebral body can be restored to the best by using 16% bone cement combined with bilateral percutaneous kyphoplasty.

Key words: percutaneous kyphoplasty, osteoporotic, vertebral compression fracture, bone cement, finite element technique, low-temperature bone cement perfusion technique, biomechanics, sheep

CLC Number:

Guo Ersong, Ma Pengpeng, Zhang Xin, Zhang Chunlin, Cai Ming, Su Feng, Liu Su, Li Wei, Hu Zhenshun, Zhang Zhimin. Optimal perfusion volume of low-temperature bone cement for treatment of osteoporotic vertebral compression fractures[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(16): 2542-2547.

Figures/Tables 4

2.4 各组椎体术后前缘高度、强度和刚度比较第一阶段内，各组间术后椎体高度比较并经Tukey-HSD进行事后检验显示，20%组与15%组、15%组与10%组、10%组与5%组比较差异均无显著性意义(P > 0.05)，20%组与10%，5%组、15%与5%组比较差异均有显著性意义(P < 0.05)，所以可得骨水泥灌注体积范围为15%-20%，见表2。由此进行第二阶段实验，各组间术后椎体高度比较差异无显著性意义(P > 0.05)，见表2。第一阶段内，各组间术后椎体强度比较并经Tukey-HSD进行事后检验显示，20%组与15%组比较差异无显著性意义(P > 0.05)，20%，15%组与10%，5%组比较差异有显著性意义(P < 0.05)，所以可得骨水泥灌注体积范围为15%-20%，见表4。由此进行第二阶段实验，各组间术后椎体强度比较并经Tukey-HSD进行事后检验显示，18%，19%，20%组间比较差异无显著性意义(P > 0.05)，15%，16%，17%组间比较差异无显著性意义(P > 0.05)，18%，19%，20%组术后椎体强度高于15%，16%，17%组，但与16%，17%组比较时差异无显著性意义(P > 0.05)，见表4。第一阶段内，各组间比较并经Tukey-HSD进行事后检验显示，20%组与15%组术后椎体刚度比较差异无显著性意义(P > 0.05)，20%，15%组术后椎体刚度高于10%，5%组(P < 0.05)，所以可得骨水泥灌注体积范围为15%-20%，见表4。由此进行第二阶段实验，各组术后椎体刚度比较差异无显著性意义(P > 0.05)，见表4。 2.5 各组椎体手术前后前缘高度、强度、刚度比较两个阶段中，各组术后椎体高度均高于术前(P < 0.05)，见表2。第一阶段，20%组术后椎体强度高于术前(P < 0.05)，15%，16%，17%，18%，19%组术后椎体强度低于术前(P < 0.05)，所以可知骨水泥灌注体积范围为15%-20%，见表4。由此进行第二阶段实验，15%，16%，17%组术后椎体强度低于术前(P < 0.05)，18%，19%，20%组术后椎体强度高于术前(P < 0.05)，见表4。两个阶段中，各组术后椎体刚度均低于术前(P < 0.05)，见表4。 2.6 骨水泥渗漏情况第一阶段内，20%组有4个椎体出现渗漏。第2阶段内，17%组有2个椎体出现渗漏趋势，18%组内有3个椎体出现渗漏，19%组内有3个椎体出现渗漏，20%组内5个椎体均出现不同程度渗漏。"

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