背景:骨水泥分布是影响骨质疏松性椎体压缩骨折(OVCF)椎体强化治疗的疼痛缓解和长期预后的重要因素。单侧经皮椎体后凸成形术(PKP)是最常见的手术,骨水泥分布不足比双侧PKP更常见。然而,仍然缺乏有效的补救措施。在这项研究中,通过调整工作通道,然后在水泥分配不足的情况下进行第二次水泥注入作为补救措施,实现了足够的水泥分配,目的是通过回顾性队列研究评估临床结局.
方法:从2017年7月1日至2020年7月31日,接受单侧PKP治疗的OVCF患者被纳入这项回顾性队列研究。根据骨水泥分布(当水泥未超过前膜中椎体的中线或/和水泥未接触侧膜中的上/下椎体终板时,确认水泥分布不足。)以及是否在手术过程中进行了第二次注射,患者分为三组。不足组:经透视或术后X线证实骨水泥分布不足的患者。第二注射组:术中发现骨水泥分布不足的患者,并进行第二次注射以改善水泥分布。
方法:在一次注射中具有足够骨水泥分布的患者。主要结果是骨水泥椎体再塌陷率。次要结果包括手术时间,辐射暴露,水泥渗漏率,VAS,ODI,和相邻椎体骨折率。
结果:不足组34例,第二注射组45例,对照组241例。三组患者基线资料及随访时间差异无统计学意义。
方法:注射不足组的伤椎再塌陷率明显高于第二注射组(42.22%vs20.59%,P=0.000)和对照组(42.22%vs.18.26%,P=0.000)。Kaplan-Meier生存分析显示,第二次注射组与对照组的生存时间差异无统计学意义(P=0.741,Log-rank检验)。两者均显著低于不足组(P=0.032和0.000)。
结果:二次注射组与对照组术后VAS评分和ODI比较差异无统计学意义。两者均优于不足组(P=0.000)。在最后的后续行动中,三组间VAS和ODI比较差异无统计学意义(P>0.05)。二次注射组的手术时间明显高于不足组(53.41±8.85vs44.18±7.41,P=0.000)和对照组(53.41±8.85vs44.28±7.22,P=0.000)。第二注射组的辐射暴露量明显高于不足组(40.09±8.39vs30.38±6.87,P=0.000)和对照组(40.09±8.39vs31.31±6.49,P=0.000)。第二注射组的骨水泥渗漏率(20.59%)与不足组(24.44%)和对照组(21.26%)相当(P=0.877)。第二注射组的住院时间(4.38±1.72)与不足组(4.18±1.60)和对照组(4.52±1.46)相当(P=0.431)。
结论:当单侧PKP过程中水泥分布不足时,第二次注射可以缓解早期疼痛,减少骨水泥椎体再塌陷和相邻椎体骨折的发生率,在不增加水泥渗漏率的情况下,尽管此程序可能会增加手术时间和辐射暴露。
BACKGROUND: Bone cement distribution is an important factor affecting pain relief and long-term prognosis of osteoporotic vertebral compression fracture (OVCF) treated with vertebral augmentation. Unilateral percutaneous kyphoplasty (PKP) is the most common procedure, and insufficient bone cement distribution is more common than bilateral PKP. However, effective remedies are remain lack. In this
study, sufficient cement distribution was achieved by adjusting the working channel followed by second cement injection as a remedy in cases with insufficient cement distribution, and the purpose was to evaluate the clinical outcomes by a retrospective cohort
study.
METHODS: From July 1, 2017 to July 31, 2020, OVCF patients treated with unilateral PKP were included in this retrospective cohort
study. According to the bone cement distribution (insufficient cement distribution was confirmed when the cement did not exceed the mid line of the vertebral body in frontal film or/and the cement did not contact the upper/lower vertebral endplates in the lateral film.) and whether second injection was performed during surgery, the patients were divided into three groups. Insufficient group: patients with insufficient cement distribution confirmed by fluoroscopy or postoperative x-ray. Second injection group: patients with insufficient cement distribution was found during the procedure, and second injection was performed to improve the cement distribution.
METHODS: patients with sufficient cement distribution in one injection. The Primary outcome was cemented vertebrae re-collapse rate. The secondary outcomes included operative time, radiation exposure, cement leakage rate, VAS, ODI, and adjacent vertebral fracture rate.
RESULTS: There are 34 cases in insufficient group, 45 cases in second injection group, and 241 cases in control group. There was no significant difference in baseline data and follow-up time among the three groups.
METHODS: The injured vertebrae re-collapse rate of insufficient group was significantly higher than that of second injection group (42.22% vs 20.59%, P = 0.000) and control group (42.22% vs. 18.26%, P = 0.000). Kaplan-Meier survival analysis showed that there was no significant difference in the survival time between second injection group and control group (P = 0.741, Log-rank test), both of which were significant less than that in insufficient group (P = 0.032 and 0.000, respectively).
RESULTS: There was no significant difference in VAS score and ODI after operation between second injection group and control group, both of which were superior to those in insufficient group (P = 0.000). At the final follow-up, there was no significant difference in VAS and ODI among the three groups (P > 0.05). The operation time of second injection group was significantly higher than that of insufficient group (53.41 ± 8.85 vs 44.18 ± 7.41, P = 0.000) and control group (53.41 ± 8.85 vs 44.28 ± 7.22, P = 0.000). The radiation exposure of the second injection group was significantly higher than that of insufficient group (40.09 ± 8.39 vs 30.38 ± 6.87, P = 0.000) and control group (40.09 ± 8.39 vs 31.31 ± 6.49, P = 0.000). The cement leakage rate of second injection group (20.59%) was comparable with that of insufficient group (24.44%) and control group (21.26%) (P = 0.877). The length of hospital stay of the second injection group (4.38 ± 1.72) was comparable with that of insufficient group (4.18 ± 1.60) and control group (4.52 ± 1.46) (P = 0.431).
CONCLUSIONS: When cement distribution is insufficient during unilateral PKP, second injection may relieve early pain, reduce the incidence of cemented vertebral re-collapse and adjacent vertebral fracture, without increasing the cement leakage rate, although this procedure may increase the operation time and radiation exposure.