Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Zhiqiang ¹ , ZHOU Yunlong ² , LEI Fei ¹ , YE Fei ¹ , ZHOU Qingzhong ¹ , ZHENG Lipeng ¹ ,  FENG Daxiong ¹

1. Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Departmen of Spine Surgery, the People’s Hospital of Leshan, Leshan Sichuan, 614000, P.R China;

Corresponding?author：

FENG Daxiong, Email: fdxlz2002@163.com

Keywords：

Percutaneous kyphoplasty; osteoporotic vertebral compression fracture; low-viscosity wet-sand phase bone cement; low-viscosity wire-drawing phase bone cement; refracture

DOI：

10.7507/1002-1892.201909031

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Objective To compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF).Methods The clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients’ symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.Results The injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups (t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups (χ²=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation (P<0.05), and there were significant differences among the postoperative time points (P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group (P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up (P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups (P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant (χ²=4.105, P=0.043; χ²=4.661, P=0.031).Conclusion Bone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.

Citation： LIU Zhiqiang, ZHOU Yunlong, LEI Fei, YE Fei, ZHOU Qingzhong, ZHENG Lipeng, FENG Daxiong. Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 435-441. doi: 10.7507/1002-1892.201909031 Copy

1.	Zhang Y, Shi L, Tang P, et al. Comparison of the efficacy between two micro-operative therapies of old patients with osteoporotic vertebral compression fracture: a network Meta-analysis. J Cell Biochem, 2017, 118(10): 3205-3212.
2.	Wang F, Wang LF, Miao DC, et al. Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP? J Pain Res, 2018, 11: 2625-2631.
3.	He X, Li H, Meng Y, et al. Percutaneous kyphoplasty evaluated by cement volume and distribution: an analysis of clinical data. Pain Physician, 2016, 19(7): 495-506.
4.	Chen B, Fan S, Zhao F. Percutaneous balloon kyphoplasty of osteoporotic vertebral compression fractures with intravertebral cleft. Indian J Orthop, 2014, 48(1): 53-59.
5.	Abduljabbar FH, Al-Jurayyan A, Alqahtani S, et al. Does balloon kyphoplasty deliver more cement safely into osteoporotic vertebrae with compression fractures compared with vertebroplasty? A study in vertebral analogues. Global Spine J, 2015, 5(4): 300-307.
6.	Wang YT, Wu XT, Chen H, et al. Adjacent-level symptomatic fracture after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a retrospective analysis. J Orthop Sci, 2014, 19(6): 868-876.
