骨填充囊袋对后凸成形骨水泥注入量及渗漏的影响△

Effect of bone-filling mesh container on bone cement injected and leakage in percutaneous kyphoplasty

摘要:

[目的] 探讨骨填充囊袋（bone-filling mesh container, BFMC） 对于经皮球囊扩张椎体后凸成形术（percutaneous ky-phoplasty, PKP） 治疗骨质疏松性椎体骨折（osteoporotic vertebral compression fracture, OVCF） 中双侧骨水泥注入量及渗漏的影响。[方法] 回顾性分析本科2022 年10 月—2023 年7 月行单椎体PKP 的100 例OVCF 患者的临床资料，根据医患沟通结果，其中50 例接受BFMC-PKP 治疗（BFMC 组），另50 例接受常规双侧PKP 治疗（PKP 组）。比较临床早期结果与影像资料。[结果] BFMC 组囊袋侧的骨水泥推注量[(4.8±0.8) ml vs (2.6±0.6), P＜0.001] 显著多于PKP 侧。BFMC 侧推注的骨水泥量[(4.8±0.8) mlvs (4.1±0.9), P=0.030] 显著大于PKP 组。与术前相比，两组术后3 d VAS 评分显著降低（P＜0.05），相应时间点，两组VAS 评分的差异均无统计学意义（P＞0.05）。BFMC 组囊袋侧骨水泥渗漏率[例(%), 5 (10.0) vs 20 (40.0), P＜0.001] 显著低于对侧，BFMC 组囊袋侧的骨水泥渗漏率[例(%), 5 (10.0) vs 14 (28.0), P=0.020] 显著低于PKP 组。骨水泥渗漏较多发生于上终板、侧方以及前方。与术前相比，两组伤椎前缘高度均显著增加（P＜0.05），局部后凸角均显著减小（P＜0.05）。[结论] BFMC 在PKP 治疗OVCF 时可显著降低同侧的骨水泥渗漏率，但会导致对侧骨水泥注入量减少以及渗漏率的增加。

Abstract:

[Objective] To investigate effect of bone-filling mesh container (BFMC) in percutaneous kyphoplasty (PKP) on bilateral bonecement injection and leakage for osteoporotic compression fracture (OVCF). [Methods] A retrospective analysis was performed on 100 pa-tients who received single-segment bilateral PKP in our department from 2022.10 to 2023.7. According to doctor-patient communication, 50of them received BFMC-PKP (the BFMC group), while other 50 received routine bilateral PKP (PKP group). Early clinical results with imag-ing data were compared. [Results] The bone cement injection volume in the BFMC side group was significantly higher than that in PKP side inthe BFMC group [(4.8±0.8) ml vs (2.6±0.6) ml, P＜0.001], while the amount of bone cement injected in the BFMC side was also significantlyhigher than that in PKP group [(4.8±0.8) ml vs (4.1±0.9) ml, P=0.030]. The VAS scores significantly declined in both groups 3 days postopera-tively compared with that preoperatively (P＜0.05), whereas which was not significantly different between the two groups at any time points ac-cordingly (P＞0.05). Bone cement leakage rate on BFMC side was significantly lower than that in PKP side in the BFMC group [case (%), 5(10.0) vs 20 (40.0), P＜0.001], and which on BFMC side in the BFMC group was significantly lower than that in PKP group [case (%), 5 (10.0) vs14 (28.0), P=0.020] . Most of the bone cement leakage occurred in the upper endplate, lateral and anterior sides. The anterior vertebral heightof injured vertebrae increased significantly (P＜0.05), while the local kyphotic angle decreased significantly in both groups postoperatively com-pared with those preoperatively (P＜0.05). [Conclusion] In PKP for OVCF, BFMC can significantly reduce the bone cement leakage on the ipsi-lateralside,butleadtoadecreaseintheamountofbonecementinjectionandanincreaseintheleakagerateonthecontralateralside.