Percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradients for metastatic tumor in thoracic lumbar vertebrae

doi:10.3969/j.issn.2095-4344.2014.26.020

Abstract

Abstract:

BACKGROUND: Percutaneous vertebroplasty has been extensively applied in treatment of osteoporotic vertebral compression fractures, and now it is also used in spinal metastatic tumor.
OBJECTIVE: To evaluate the effectiveness of percutaneous vertebroplasty for metastatic tumor of thoracic lumbar vertebrae by bone cement perfusion at different times and temperature gradient.
METHODS: A total of 24 cases (38 vertebrae) of metastatic tumor receiving percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient were reviewed retrospectively. All patients were classified into group A (11 vertebrae in 9 cases) featured with apparent vertebral compression (≥ 1/4) and group B (27 vertebrae in 15 cases) of no obvious compression (< 1/4). The percutaneous vertebroplasty was conducted with C-arm fluoroscopy positioning. Bone cement was injected by perfusion at different times and temperature gradient method. Visual Analogue Scales and Owestry Disability Index were recorded to assess pain alleviation and functional restoration before and after bone cement injection at different times and temperature gradient. The height of treated vertebrae was also analyzed. Follow-up was performed for 12 to 56 months.
RESULTS AND CONCLUSION: All 24 patients successfully underwent percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient. Bone cement (4±1) mL was averagely injected into each thoracic vertebra. Bone cement (5±1) mL was injected into each lumbar vertebra. Postoperative recheck radiographs revealed good bone cement distribution, no nerve root injury or spinal compression occurred. Vertebral height was significantly higher posttreatment compared with pretreatment in both groups (P < 0.05). Visual Analogue Scales and Owestry Disability Index scores were significantly lower at 1 day, 1 month after treatment and during final follow-up compared with preoperation in all patients (P < 0.05). No significant difference in Visual Analogue Scales and Owestry Disability Index scores was detected between two groups at the same time point. Results suggested that percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient for metastatic tumor of thoracic lumbar vertebrae could reduce the occurrence of bone cement leakage, and could ease the pain quickly for apparent and non-apparent compressed tumor metastatic vertebrae. It is an effective method to treat metastatic tumor of vertebrae.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: spine, bone neoplasms, vertebroplasty

CLC Number:

R318

Zhang Fan, Yang Hui-lin, Guan Hua-qing . Percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradients for metastatic tumor in thoracic lumbar vertebrae[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(26): 4206-4211.

Figures/Tables 3

2.4 治疗前后椎体中线高度测量治疗前后X射线片，椎体压缩≥1/4组治疗前椎体中线高度为(15.81±6.98) mm，治疗后椎体中线高度为(23.95±8.70) mm，椎体中线高度明显恢复，差异有显著性意义(P < 0.05)。椎体压缩< 1/4组治疗前椎体中线高度为(26.07±7.59) mm，治疗后椎体中线高度为(28.48±8.41) mm，差异有显著性意义(P < 0.05，表2)。与椎体压缩<1/4组相比，椎体压缩≥1/4组治疗后椎体中线高度恢复效果更明显。 2.5 治疗前后目测类比评分变化 24例患者均成功完成手术，治疗后24 h内疼痛得到明显缓解。与治疗前相比，椎体压缩≥1/4组治疗后1 d、治疗后1个月、末次目测类比评分均显著降低(P < 0.05)；与治疗前相比，椎体压缩< 1/4组治疗后1 d、治疗后1个月、末次目测类比评分分均显著降低(P < 0.05)，见表2。可认为患者术后疼痛明显缓解，并趋于稳定。两组目测类比评分的改变值之间差异无显著性意义，可认为无论椎体有无明显压缩，患者治疗后的疼痛缓解程度无明显差异。 2.6 治疗前后功能障碍指数变化与治疗前相比，椎体压缩≥1/4组治疗后1 d、治疗后1个月、末次功能障碍指数评分值明显降低；与治疗前相比，椎体压缩< 1/4组治疗后1 d、治疗后1个月、末次功能障碍指数评分值明显降低。可认为患者治疗后日常活动功能明显改善，生活质量明显提高。两组功能障碍指数评分的改变值之间差异无显著性意义，可认为无论椎体有无明显压缩，患者治疗后的日常生活改善程度无明显差异，见表2。 2.7 骨水泥漏发生情况及不良反应治疗后复查X射线片见骨水泥分布情况良好，椎体压缩≥1/4组共2例发生椎间盘骨水泥漏，椎体压缩< 1/4组共2例发生椎间盘骨水泥漏，以上4例均未发生神经损伤、肺栓塞等临床症状。"

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