7.	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.
8.	Itshayek E, Miller P, Barzilay Y, et al. Vertebral augmentation in the treatment of vertebral compression fractures: review and new insights from recent studies. J Clin Neurosci, 2012, 19(6): 786-791.
9.	Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res, 1993, 8(9): 1137-1148.
10.	張磊, 汪凌駿, 楊惠林, 等. 椎體后凸成形骨水泥注射治療不同部位骨質疏松性椎體壓縮骨折的療效分析. 中國組織工程研究, 2019, 23(14): 2140-2146.
11.	張大鵬, 毛克亞, 強曉軍, 等. 椎體增強術后骨水泥分布形態分型及其臨床意義. 中華創傷雜志, 2018, 34(2): 130-137.
12.	羅斌, 吳星火, 邸方. 椎體后凸成形術后鄰近椎體再發骨折發生率及相關危險因素的分析研究. 創傷外科雜志, 2013, 15(1): 23-27.
13.	曹源, 郭金超, 馬超, 等. 骨水泥椎體強化與保守治療骨質疏松椎體壓縮性骨折再骨折風險的 Meta 分析. 中國脊柱脊髓雜志, 2018, 28(9): 792-800.
14.	Bae JS, Park JH, Kim KJ, et al. Analysis of risk factors for secondary new vertebral compression fracture following percutaneous vertebroplasty in patients with osteoporosis. World Neurosurg, 2017, 99: 387-394.
15.	賀寶榮, 許正偉, 郝定均, 等. 骨水泥在骨質疏松性骨折椎體內分布狀態與生物力學性能的關系. 中華骨科雜志, 2012, 32(8): 768-773.
16.	Gao C, Zong M, Wang WT, et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol, 2018, 59(5): 577-585.
17.	陳柏齡, 謝登輝, 黎藝強, 等. 單側 PKP 骨水泥注射過中線分布對壓縮性骨折椎體兩側剛度的影響. 中國脊柱脊髓雜志, 2011, 21(2): 118-121.
18.	盧昌懷, 劉志軍, 張宏波, 等. 骨水泥量及分布對椎體成形術后相鄰椎體生物力學影響的三維有限元分析. 中國骨質疏松雜志, 2015, 21(1): 29-33.
19.	Berlemann U, Ferguson SJ, Nolte LP, et al. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg (Br), 2002, 84(5): 748-752.
20.	Tang S, Fu W, Zhang H, et al. Efficacy and safety of high-viscosity bone cement vertebroplasty in treatment of osteoporotic certebral compression fractures with intravertebral cleft. World Neurosurg, 2019, 132: e739-e745.
21.	沈凱, 張勝利, 譚祖鍵, 等. 經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折中骨水泥單側與雙側彌散對療效的影響. 中華創傷雜志, 2018, 34(6): 527-533.
22.	楊德順, 雷丙俊, 廖亮, 等. 改良推管在單側椎弓根穿刺經皮椎體后凸成形術的應用. 中國修復重建外科雜志, 2017, 31(2): 197-202.
23.	Liu Y, Wang Y, Zhao L, et al. Effectiveness and safety of percutaneous vertebroplasty in the treatment of spinal metastatic tumor. Pak J Med Sci, 2017, 33(3): 675-679.
24.	唐沖, 吳四軍, 劉正, 等. 高粘度骨水泥經皮椎體成形術治療骨質疏松性椎體壓縮骨折的療效分析. 中國脊柱脊髓雜志, 2017, 27(8): 720-726.
25.	李玉偉, 王海蛟, 崔巍, 等. 極外側穿刺法行經皮椎體成形術治療骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2019, 33(5): 612-617.
26.	Komemushi A, Tanigawa N, Kariya S, et al. Percutaneous vertebroplasty for compression fracture: analysis of vertebral body volume by CT volumetry. Acta Radiol, 2005, 46(3): 276-279.
27.	Sun HB, Jing XS, Liu YZ, et al. The optimal volume fraction in percutaneous vertebroplasty evaluated by pain relief, cement dispersion, and cement leakage: A prospective cohort study of 130 patients with painful osteoporotic vertebral compression fracture in the thoracolumbar vertebra. World Neurosurg, 2018, 114: e677-e688.
28.	陳吉, 陳勇, 張征石, 等. 骨質疏松性椎體壓縮性骨折經皮椎體后凸成形術中骨水泥滲漏原因回顧性分析. 中華骨質疏松和骨礦鹽疾病雜志, 2017, 10(1): 27-33.

