Influencing factors for bone cement dispersion within the vertebral body after vertebroplasty

doi:10.3969/j.issn.2095-4344.2014.43.006

Abstract

Abstract:

BACKGROUND: Percutaneous vertebroplasty and kyphoplasty are both effective in the treatment of osteoporotic vertebral compression fractures, but different in the distribution and dispersion of bone cement.
OBJECTIVE: To analyze the factors affecting the bone cement dispersion within the vertebral body in treatment of osteoporotic vertebral compression fracture with vertebroplasty or kyphoplasty.
METHODS: A total of 41 patients with osteoporotic vertebral compression fractures were included, and divided into three groups: group A (22 cases receiving high viscosity bone cement vertebroplasty treatment), group B (5 cases receiving high viscosity bone cement kyphoplasty), group C (14 cases receiving low viscosity bone cement vertebroplasty treatment). The groups A and C were divided into subgroups according to bone cement injection volume, time from fracture to operation, preoperative degree of vertebral compression. The distribution and dispersion of bone cement in the vertebra were reconstructed by the CT three-dimensional imaging and volume rendering analysis.
RESULTS AND CONCLUSION: In the three groups, after operation, relative dispersion area and relative dispersion volume in the vertebrae had no obvious difference, and the bone cement could all diffuse to upper and
lower lamina cross the vertebral midline. There was no significant difference in bone cement diffusion coefficient among the three groups. In a certain range, the bone cement injection volume and bone cement dispersion volume was positively correlated. In groups A and C, bone cement diffusion coefficient decreased with the increasing of bone cement injection volume, time from fracture to operation, and the compression degree of the fractured vertebrae, but showed no significant correlation with bone cement viscosity.

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: vertebroplasty, osteoporotic fractures, imaging, three-dimensional

CLC Number:

R318

Wu Qiang, Mo Shi-zan, Bao Yong-zheng, Hu Kong-he, He Xiao-long, Zhu Wen-gang, Xi Xin-hua, . Influencing factors for bone cement dispersion within the vertebral body after vertebroplasty[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(43): 6922-6928.

