Percutaneous vertebroplasty for treatment of osteoporotic vertebral fractures: high-viscosity versus low-viscosity bone cement

doi:10.3969/j.issn.2095-4344.2014.16.001

Abstract

Abstract:

BACKGROUND: Studies have suggested that high-viscosity bone cement can reduce bone cement leakage in the percutaneous vertebroplasty, but compared to the low-viscosity bone cement, there are still some controversies on clinical advantages of high-viscosity bone cement.

OBJECTIVE: To compare the bone cement leakage and clinical outcomes of high-viscosity and low-viscosity bone cement in percutaneous vertebroplasty for osteoporotic vertebral fractures.

METHODS: Sixty patients with osteoporotic vertebral fractures were enrolled in this study. All patients were randomly divided into two groups: high-viscosity bone cement group and low-viscosity bone cement group. We compared the venous leakage rate, disc leak rate, visual analogue scale scores for low back pain, and Oswestry disability index between two groups.

RESULTS AND CONCLUSION: All patients were successfully operated and low back pain and Oswestry disability index had significant improvement as compared with the preoperative status (P=0). By the final follow-up visit, there was no significant difference in disc leak rate, visual analogue scale scores, and Oswestry disability index between two groups. The venous leakage rate in the high-viscosity bone cement group was lower than that in the low-viscosity bone cement group (P=0). This study shows that high-viscosity bone cement can reduce bone cement leakage in the percutaneous vertebroplasty.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: biocompatible materials, vertebroplasty, osteoporosis, spinal fractures

CLC Number:

R318

Huang Xiao-nan. Percutaneous vertebroplasty for treatment of osteoporotic vertebral fractures: high-viscosity versus low-viscosity bone cement[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(16): 2461-2467.

Figures/Tables 3

2.1 参与者数量分析纳入60例具备完整治疗前后胸部X射线资料的患者，均在局麻下顺利完成手术，手术前后均未发生严重并发症。最后随访时间2-5年，平均(3.7±1.0)年，无失访患者。 2.2 临床疗效评估高黏度组：目测类比评分由治疗前的(7.7±0.8)分降低到末次随访时的(2.3±0.8)分(P=0)；Oswestry功能障碍指数由治疗前的(76.4±8.2)%降低到末次随访时的(24.9±4.6)%(P=0)。低黏度组：目测类比评分由治疗前的(7.7±1.0)分降低到末次随访时的(2.2±0.8)分(P=0)；Oswestry功能障碍指数由治疗前的(76.3±8.4)% 降低到末次随访时的(24.5± 2.7)%(P=0)。两组间治疗前及末次随访腰痛目测类比评分、Oswestry功能障碍指数比较差异无显著性意义。 2.3 骨水泥渗漏的比较高黏度组：共6例(20%)8个(8.2%)椎体术后CT发现静脉渗漏(图2A)，但无临床症状，故均未作特殊处理，其中2例X射线片上没有发现静脉渗漏，而在CT上发现；共6例(20%)6个(6.1%)椎体术后发现椎间盘渗漏(图2B)，这6例渗漏在X射线片上均被发现，均无临床症状，未作特殊处理。低黏度组：术后CT检查发现，共24例(80%)38个(41.3%)椎体发生静脉渗漏，但无临床症状，故均未作特殊处理；11例(37%)12个(13%)椎体发生椎间盘渗漏，均无临床症状，未作特殊处理。 2.4 邻近椎体骨折发生情况随访2-5年，共3例患者发生邻近椎体骨折，高黏度组2例(7%)，低黏度组1例(3%)，此3例患者均再次行高黏度骨水泥经皮椎体成形成功治疗，未出现并发症。 2.5 数据分析两组术后骨水泥静脉渗漏率差异有显著性意义(P=0)，但两组椎间盘渗漏率差异无显著性意义(P=0.137)(表1)。试验也比较了高黏度组与以前学者报道低黏度骨水泥经皮椎体成形后骨水泥渗漏率之间是否存在差异(表2-4)，发现高黏度骨水泥椎体成形治疗可明显降低静脉渗漏率[22-24](P < 0.05)，即使低黏度骨水泥注射预先明胶海绵预栓塞[22]；但椎间盘渗漏率除了与Jung等[24]报道有差异外(P=0.007)，与其他学者报道均无差异(P > 0.05)[22-23]。两组新发椎体骨折率差异无显著性意义(P > 0.05)。"

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