1. Zhang Y, Shi L, Tang P, et al. Comparison of the efficacy between two micro-operative therapies of old patients with osteoporotic vertebral compression fracture: a network Meta-analysis. J Cell Biochem, 2017, 118(10): 3205-3212.
2. Wang F, Wang LF, Miao DC, et al. Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP? J Pain Res, 2018, 11: 2625-2631.
3. He X, Li H, Meng Y, et al. Percutaneous kyphoplasty evaluated by cement volume and distribution: an analysis of clinical data. Pain Physician, 2016, 19(7): 495-506.
4. Chen B, Fan S, Zhao F. Percutaneous balloon kyphoplasty of osteoporotic vertebral compression fractures with intravertebral cleft. Indian J Orthop, 2014, 48(1): 53-59.
5. Abduljabbar FH, Al-Jurayyan A, Alqahtani S, et al. Does balloon kyphoplasty deliver more cement safely into osteoporotic vertebrae with compression fractures compared with vertebroplasty? A study in vertebral analogues. Global Spine J, 2015, 5(4): 300-307.
6. Wang YT, Wu XT, Chen H, et al. Adjacent-level symptomatic fracture after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a retrospective analysis. J Orthop Sci, 2014, 19(6): 868-876.
7. 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.
8. Itshayek E, Miller P, Barzilay Y, et al. Vertebral augmentation in the treatment of vertebral compression fractures: review and new insights from recent studies. J Clin Neurosci, 2012, 19(6): 786-791.
9. Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res, 1993, 8(9): 1137-1148.
10. 張磊, 汪凌駿, 楊惠林, 等. 椎體后凸成形骨水泥注射治療不同部位骨質疏松性椎體壓縮骨折的療效分析. 中國組織工程研究, 2019, 23(14): 2140-2146.
11. 張大鵬, 毛克亞, 強曉軍, 等. 椎體增強術后骨水泥分布形態分型及其臨床意義. 中華創傷雜志, 2018, 34(2): 130-137.
12. 羅斌, 吳星火, 邸方. 椎體后凸成形術后鄰近椎體再發骨折發生率及相關危險因素的分析研究. 創傷外科雜志, 2013, 15(1): 23-27.
13. 曹源, 郭金超, 馬超, 等. 骨水泥椎體強化與保守治療骨質疏松椎體壓縮性骨折再骨折風險的 Meta 分析. 中國脊柱脊髓雜志, 2018, 28(9): 792-800.
14. Bae JS, Park JH, Kim KJ, et al. Analysis of risk factors for secondary new vertebral compression fracture following percutaneous vertebroplasty in patients with osteoporosis. World Neurosurg, 2017, 99: 387-394.
15. 賀寶榮, 許正偉, 郝定均, 等. 骨水泥在骨質疏松性骨折椎體內分布狀態與生物力學性能的關系. 中華骨科雜志, 2012, 32(8): 768-773.
16. Gao C, Zong M, Wang WT, et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol, 2018, 59(5): 577-585.
17. 陳柏齡, 謝登輝, 黎藝強, 等. 單側 PKP 骨水泥注射過中線分布對壓縮性骨折椎體兩側剛度的影響. 中國脊柱脊髓雜志, 2011, 21(2): 118-121.
18. 盧昌懷, 劉志軍, 張宏波, 等. 骨水泥量及分布對椎體成形術后相鄰椎體生物力學影響的三維有限元分析. 中國骨質疏松雜志, 2015, 21(1): 29-33.
19. Berlemann U, Ferguson SJ, Nolte LP, et al. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg (Br), 2002, 84(5): 748-752.
20. Tang S, Fu W, Zhang H, et al. Efficacy and safety of high-viscosity bone cement vertebroplasty in treatment of osteoporotic certebral compression fractures with intravertebral cleft. World Neurosurg, 2019, 132: e739-e745.
21. 沈凱, 張勝利, 譚祖鍵, 等. 經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折中骨水泥單側與雙側彌散對療效的影響. 中華創傷雜志, 2018, 34(6): 527-533.
22. 楊德順, 雷丙俊, 廖亮, 等. 改良推管在單側椎弓根穿刺經皮椎體后凸成形術的應用. 中國修復重建外科雜志, 2017, 31(2): 197-202.
23. Liu Y, Wang Y, Zhao L, et al. Effectiveness and safety of percutaneous vertebroplasty in the treatment of spinal metastatic tumor. Pak J Med Sci, 2017, 33(3): 675-679.
24. 唐沖, 吳四軍, 劉正, 等. 高粘度骨水泥經皮椎體成形術治療骨質疏松性椎體壓縮骨折的療效分析. 中國脊柱脊髓雜志, 2017, 27(8): 720-726.
25. 李玉偉, 王海蛟, 崔巍, 等. 極外側穿刺法行經皮椎體成形術治療骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2019, 33(5): 612-617.
26. Komemushi A, Tanigawa N, Kariya S, et al. Percutaneous vertebroplasty for compression fracture: analysis of vertebral body volume by CT volumetry. Acta Radiol, 2005, 46(3): 276-279.
27. Sun HB, Jing XS, Liu YZ, et al. The optimal volume fraction in percutaneous vertebroplasty evaluated by pain relief, cement dispersion, and cement leakage: A prospective cohort study of 130 patients with painful osteoporotic vertebral compression fracture in the thoracolumbar vertebra. World Neurosurg, 2018, 114: e677-e688.
28. 陳吉, 陳勇, 張征石, 等. 骨質疏松性椎體壓縮性骨折經皮椎體后凸成形術中骨水泥滲漏原因回顧性分析. 中華骨質疏松和骨礦鹽疾病雜志, 2017, 10(1): 27-33.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures

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