Figures/Tables 4

2.1 骨水泥在椎体内分布情况按骨折时间分：①高黏度骨水泥椎体成形组：新鲜组21个椎体，亚急性组10个椎体，陈旧组2个椎体。②低黏度骨水泥椎体成形组：新鲜组7个椎体，亚急性组7个椎体，陈旧组6个椎体。按剂量分：①高黏度骨水泥椎体成形组：高剂量组17个椎体，低剂量组16个椎体。②低黏度骨水泥椎体成形组：高剂量组12椎体，低剂量组8个椎体。按骨折压缩程度分：①高黏度骨水泥椎体成形组：Ⅰ度组14个椎体，Ⅱ度组9个椎体，Ⅲ度组10个椎体。②低黏度骨水泥椎体成形组中Ⅰ度组6个椎体，Ⅱ度组6个椎体，Ⅲ度组8个椎体。各组骨水泥在椎体内的分布特征见表1所示。3组术后骨水泥在椎体内的相对弥散面积及相对弥散体积无明显区别，均能较好地弥散到上下椎板及越过椎体中线。高黏度骨水泥多呈团块样伴边缘毛刺样分布，低黏度骨水泥多呈蜂窝状分布。椎体成形中骨水泥多呈蜂窝状弥散，椎体后凸成形中骨水泥多呈团块状弥散。 2.2 不同手术方式、骨水泥黏度间骨水泥弥散系数的比较 3组骨水泥注射量、弥散体积及骨水泥弥散系数见表2所示。高黏度骨水泥椎体成形组弥散系数较高黏度骨水泥椎体后凸成形组大，但差异无显著性意义(P=0.124)，高黏度骨水泥椎体成形组与低黏度骨水泥椎体成形组弥散系数相当(P=0.619)。 2.3 骨水泥注射量与骨水泥弥散的关系骨水泥注射量与骨水泥弥散体积的相关性：在一定范围内骨水泥注射量与骨水泥弥散体积呈正相关，在同一手术方式下高黏度骨水泥椎体成形组与低黏度骨水泥椎体成形组中相关系数分别为0.963和0.918(P < 0.001)，经F显著性检验，高黏度骨水泥椎体成形组的F=394.3，P < 0.001，差异有显著性意义，回归方程可建立，其回归方程为YA(弥散体积)=0.891+2.175XA(注射体积)(图4A)；低黏度骨水泥椎体成形组的F=96.38，P < 0.001，差异有显著性意义，回归方程可建立，其回归方程为YC(弥散体积)=1.508+ 1.988XC(注射体积)(图4B)。骨水泥注射量对骨水泥弥散系数的影响：高黏度骨水泥椎体成形组与低黏度骨水泥椎体成形组中不同骨水泥注射量下骨水泥弥散系数见表3所示，两组骨水泥弥散系数随骨水泥注射量的增多而降低。在高黏度骨水泥椎体成形组中，高剂量组骨水泥弥散系数较低剂量组小(P < 0.01)。而低黏度骨水泥椎体成形组中，高剂量组骨水泥弥散系数亦较低剂量组小，但其差异无显著性意义(P=0.747)。 2.4 骨折至手术时间与骨水泥弥散系数的关系高黏度骨水泥椎体成形组与低黏度骨水泥椎体成形组中，不同的骨折至手术时间的骨水泥弥散系数见表4，从表中可看出，两组患者骨水泥弥散系数均随着骨折到手术时间的延长而降低。高黏度骨水泥椎体成形组中，新鲜组与亚急性组间骨水泥弥散系数比较差异有显著性意义(P < 0.05)，新鲜组与陈旧组间骨水泥弥散系数比较差异有非常显著性意义(P < 0.001)，亚急性组与陈旧组间骨水泥弥散系数比较差异无显著性意义(P=0.087)。低黏度骨水泥椎体成形组中，新鲜组与亚急性组骨水泥弥散系数比较差异有显著性意义(P < 0.05)，新鲜组与陈旧组间骨水泥弥散系数比较差异有非常显著性意义(P < 0.001)，亚急性组与陈旧组间骨水泥弥散系数比较差异有显著性意义(P < 0.05)。 2.5 术前椎体压缩程度与骨水泥弥散系数的关系高黏度骨水泥椎体成形组与低黏度骨水泥椎体成形组中，不同的术前椎体压缩程度下骨水泥弥散系数见表5。从表中数据可看出，两组患者骨水泥弥散系数均随着椎体压缩的程度的增大而下降。高黏度骨水泥椎体成形组中，Ⅰ度组与Ⅱ度组间骨水泥弥散系数比较差异有显著性意义(P < 0.05)，Ⅰ度组与Ⅲ度组间骨水泥弥散系数比较差异有非常显著性意义(P < 0.001)，Ⅱ度组与Ⅲ度间骨水泥弥散系数比较差异无显著性意义(P=0.167)。低黏度骨水泥椎体成形组中，Ⅰ度组与Ⅱ度组间骨水泥弥散系数比较差异无显著性意义(P=0.419)，Ⅰ度组与Ⅲ度组骨水泥弥散系数比较差异有非常显著性意义(P < 0.001)，Ⅱ度组与Ⅲ度间骨水泥弥散系数比较差异有显著性意义(P < 0.05)。"

References

[1] Galibert P,Deramond H,Rosat P,et al.Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty.Neurochirurgie. 1987;33(2):166-168.
[2] 余卫.脊柱骨折影像诊断(骨质疏松椎体骨折的评估及鉴别)[C].中华医学会第七次全国骨质疏松和骨矿盐疾病学术会议论文汇编,2013.
[3] 张亮,高梁斌,李健,等.椎体成形术中椎体骨密度对骨水泥弥散体积的影响[J].中国脊柱脊髓杂志,2011,21(11):915-918.
[4] 赵永生.老年骨质疏松性胸腰椎压缩骨折的微创治疗对策[D].山东大学,2013.
[5] 王尔天,易伟宏,黄曹,等.PVP与PKP治疗骨质疏松性压缩骨折时骨水泥填充效果及弥散方式的比较研究[J].中国伤残医学, 2010, 18(5):2-4.
[6] 郑召民,李佛宝.经皮椎体成型术和经皮椎体后凸成形术-问题与对策[J].中华医学杂志,2006,86(27):1878-1880.
[7] Jin YJ,Yoon SH,Park KW,et al. The volumetric analysis of cement in vertebroplasty：relationship with clinical outcome and complications.Spine (Phila Pa 1976). 2011;36(12): 761-772.
[8] 王岩,毛克亚,刘保卫,等.椎体强化在骨质疏松性椎体压缩骨折中的应用[J].中国骨科,2005,25(4):18-20.
[9] 李春海,刘尚礼,叶伟,等.高黏度骨水泥在经皮椎体成形术中的应用[J].中华骨科杂志,2007,27(4):259-262.
[10] 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.
[11] 蔺福辉,易小波,任志宏,等. 高粘度骨水泥在椎体成形术中的应用[J].中国骨与关节损伤杂志,2009,24(1):66-67.
[12] Georgy BA.Clinical experience with high-viscosity cements for percutaneous vertebral body augmentation: occurrence, degree, and location of cement leakage compared with kyphoplasty. AJNR.2010;31(3):504-508.
[13] 包拥政.高粘度骨水泥椎体后凸成形术治疗骨质疏松椎体压缩性骨折的近期疗效观察[D].汕头大学,2011.

[1]	Zhong Yuanming, Wan Tong, Zhong Xifeng, Wu Zhuotan, He Bingkun, Wu Sixian. Meta-analysis of the efficacy and safety of percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(3): 456-462.
[2]	Feng Guancheng, Fang Jianming, Lü Haoran, Zhang Dongsheng, Wei Jiadong, Yu Bingbing. How does bone cement dispersion affect the early outcome of percutaneous vertebroplasty [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(22): 3450-3457.
[3]	Sun Yiqiang, Xing Jianqiang, Li Xuecheng, Wang Xin, Tian Shenglan, Zhao Zihao, Geng Xiaopeng. Kyphoplasty versus vertebroplasty in the treatment of osteoporotic vertebral compression fracture in the elderly: a comparison of vertebral height recovery [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2851-2855.
[4]	Li Qiang, Li Jun, Luan Jian, Jin Canghai, Hao Meng, Lin Yong. Bone cement distribution of percutaneous curved vertebroplasty for the treatment of osteoporotic vertebral compression fractures [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(16): 2466-2471.
[5]	Zhong Yuanming, Wan Tong, Zhong Xifeng, Wu Zhuotan, He Bingkun, Wu Sixian. Meta-analysis of efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture#br# [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(12): 1930-1935.
[6]	Jing Wanli, Zhang Tao, Teng Donghui, Shi Tao, Zhou Qiang. Poor outcomes of bone filling mesh container vertebroplasty for the treatment of osteoporotic vertebral compression fractures with vertebral body wall incompetence [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(10): 1522-1527.
[7]	Zhang Zhiwei, Li Li, Huang Ziyu, Wu Duoyi, Gan Farong, Ye Baofei, Zhang Yan, Zhang Taibiao, Hu Wanjun. Percutaneous vertebroplasty through unilateral and bilateral pedicle approaches and unilateral pedicle extrapedicle approach for the treatment of thoracolumbar vertebral compression fractures: bone cement perfusion volume and cement leakage rate [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1353-1358.
[8]	Wang Yiya, Zhang Han, Lan Hai. Digital evaluation of finite element model for percutaneous kyphoplasty with bone cement injection [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1378-1383.
[9]	Li Kaiming, Wang Shangquan, Li Linghui, Zhu Liguo, Zhang Qing, Xie Rui. Bone filling bag vertebroplasty and percutaneous kyphoplasty for the treatment of thoracolumbar osteoporotic compression fractures: a meta-analysis of improving Cobb angle and reducing bone cement leakage [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(4): 650-656.
[10]	Wang Xiuting, Li Sisheng, Sun Jian, Zhang Genyuan, Liu Fayin, Zhang Jintao. Effectiveness of artificial intelligent laser location system in reducing the location time and radiation dose of vertebroplasty [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(33): 5295-5299.
[11]	Zhan Fangbiao, Xie Lizhong, Zou Xinsen, Long Jie, Cheng Jun, Zhang Xianwei. Efficacy and safety of percutaneous kyphoplasty versus posterior short-segment fixation with vertebra augmentation for Kummell’s disease: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(33): 5397-5404.
[12]	Liu Ruizhen, Wang Wangren, Hao Chen, Liang Dongmu, Guan Haishan. Effect of bone cement distribution on adjacent vertebral body fracture after unilateral percutaneous vertebroplasty for single segment osteoporotic vertebral compression fracture [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(28): 4498-4504.
[13]	Pang Jutao, Chen Hong, Liu Bin, Zhang Wei, Sun Jianhua, Zhou Lianjun, Zhang Xinhu. Lateral versus anterior open injectors in the percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(16): 2461-2466.
[14]	Wu Haibo, Yu Zhijun, Bai Manmo. Correlation of percutaneous vertebroplasty effect on osteoporotic vertebral compression fracture with injection amount and dispersion degree of bone cement [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(16): 2473-2477.
[15]	Wang Mengran, Fu Zhiyi, Wang Huidong, Wu Yujie. Efficacy and complications of different viscosities of high-dose bone cement applied in percutaneous vertebroplasty [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(16): 2500-2505.